What is Prolactin?
Prolactin is one of many hormones which the pituitary gland produces. All over the body, prolactin has several different functions. Maybe prolactin’s most important function is to stimulate milk development in women after a baby has been born. During pregnancy, the prolactin levels increase allowing the mammary glands in a woman’s breast to expand in preparation for breastfeeding. Often, prolactin assists in milk release while the baby is breastfeeding.
The high levels of prolactin also help to prevent ovulation for the first few months that a woman is breastfeeding. That’s the reason why breastfeeding women don’t get their periods and therefore don’t get pregnant often. However, as time goes on, the levels of prolactin may not remain as high with breastfeeding and the woman may begin ovulating.
Infertility and prolactin
High levels of prolactin can cause infertility. Hyperprolactinemia is another name for elevated prolactin levels. Women who are not pregnant and don’t breastfeed should have low prolactin levels. If a non-pregnant woman has an abnormally high prolactin level, it can cause her trouble getting pregnant.
Prolactin can cause infertility in several ways. First, prolactin may halt ovulation by a woman. If it does, the menstrual cycles of a woman will stop. In less severe cases, high levels of prolactin may only occasionally disrupt ovulation. This would result in intermittent ovulation or ovulation, which will take a long time. Women with the mildest cases that involve high levels of prolactin may ovulate regularly but after ovulation does not produce enough of the hormone progesterone. That is regarded as a phase defect in the luteal. Deficiency in the amount of progesterone produced after ovulation which results in uterine lining which is less capable of producing an implant for the embryo.
Symptoms of elevated prolactin
As mentioned above, some women with high levels of prolactin may have no cycles or cycles which are irregular. Another potential symptom of elevated levels of prolactin in breast discharge. The discharge results from prolactin that attempts to stimulate the breast to produce milk. The presence of a milky breast discharge in a woman who was not pregnant recently is called galactorrhea. Some females can spontaneously see galactorrhea. Others can see this only when their nipples are squeezed.
A simple blood test taken at the fertility doctor’s office may be used to assess prolactin. Prolactin should be drawn first thing in the morning, in order to get accurate results. The woman should have had nothing to eat from the night before, and should also avoid any breast or nipple stimulation from the day before.
One common mistake doctors make is to take a blood test with prolactin immediately after a patient has had a breast examination in the office. Because of the test, these women would have high levels of prolactin and thus have no clinically elevated levels.
Early in the menstrual cycle, prolactin should also be drawn-before ovulation. That is because the levels of prolactin after ovulation are naturally higher.
There are various forms of prolactin, called isoforms or isotypes. Not all types cause fertility complications though they are all tested together on a standardized blood test for prolactin. For this reason, if a prolactin level returns elevated, it should be repeated with a more detailed test which individually looks at the different isoforms.
Causes of high prolactin levels
Prolactinoma (pituitary adenoma)
In some people, a small group of cells in the pituitary gland may develop a cyst that produces elevated prolactin levels. These cysts are called pituitary adenomas, or prolactinomas. Exactly how those cysts get started is unclear. Classification of the adenomas may be based on their size. Using MRI (magnetic resonance imaging) to display and measure the adenomas.
Small adenomas, called microadenomas. They measure in diameter less than one centimeter. This is the most prevalent type of adenoma found. Microadenomas can even occur in healthy people who don’t have high levels of prolactin. A medication may be used to treat microadenomas. They do not grow big and need not be treated when the hormone levels are normal.
Macroadenomas are considered adenomas greater than 1 centimeter. Macroadenomas may grow larger if untreated and start pressing on surrounding structures. The nearest structures are the nerves in the optics. Where a macroadenoma causes optic nerve compression, partial blindness can result. For this reason, treating macroadenomas is necessary whether a woman is interested in becoming pregnant or not.
If a woman has an underactive thyroid gland, the hypothalamus is a part of the brain that secretes hormones to try to stimulate the thyroid gland. Often this same hormone may cause the pituitary to produce excess prolactin. Treatment with supplements to the thyroid hormone can result in both thyroid and high levels of prolactin being corrected.
PCOS (Syndrome for the polycystic ovary)
PCOS is a common problem that prevents ovulation and can cause infertility. Some women with PCOS may have slightly elevated levels of prolactin, for unclear reasons.
Treatment of high prolactin levels
As noted above, levels of prolactin may also be rectified by stopping or transitioning to another drug. Hypothyroid treatment is also very effective. If prolactin levels are persistently high, a group of medications known as dopamine agonists can be used to effectively treat these.
Cabergoline is an important, affordable treatment for high levels of prolactin. Cabergoline is normally taken with a snack at bedtime. This is because Dostinex sometimes triggers stomach discomfort or dizziness. So take it before you go to sleep and every some side effects with the food. The side-effects usually cease with time anyway.