AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE
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PATIENT FACT SHEET Hyperprolactinemia (Prolactin Excess) What is Prolactin?
classified depending on its size. If the growth is small, it is called a
Prolactin is a hormone produced by your pituitary gland, the gland that sits
microadenoma. If the growth is larger (>1 cm in diameter), then it is
at the bottom of the brain. Though prolactin plays a role in the growth and
development of your breasts, its primary function is in milk productionafter a child is born. Normally, it is present in small amounts throughout
How is Hyperprolactinemia Treated?
your bloodstream (and in men's), kept under control by another hormone
The treatment depends on the cause. If your doctor cannot identify a
called a prolactin inhibiting factor (dopamine). When you get pregnant,
cause or you have a microadenoma or a macroadenoma in the pituitary
however, prolactin levels increase significantly. Then, after the baby is
gland, the primary treatment is with medication. The most commonly
born, the combination of high prolactin levels and the abrupt drop in estro-
used medications are Parlodel® (bromocriptine) and Dostinex® (caber-
gen and progesterone occurring after birth enable your body to produce
goline). Your doctor will start you on a low dose and gradually increase
the dose until your prolactin levels return to normal. The treatment con-tinues until you get pregnant. Discontinuing the medication once
What is Hyperprolactinemia?
pregnant should be discussed with your physician.
Hyperprolactinemia is a condition in which too much prolactin is present
The most common side effects from Parlodel® include lightheaded-
in the blood of women who are not pregnant and in men. In women, this
ness, nausea and headache. Other side effects include nasal congestion,
results in a decline in the body's production of progesterone after ovula-
dizziness, constipation, abdominal cramps, fatigue, vomiting, and, rarely,
tion which, in turn, can lead to irregular ovulation and infrequent men-
neurologic symptoms such as hallucinations. Slowly increasing the dose
struation, cause you to stop menstruating altogether, or cause your
helps reduce side effects. You can also take Parlodel® as a vaginal sup-
breasts to start producing milk, a condition called galactorrhea.
pository or tablet at bedtime (although this is not approved by the FDA),
Men also can experience galactorrhea. High prolactin levels in men
which also helps reduce side effects.
can also lead to impotence, reduced libido, and infertility.
While Dostinex® can be taken twice a week and has significantly
Hyperprolactinemia is relatively common. In women of reproductive
fewer side effects, it is much more expensive than Parlodel®. In addi-
age who stop menstruating and have low FSH levels, up to a third of
tion, questions have been raised about heart valve problems being
women have hyperprolactinemia. Up to 90% of women who have galac-
caused by higher doses of Dostinex®. One drug, pergolide, has been
voluntarily withdrawn from the U.S. market because of this problem.
It is acceptable to choose not to treat women who have hyperpro-
What causes Hyperprolactinemia?
lactinemia and no identifiable causes or a small pituitary tumor.
Prolactin levels increase as a result of:
Similarly, there does not appear to be any risk to using oral contracep-
• Certain medications, including commonly prescribed antidepressants,
tive pills if irregular periods are present or to prevent pregnancy.
anti-psychotics, and blood pressure medications
Surgery is rarely required, only for large pituitary tumors that don't
• Herbs, including fenugreek, fennel seeds and red clover
improve with medical treatment. With larger pituitary tumors, occasional
• Chest wall irritation (from surgical scars, shingles, or even a too-tight bra)
monitoring with an MRI or CT scan should be performed.
If you have hypothyroidism, your doctor will treat it with thyroid
replacement medication, which should bring prolactin levels back to
normal. If the medication(s) you're taking (is) are responsible for your
high prolactin, your doctor will work with you to find other options. In
Sleep (prolactin levels are highest at night)
some cases, you may require hormone therapy to bring your estrogen
• Hypothyroidism, or underactive thyroid• Pituitary tumors. These are usually very tiny, but account for about
Words to Know
30% of all cases of hyperprolactinemia. Galactorrhea: A condition in which the breasts secrete milk in men or
In about a third of all cases of hyperprolactinemia, no cause is found. Hyperprolactinemia: A condition in which blood levels of prolactin are
How is Hyperprolactinemia Tested?
If you have absent or irregular periods, produce milk from the breasts, or
Hypothyroidism: Underactive thyroid
experience problems getting pregnant, especially if you or your partner
Macroadenoma: Larger pituitary tumor (measuring >1 cm) that causes
have any symptoms of high prolactin production, your doctor may order
a blood test to measure blood levels of prolactin. If those levels are high,
Microadenoma: Smaller pituitary tumor
your doctor generally will conduct a second test while you're fasting and
Pituitary: A walnut-sized gland that sits at the bottom of the brain and
releases various hormones related to reproduction and growth
If levels are still high, your doctor will obtain tests to rule out thyroid
Prolactin: A hormone produced by the pituitary gland that controls milk
and kidney problems. If the thyroid and kidneys are functioning
normally, magnetic resonance imaging (MRI) or computed axial tomog-
Prolactin inhibiting factor (PIF): A hormone that inhibits the release of
raphy (CT scan) can identify any tumor of the pituitary gland that could
prolactin; dopamine is believed to be PIF
cause this condition. If the MRI or CT scan reveals a growth, it will be
The American Society for Reproductive Medicine grants permission to photocopy this fact sheet and distribute it to patients.
SOGC CLINICAL PRACTICE GUIDELINE SOGC Clinical Practice Guideline No. 248, September 2010 (Replaces No. 74, July 1998) Guidelines for the Evaluation and Treatment of Recurrent Urinary Incontinence Following Pelvic Floor Surgery Abstract This clinical practice guideline has been prepared by the Objective: To provide general gynaecologists and urogynaecologists Urogynaecology Committe
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