Hyperprolactinemia is a disorder in which your pituitary gland produces excessive amounts of the hormone prolactin.
Prolactin is a hormone produced by your pituitary gland which sits at the bottom of the brain. Prolactin causes breasts to grow and develop and causes milk to be made after a baby is born. Prolactin normally circulates in the blood in small amounts in women who are not pregnant, and in large amounts during pregnancy and right after birth. Prolactin levels are controlled by other hormones called prolactin inhibiting factors (PIFs), such as dopamine.
Hyperprolactinemia (excessive prolactin) is a condition of too much prolactin in the blood of women who are not pregnant and in men. Hyperprolactinemia is relatively common in women. About a third of women in their childbearing years with irregular periods but normal ovaries have hyperprolactinemia. High prolactin levels interfere with the normal production of other hormones, such as estrogen and progesterone. This can cause irregular or no ovulation, resulting in infertility. Women who have this disorder often have irregular periods, and may also experience galactorrhoea – milk production when not pregnant. In some cases suppression of the progesterone hormone may cause a miscarriage. Some women have high prolactin levels without any symptoms.
In men, high prolactin levels can cause galactorrhoea, impotence (inability to have an erection during sex), reduced desire for sex, and infertility. A man with untreated hyperprolactinemia may make less sperm or no sperm at all.
What are common causes of hyperprolactinemia?
- A tumour of the pituitary gland in the brain called a ‘prolactinoma’
- Hypothyroidism (underactive thyroid)
- Certain medical drugs such as antidepressants, tranquillisers, antihistamines and anti-nausea agents
- Herbs, including fenugreek, fennel seeds, and red clover
- Irritation of the chest wall (from surgical scars, shingles, or even a too-tight bra)
- Stress – both physical and emotional (usually excessive or extreme)
- Certain foods
How is hyperprolactinemia tested?
Blood tests can measure levels of prolactin. Levels are sometimes higher if you have eaten recently or are under stress. The test may be done again after you’ve fasted and are relaxed. Your doctor may also perform a physical exam to find any obvious causes or any breast discharge. If levels are still high after the second check, your doctor may order a magnetic resonance imaging (MRI) scan of the brain to check for a tumour of the pituitary gland. A blood test that diagnoses thyroid disorders such as hypothyroidism (underactive thyroid) may be conducted.
How is hyperprolactinemia treated?
Your treatment will depend on the cause of your excessive prolactin production. If you are diagnosed with an underactive thyroid, your doctor can prescribe a thyroid medication for you. Once your thyroid problem is corrected, the amount of prolactin in your blood should decline to a normal level. If you have a tumour on your pituitary gland, treatment with medication can reduce your prolactin levels. Also, the medication usually causes pituitary tumours to shrink. If your regular medicine is the reason for your high prolactin levels, your doctor will work with you to find a different medicine or add one to help your prolactin levels go down.
If you are severely stressed you will be encouraged to deal with this. High stress levels are a very common reason for hyperprolactinemia. Our resident psychologist Mandy Rodrigues is an expert on dealing with stress related issues and can be contacted on +27 (11) 463 2244.
Once your prolactin blood level is within the normal range, your periods should become more regular and you should start ovulating normally again.
Although medications are very effective in bringing down prolactin level to a normal range, they cannot cure the disorder. If you stop treatment, your prolactin levels are likely to increase again, and your symptoms will probably return.