What Is Hyperprolactinemia and How Can It Affect Getting Pregnant?
What is hyperprolactinemia?
Hyperprolactinemia is a very common condition where a person has more prolactin than is normal or required in their body.
Every person produces the prolactin hormone mainly from the pituitary gland, which is a little hormone-secreting gland situated at the base of the brain.
Prolactin is a very vital hormone as it has several roles to play in many bodily functions, including ovulation, reproduction, immunity, and even blood d cell formation.
Nevertheless, the primary purpose of the prolactin hormone is to stimulate lactation.
A case of hyperprolactinemia must be attended to immediately, as cases that are left unmanaged can impact a person’s fertility and bone density, leading to osteoporosis.
In many cases, it can also cause neurological symptoms. Early diagnosis and proper treatment can go a long way to help reduce risks and possible complications connected with such conditions.
What causes hyperprolactinemia?
One common cause of hyperprolactinemia is a growth or tumor on the pituitary gland called a prolactinoma. The tumor produces high levels of prolactin. These tumors can be large or small and are usually benign. Small tumors (smaller than 1 cm) are called mircoprolactinomas and larger tumors (more than 1 cm) are called macroprolactinomas. Large tumors can also cause headaches, vision problems, or both. Prolactinomas are more common in women than in men and rarely occur in children.
Certain prescription medicines can also increase prolactin levels. These include medicines for:
• High blood pressure (such as calcium-channel blockers and methyldopa)
• Depression (tricyclic and SSRI antidepressants)
• Heartburn and gastroesphageal reflux disease
• Nausea and vomiting
• Pain (opiates—drugs derived from opium)
• Birth Control Pills
• Serious mental health disorders (antipsychotics such as haloperidol)
• Menopausal symptoms (estrogen)
Other causes include:
• Hypothyroidism or underactive thyroid—meaning the thyroid gland does not produce enough thyroid hormone
• Pregnancy and lactation
• Other tumors and diseases affecting the pituitary gland, or radiation treatment for tumors on or near the pituitary
• Chronic liver and kidney diseases
Sometimes, no cause for hyperprolactinemia can be found.
What are the signs and symptoms of hyperprolactinemia?
Both men and women may have infertility, decreased sex drive, and bone loss. In addition, women may have:
• Vaginal dryness, leading to pain during intercourse
• Problems with menstruation—having no periods or irregular periods
• Production of breast milk when not pregnant or nursing
Men may also have:
• Erectile dysfunction—trouble getting or keeping an erection
• Breast enlargement, called gynecomastia
• Decreased muscle mass and body hair
How is hyperprolactinemia diagnosed?
A blood test is used to detect excess prolactin. If prolactin levels are high, more tests are usually done to check blood levels of thyroid hormone. Normal thyroid hormone levels rule out hypothyroidism as a cause of hyperprolactinemia. Doctors will also ask about other conditions and medication use, and rule out pregnancy.
If a prolactinoma is suspected, an MRI (magnetic resonance imaging) of the brain and pituitary is often the next step. Using a special machine that creates images of body tissues, an MRI can reveal a pituitary tumor and show its size.
What’s the treatment for hyperprolactinemia?
If you have mild or no symptoms, you may not need treatment. But tell your doctor if you have symptoms that are bothering you, or if you’re having trouble getting pregnant.
Treatment is based on the cause. Some people with high prolactin levels, but few or no signs and symptoms, do not need any treatment. Options for treating tumors include:
• Prescription medicines. Dopamine Agonists like Bromocriptine and cabergoline decrease prolactin production. Medicines work well for most people with prolactinomas and are well tolerated. Bromocriptine is taken 2-3 times a day and Cabergoline is long acting and used twice weekly.
• Surgery to remove a tumor. Surgery may be used if medicines have not been effective. Surgery is sometimes needed if the tumor is affecting vision.
• Radiation Rarely, if medicines and surgery have not been effective, radiation is used to shrink the tumor.
Hypothyroidism is treated with synthetic thyroid hormone, which should bring prolactin levels back to normal. If high prolactin levels are caused by prescription medications, other types of medications can be explored.
When you’re ready, you can try to conceive naturally or with a doctor’s help, depending on your fertility situation. If you don’t conceive after ovulating for a few months, your doctor may recommend a different treatment.
How does hyperprolactinemia affect fertility and getting pregnant?
Fertility and getting pregnant depend on the right balance of reproductive hormones all working in concert with each other and at the right time. Any time one of those hormones is out of balance, fertility can be impacted.
Too much prolactin can lead to irregular ovulation and can impact the quality of the luteal phase, or second half of the menstrual cycle, which obviously negatively impacts fertility. Too much prolactin can also inhibit the secretion of follicle-stimulating hormone, or FSH — the hormone that stimulates the ovarian follicles to mature. Without FSH, there’s no ovulation — and without ovulation, it’s impossible to get pregnant.
How does hyperprolactinemia affect pregnancy?
Some experts theorize that higher-than-normal levels of prolactin during pregnancy may increase the risk for miscarriage, though the link is not well established.