Prolactin is the hormone that enables milk production in the body. When a woman becomes pregnant, the hormones that rise stimulate prolactin to produce milk from the breasts. Prolactin hormone is necessary for the development and function of female reproductive organs at certain levels even without pregnancy.
This hormone is produced by cells in the gland called pituitary in the lower part of our brain. It is also kept under control by the release of another substance called Dopamine, which is secreted from the part of our brain called hypothalamus.
Increase in prolactin hormone hyperprolactinemia is called.
So what happens in the body in this case?
-Menstrual irregularities (few menstrual periods, infrequent menstrual periods, absent menstrual cycles)
-Nipple discharge (milk discharge outside pregnancy = galactorrhea).
-Inability to become pregnant (infertility) may occur due to disruption of ovulation
The diagnosis of high prolactin is made by measuring the prolactin level in the blood.
Women who apply with one or more of the complaints of menstrual irregularity, inability to get pregnant, or milk coming out of the breasts outside the breastfeeding period are asked to measure the prolactin hormone level in the blood. When the hormone level in a woman diagnosed with hyperprolactinemia is above a certain level (normal is usually 5-25 ngr/ml), these regions are usually examined with a method that images the hypothalamus and pituitary. The purpose of this examination is to determine whether the woman has a benign pituitary tumor called pituitary adenoma, which is the most common cause of hyperprolactinemia, and to investigate other rare conditions that may cause hyperprolactinemia in the region.
Does high prolactin cause infertility?
One of the causes of infertility is excessive elevation of the prolactin hormone. However, infertility may not occur in everyone with high prolactin levels. As the prolactin hormone increases, deterioration is observed in the woman's ovulation function. This deterioration is directly proportional to the level of prolactin hormone. In other words, the higher the prolactin hormone, the more the ovulation functions will deteriorate, and eventually, no menstruation or even cessation of menstruation may occur. While menstrual irregularities are frequently detected in women with high blood prolactin, they may or may not be accompanied by complaints of milk discharge from the breasts. On the other hand, prolactin hormone measurements can sometimes be found to be normal in women who complain of milk coming from their breasts. The possible reason for this is the existence of some prolactin hormone subtypes that cannot be measured by today's classical laboratory methods but have strong milk-forming properties. This condition is called macroprolactinemia.
How is high milk hormone levels treated?
Hyperprolactinemia responds well to drug treatment, and in most patients the problem disappears with treatment.
However, drug therapy is not an easy treatment due to side effects.
In some patients, it may cause problems such as dizziness, nausea and weakness, and low blood pressure, which decrease over time and disappear when the treatment is finished.
First of all, the cause that increases the prolactin level should be tried to be found and this cause should be treated.
If the complaint is of not being able to get pregnant and the person has high prolactin level, drugs that lower the prolactin level are generally used and sometimes drugs that promote ovulation are used.
When the problem is milk coming from the breasts, medications that lower the prolactin level are used.
When the complaint is menstrual irregularity, drugs that lower the prolactin level can be used, but in a woman who does not want a child, drugs such as birth control pills that only eliminate the symptom, that is, regulate menstrual bleeding, can be used.
How should pituitary adenoma be treated?
When benign tumors called pituitary adenomas are detected in a person through imaging methods, it is first investigated whether they cause compression symptoms.
Adenomas are benign tumors and are observed quite frequently. They do not tend to become cancerous and generally grow slowly. In autopsies, pituitary adenoma can be found in 5% of women who are 70 years old and have no complaints.
Pituitary adenomas smaller than one centimeter in diameter are called microadenomas, and larger ones are called macroadenomas. However, what is important is whether it puts pressure on the surrounding tissues and the rate of growth and hormone secretion.
Although the degree of pressure exerted by the pituitary adenoma on the environment is usually clearly observed in the imaging method, visual field examination may also be performed to investigate the presence of pressure on the optic nerve.
Most adenomas can be treated with prolactin-lowering drugs. Thus, operations are used very rarely. Surgery may also be required by neurosurgeons, especially in adenomas that cause severe symptoms (severe headache, very narrow visual field) or tend to grow rapidly.
Today's opinion; If the woman has no complaints and hyperprolactinemia is detected incidentally, this is not a big deal. Today, it is known that prolactin has different types of molecules and that prolactin levels that do not cause clinical complaints are largely due to inactive molecules and do not require treatment. However, if there is menstrual irregularity, milk discharge from the breasts and a significant increase in the prolactin hormone, especially if there is a desire to become pregnant, this needs to be treated.
I wish you healthy days…
Assoc. Dr. Selman Lacin
Medicana International Istanbul Hospital
Head of In Vitro Fertilization Center
www.tupbebek-istanbul.com