Hyperprolactinemia with suspected prolactinoma

Hyperprolactinemia means that you have elevated prolactin levels, and it’s a relatively common condition in women. It also prevents the body from releasing gonadotropin hormones and estrogen. Prolactin is a reproductive hormone made by the pituitary gland which increases during pregnancy and makes the breasts produce milk after delivery.
Your pituitary gland is a pea-sized gland at the base of your brain, around eye level. Although it’s very small, it plays an essential role in your endocrine system and affects almost every part of your body.
A prolactinoma is a noncancerous tumor on the pituitary gland which could be responsible for your high prolactin levels.

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Impact of hyperprolactinemia and prolactinoma on fertility

High prolactin can stop ovulation by preventing the release of gonadotropin hormones, including FSH (follicle stimulating hormone), the hormone in charge of maturing your eggs each menstrual cycle. Hyperprolactinemia can decrease levels of important sex hormones, including estrogen and testosterone. It can also affect progesterone and the luteal phase of your cycle.

Potential causes of hyperprolactinemia and prolactinoma

Medical experts are unsure what causes a prolactinoma to form. A rare genetic disorder called multiple endocrine neoplasia, type 1, can increase the risk of getting a prolactinoma.

Hyperprolactinemia can be due to the following:

• Underactive thyroid (hypothyroidism) – about half of all women with hyperprolactinemia have a thyroid disorder
• Kidney condition
• Medicines for depression, psychosis, and high blood pressure
• Certain herbs (e.g. fenugreek, fennel seeds, and red clover)
• Chest wall irritation (from scarring after surgery, shingles, or a bra that’s too tight)
• Excessive stress or exercise
• Lack of sleep

Symptoms of hyperprolactinemia and prolactinoma

These are potential symptoms of hyperprolactinemia in women:

• Irregular or missed periods (amenorrhea)
• Milky discharge from the nipples when not pregnant or breastfeeding
• Vaginal dryness and painful sex
• Infertility 
• Weak, brittle bones
• Vision problems
• Headache

Diagnosis of hyperprolactinemia and prolactinoma

Hyperprolactinemia is diagnosed through a blood test that shows elevated prolactin levels. When prolactinoma is suspected, you will be referred to have an MRI scan of your brain. You should also see an eye doctor (ophthalmologist) to test if a prolactinoma is causing any vision problems. Finally, you may be referred to a specialist in hormonal disorders (endocrinologist) for further testing and treatment.

Treatment to improve fertility

Hyperprolactinemia and prolactinoma are usually treated with medication (dopamine agonists) which reduce the prolactin levels in the body and increase fertility. These drugs shrink a prolactinoma, get rid of symptoms, and restore the normal functioning of the ovaries.

Rarely, if medication isn’t successful, surgery or radiation therapy may be necessary to remove the prolactinoma.

If your high prolactin levels are due to another medication you’re currently taking, your doctor will recommend lowering your dose or changing your prescription. In case it’s because of hypothyroidism, you will receive treatment with medication that increases your levels of thyroid hormones.

As soon as your prolactin levels are in a healthy range, your menstrual cycle should return to normal, and fertility will be restored.

This article has been verified by a medical professional

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