Endocrine Disorders

Hyperprolactinemia

Hyperprolactinemia is a condition of too much prolactin in the blood of women who are not pregnant but it can also occur in men. About a third of women in their childbearing years with irregular periods but normal ovaries have hyperprolactinemia. When this happens, a woman might have trouble getting pregnant or her breasts have increased tenderness (engorgement) or may start producing milk outside of pregnancy (galactorrhea). Ninety percent of women with galactorrhea also have hyperprolactinemia.

How hyperprolactinemia affects fertility

High prolactin levels interfere with the normal production of other hormones, such as estrogen and progesterone. This can change or stop ovulation (the release of an egg from the ovary). It can also lead to irregular or missed periods. Some women, however, can have high prolactin levels without any symptoms.

In men, high prolactin levels can cause galactorrhea, impotence (inability to have an erection during sex), reduced desire for sex, and infertility. Men rarely develop breast discharge (galactorrhoea). A man with untreated hyperprolactinemia may make less sperm or no sperm at all.

What causes hyperprolactinemia?

Some common causes are:

• Pituitary tumours (prolactinomas)
• Hypothyroidism (underactive thyroid)
• Medicines given for depression, psychosis, and high blood pressure
• Herbs, including fenugreek, fennel seeds, and red clover
• Irritation of the chest wall (from surgical scars, shingles, or even a too-tight bra)
• Stress or exercise (usually excessive or extreme)
• Certain foods

No cause is found in about a third of all cases of hyperprolactinemia.

What are the symptoms of hyperprolactinemia?

Symptoms in females:

• infertility
• irregular periods
• change in menstrual flow
• pause in menstrual cycle
• loss of libido
• lactation (galactorrhea)
• pain in breasts
• vaginal dryness

Symptoms in males:

• abnormal breast growth (gynecomastia)
• infertility
• erectile dysfunction
• loss of sexual desire
• headaches
• vision change
• Lactation (this is very rare)

Diagnosis of hyperprolactinemia

Hyperprolactinemia can be diagnosed by a blood test to measure levels of prolactin. Your doctor may also perform a physical exam as well.

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Treating hyperprolactinemia

Typically, hyperprolactinemia is treatable and the treatment depends on the cause. Hypothyroidism is treated with thyroid replacement medicine, which should also make prolactin levels return to normal. 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. In those with unexplained high prolactin, medications can be used to effectively lower the levels and induce ovulation which often leads to good pregnancy outcomes.