07.02.2023

Increased prolactin in women: symptoms, causes and treatment

The state, which is accompanied by a high concentration of prolactin is called hyperprolactinemia and can be diagnosed in persons, male and female. Prolactin is a hormone that is synthesized in the pituitary, or rather its anterior lobe (anterior pituitary).

The pituitary gland refers to glands of internal secretion, is located in the brain and is located in the “Turkish saddle” (a depression in the skull). Except prolactin the anterior pituitary to synthesize FSH and LH hormones that affect menstrual and reproductive function of the female body.

The value of prolactin in the female body

In the female body this hormone plays a major role in reproductive and menstrual functions in the body and is found in three fractions: the Monomeric, dimeric prolactin and three-dimensional. The highest activity is Monomeric prolactin, the concentration of which reaches 80% in comparison with the other fractions. Synonyms of prolactin are mammotropin or lactotropic hormone (LTG).

The leading function of mammotropin in the female body:

  • stimulating growth and development of mammary glands in puberty and gestation;
  • secretion of colostrum during pregnancy and after childbirth milk;
  • maintaining progesterone levels during the period of gestation;
  • regulation of the second phase of the menstrual cycle;
  • regulation of the composition of the amniotic fluid;
  • participation in metabolic processes;
  • maintaining water-salt balance;
  • part in achieving orgasm;
  • the increase in pain threshold (decreases pain in childbirth);
  • the suppression of ovulation during the first 6 months after childbirth and breastfeeding;
  • the establishment and maintenance of maternal instinct;
  • participate in immune processes.

A normal prolactin

Standard units are LTG mu/l, but some laboratories the content of the hormone is measured in ng/ml.

Normal levels of prolactin:

  • pregnant (more than 8 weeks) – 500 – 10000мЕд/l;
  • lactating women from 600 to 2500 mu/l;
  • nonpregnant 250 – 504 mu/l or 4.5 – 23 ng/ml (in the second phase the content of LTG can be increased by 100 units and be 300 – 600 mu/l or 4.9 – 30 ng/ml);
  • in women in menopause – 25 – 400 mu/l with a tendency to decrease.

Elevated prolactin levels (greater than 1000 but less than 2000 mu/l) requires monitoring and three-time blood analysis of the hormone. If the content of mammotropin is 2000 mu/l or more, it is necessary to conduct MRI and CT of the brain to exclude pituitary tumors.

Increased prolactin in women: causes

Increase lactotropic hormone in women can cause a lot of reasons, which are divided into three groups:

  1. Physiological or functional:
    • pregnancy;
    • lactation;
    • hunger;
    • sexual intercourse;
    • prolonged sleep;
    • the intake of protein;
    • diet;
    • physical activity;
    • surgery (curettage, abortion, laparotomy);
    • the stress drop in blood pressure and loss of consciousness;
    • pain;
    • the luteal phase of the cycle;
    • Smoking and alcohol;
    • lack of sleep;
    • medical procedures (palpation, ultrasound, x-rays of the breast);
    • irritation of the nipples tight clothing.
  2. Pathological or organic:
  3. Iatrogenic, due to medication:
Clinical manifestations

Hyperprolactinemia may be asymptomatic and diagnosed accidentally during examination for hormones other diseases or may be accompanied by a specific clinical picture, which includes reproductive, menstrual, sexual and metabolic functions, and the emotional-mental disorders.

The high content of LTG in women is accompanied by the following symptoms:

  • Breaking the loop. Menstruation becomes irregular, with constant delays then occur less frequently or disappear altogether (secondary amenorrhea).
  • Galactorrhea. From the nipple stands out molokopodobnye liquid of yellowish or white. There are 3 degrees of galactorrhea. At 1 degree the milk is separated only when squeezing the nipple, the 2nd stage milk starts to separate jet palpation of the chest, at 3 degrees the milk come out spontaneously. This symptom is observed in 20% of patients with elevated LTG and relatively regular cycle.
  • Infertility. Increased concentration of prolactin cause anovulation leads to the shortening of the second phase of the cycle, which is not accompanied by the formation of the corpus luteum and ends with infertility or spontaneous abortion in the early stages.
  • Sexual disorders. Increased LTG reduces libido and the production of vaginal lubrication causes pain during coitus. Hyperprolactinemia also causes anorgasmia, frigidity, atrophy of urethral and vaginal mucosa.
  • Hyperandrogenism. The increase of prolactin triggers the increase in the concentration of androgens in the female organism, which is accompanied by acne and hirsutism (hair growth on the legs, around the nipples, on the face and on the white line of the abdomen).
  • Premenstrual syndrome. High rates of LTG PMS cause the development, provoke headaches and dizziness, engorgement and breast tenderness.
  • Metabolic disorders. Hyperprolactinemia increases appetite, leading to abnormal lipid metabolism, obesity (40 – 60% of cases) and insulinrezistentnost (high risk of diabetes).
  • The development of osteoporosis. Long-existing hyperprolactinemia decreases bone density due to leaching from it of calcium salts, which is accompanied by the development of osteoporosis (spontaneous fractures) and multiple cavities.
  • Autoimmune disease. High prolactin in the blood increases the risk of autoimmune conditions (systemic lupus erythematosus, antiphospholipid syndrome).
  • Psycho-emotional disorders. Against the background of elevated prolactin occur depression and sleep disturbances, fatigue and weakness, worsening memory and reduced ability to concentrate, irritability and emotional instability, anxiety and phobic States.
  • Blurred vision. Occurs when a pituitary tumor that compresses the optic nerves (decreased visual acuity, double vision, constriction of visual fields, in some cases, blindness).
  • Involution of the genital organs. Prolonged lack of correction of hyperprolactinemia leads to hypoplasia of the uterus, to reduce the size of the labia and clitoris.

Elevated prolactin in the body accompanied by a significant loss of hair on the head, and in advanced cases of baldness that is associated with an imbalance of male and female sexual hormones and eating disorder of the hair follicles. Also hyperprolactinemia is often a cause of seborrhea.

Diagnosis

Diagnosis and treatment of hyperprolactinemia is engaged in the doctor the gynecologist-endocrinologist, which collects history, examines the patient’s complaints, performs General and gynecological examination and appoint an additional examination.

Blood tests for prolactin if suspected hyperprolactinemia should be performed at least twice (in the 3rd – 5th and 22nd – 25th days of the cycle).

Preparation for blood donation on LTG:

  • cancel medication (if possible) 7 days prior to blood donation;
  • quitting Smoking, alcohol and exercise the day before testing;
  • observance of sexual rest during the day;
  • diet during the day (the rejection of protein foods: meat, fish, poultry);
  • restful sleep before taking blood.

The content of prolactin is determined in venous blood, which is necessary to take on an empty stomach 2 – 3 hours after waking up (best time 9 am). If blood counts have taken place a forced physical load (uphill or stairs, running or brisk walking), the women need to calm down and sit in front of the office 20 minutes.

Detection of elevated prolactin requires the following studies:

Also it is necessary to consult an ophthalmologist (examination of the fundus, visual elds), endocrinologist (hormonal imbalances), according to the testimony of a nephrologist, pulmonologist and gastroenterologist.

Correction of elevated prolactin

The choice of treatment is determined by the cause of hyperprolactinemia, the clinical manifestations of the desire of the patient to get pregnant.

In 70% of cases when the increase of prolactin 40 ng/ml, normal levels of hormone achieved by drug-free methods

  • diet (reducing consumption of animal and vegetable protein: meat, eggs, beans, cheese, cottage cheese);
  • avoiding harmful habits;
  • the decrease in the intensity of physical activity;
  • eliminate stressful situations;
  • welcome herbal remedies that have a sedative effect (motherwort, Valerian).

To medical correction used in the case of long-existing hyperprolactinemia caused by pituitary tumors, which is accompanied by violation of the cycle and other symptoms. Assigned to medications – dopamine agonists (inhibit the secretion of LTG in the pituitary gland): bromocriptine, cabergoline, hinagolid and others. Treatment with these preparations is long, the minimum is 6 months. Patients planning a pregnancy, consider taking bromocriptine due to less toxic effect of the drug on the body. Hinagolid and cabergoline are dopamine agonists second and third generations, adverse reactions to drugs often develop due to their prolonged action.

In the case of pituitary tumors and the lack of effect of medication correction the issue of surgical intervention. Mandatory indications for surgical treatment are persistent loss of vision and tumor growth. In preoperative period patients prescribed reception dofaminomimetikov in large doses to reduce the size of the formation. Access to the pituitary region is carried out through the sinuses.

The effect of surgical treatment is assessed:

  • to normalize the content of LTG 2 hours after surgery;
  • to restore ovulation in the first menstrual cycle after surgery.

In the presence of contraindications to the operation is assigned to radiation therapy, although the probability of normalization of prolactin concentration is quite low and does not exceed 37%. Patients with hyperprolactinemia are placed on the dispensary registration and regularly observed by a gynecologist, endocrinologist and mammalogy.

One thought on “Increased prolactin in women: symptoms, causes and treatment

  1. Your topic sounds a little hurried-you’re usually ever so eloquent in your musings.

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