Hyperprolactinemia

What it is

Hyperprolactinemia is an increase in prolactin, a hormone produced by the pituitary gland and responsible for milk production. Outside of pregnancy and breastfeeding, elevated levels can cause irregular or absent periods, nipple discharge (galactorrhea), decreased libido, vaginal dryness, difficulty becoming pregnant and, over the long term, bone loss. The most common causes are the use of certain medications — such as antidepressants, antipsychotics and anti-nausea drugs —, hypothyroidism, stress and prolactinomas, benign pituitary tumors that usually respond to medication. The investigation includes measuring prolactin under appropriate conditions, thyroid tests and, when indicated, pituitary MRI. Treatment depends on the cause: adjusting medications, treating the thyroid, or using medication that lowers prolactin, with periodic follow-up.

Most common symptoms

• Irregular, infrequent or absent periods
• Nipple discharge outside of breastfeeding
• Decreased libido and vaginal dryness
• Difficulty becoming pregnant
• Headache or vision changes
• Hot flashes and long-term bone loss

Causes and risk factors

• Use of antidepressants, antipsychotics and anti-nausea medications
• Hypothyroidism
• Prolactinoma, a benign pituitary tumor
• Physical or emotional stress and irregular sleep
• Frequent breast stimulation and certain kidney or liver diseases
• Pregnancy and breastfeeding, which naturally raise prolactin

How it is diagnosed

The investigation begins with the clinical history, paying attention to medications in use, thyroid symptoms and the possibility of pregnancy, and with a physical exam that includes a breast assessment. Prolactin is measured under appropriate conditions, at rest and avoiding stimuli that raise it, and the test may be repeated to confirm the result. Your gynecologist also orders thyroid tests and, when levels are high or there are neurological symptoms, a pituitary MRI to check for a prolactinoma.

How we treat it at Femi Saúde

Treatment depends on the cause. When a medication is responsible, the Femi Saúde gynecology team works with the prescribing physician to consider adjusting or switching it. If hypothyroidism is present, correcting the thyroid usually normalizes prolactin. In prolactinomas and in elevations with no apparent cause, medications that lower prolactin are the mainstay of treatment, with follow-up through periodic testing. When there is estrogen deficiency, hormone replacement may be considered to protect bone health. Pituitary surgery is reserved for specific situations, together with endocrinology. Women who wish to become pregnant receive individualized guidance, and the plan is reviewed according to the response.

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