Hyperprolactinemia or high prolactin levels: What to do if I want to have a baby

Hyperprolactinemia is characterized by an increase in the level of prolactin in the blood. This hormone is responsible for stimulating breast growth during pregnancy and milk production after childbirth.

Inadequate secretion of prolactin in women can lead to ovulation disorders, menstrual cycle disturbances, infertility, and the production of breast milk unrelated to breastfeeding or galactorrhea.

Knowing the causes of hyperprolactinemia is essential when selecting a treatment to achieve pregnancy with the least amount of stress. Usually, oral medications such as bromocriptine are used. If these are not enough, the best option is in vitro fertilization (IVF).

What is hyperprolactinemia?

Hyperprolactinemia is characterized by an increase in the level of prolactin in the blood of a woman who is not pregnant or breastfeeding.

Prolactin is a hormone secreted by the pituitary gland, and its main functions are to stimulate breast growth during pregnancy and milk production after childbirth.

Inadequate secretion of prolactin in women can lead to ovulation disorders, menstrual cycle disturbances, infertility, and breast milk production unrelated to breastfeeding or galactorrhea.

Main symptoms of hyperprolactinemia

Amenorrhea or absence of menstruation and galactorrhea or production of breast milk unrelated to breastfeeding are the main clinical manifestations of hyperprolactinemia, and 75% of patients with both symptoms suffer from this condition.

Other symptoms of hyperprolactinemia include:

• Anovulation or absence of ovulation
• Amenorrhea or absence of menstruation
• Opsomenorrhea or delayed menstruation
• Infertility
• Headache or piercing headaches. Usually, the pain is located below the eyes and in the front of the head.
• Visual disturbances
• Decreased libido
• Hirsutism or unwanted hair growth. This symptom appears when hyperprolactinemia is associated with polycystic ovary syndrome.
• Recurrent gestational loss

Causes of hyperprolactinemia

Hyperprolactinemia can be caused by various factors:

• Body factors: Prolactin levels can be transiently or permanently elevated for reasons such as lack of sleep, pregnancy, breastfeeding, breast manipulation, excessive exercise, and stress.
• Factors secondary to diseases: High levels of prolactin are commonly found as a consequence of other diseases, including hypothyroidism, polycystic ovary syndrome, multiple sclerosis, lupus, chronic renal failure, and liver cirrhosis. Hyperprolactinemia can also result from burns or irritation of the chest wall due to trauma.
• Factors secondary to medication: Psychotropic drugs, medications for high blood pressure, estrogens, and other dopamine receptor agonist medications such as metoclopramide, which is widely used, are associated with hyperprolactinemia.
• Tumors in the pituitary gland: Also known as adenomas, they account for around 30 percent of hyperprolactinemia cases. These tumors are usually benign and stimulate excessive prolactin secretion because they interfere with dopamine production and transport, a hormone responsible for inhibiting prolactin secretion under normal conditions.

How is hyperprolactinemia diagnosed?

If you suffer from menstrual irregularities, galactorrhea, or any of the symptoms of hyperprolactinemia, it is recommended that:

You should have a blood test to determine your prolactin level if you have menstrual irregularities, galactorrhea, or any other symptoms of hyperprolactinemia. The test should be performed in the early morning after at least thirty minutes of rest, but it can be done at any point in the menstrual cycle.

If the first test shows elevated levels, it should be repeated to confirm the diagnosis of hyperprolactinemia.

When prolactin levels are still high after the second test, the first causes to be ruled out before undertaking further studies are pregnancy and the use of medications that increase prolactin secretion. Your doctor will also conduct tests to rule out conditions such as hypothyroidism, in which excess prolactin is produced to compensate for the malfunctioning of the thyroid and the resulting lack of thyroid hormone.

Finally, once all other possible causes have been excluded, you will need to undergo magnetic resonance imaging or computed tomography to rule out the presence of a pituitary tumor or adenoma.

Treatments for achieving pregnancy when suffering from hyperprolactinemia

Understanding the causes of hyperprolactinemia is essential when selecting a treatment that allows pregnancy to be achieved with minimal wear and tear. Currently, highly effective solutions exist for each of these causes.

If your high prolactin level is caused by medication, your doctor will ask you to discontinue its use and help you find other options. If you have hypothyroidism, your doctor should prescribe a synthetic thyroid hormone to normalize your prolactin levels.

In any other case, treatment of hyperprolactinemia should begin with oral medications such as bromocriptine and cabergoline. Your doctor will ask you to take a low dose and gradually increase it until your prolactin level returns to normal. The use of medication has a very favorable prognosis, as it not only reduces prolactin levels and pituitary tumors, but also remedies galactorrhea by resuming menstruation and fertility in a short time.

If medication is not enough, the best option is in vitro fertilization (IVF), which makes it possible to aspirate eggs directly from the ovaries for subsequent fertilization and implantation in the woman's uterus.

In a small number of cases where prolactin increase is caused by pituitary tumors larger than 10 millimeters that do not improve with medication, the possibility of surgery or radiation therapy should be evaluated.