Hyperprolactinaemia is a condition where you have a higher-than-normal level of a hormone called prolactin in your blood. Prolactin is produced by the pituitary gland in your brain, and its main job is to stimulate breast milk production after childbirth.
When levels are too high at other times, it can disrupt the normal function of your ovaries, leading to menstrual problems and other symptoms. It is a treatable condition, and with proper management, normal hormone balance can usually be restored.
Common Symptoms
High prolactin interferes with the hormones that control your menstrual cycle and ovulation.
- Menstrual Changes: Irregular periods (oligomenorrhoea) or a complete absence of periods (amenorrhoea).
- Fertility Issues: Difficulty getting pregnant due to lack of ovulation.
- Galactorrhoea: Milky discharge from one or both nipples when not breastfeeding.
- Low Sex Drive (Libido).
- Vaginal Dryness and discomfort during sex.
- Symptoms Related to a Pituitary Tumour (if present): Headaches, vision problems (especially loss of peripheral vision), or fatigue.
Causes & Risk Factors
Prolactin levels can rise for many reasons, from everyday factors to specific medical conditions including following
- Prolactinoma: A benign (non-cancerous) tumour of the pituitary gland. This is the most common cause and is usually very small (a microadenoma).
- Medications: Certain prescription drugs, including some antidepressants, antipsychotics, anti-nausea drugs, and high-blood-pressure medications.
- Hypothyroidism: An underactive thyroid gland.
- Other Medical Conditions: Chronic kidney disease, liver cirrhosis, or other pituitary disorders.
- Chest Wall Stimulation: Trauma, surgery, shingles, or even very tight clothing.
- Stress (both physical and emotional).
Diagnosis
Diagnosis involves identifying the high level and then finding the cause.
- Blood Test: A simple blood test to measure your prolactin level. This should ideally be done in the morning, when you are relaxed, and not right after a breast exam.
- Pregnancy Test: To rule out pregnancy as a cause.
- Thyroid Function Tests: To check for hypothyroidism.
- MRI Scan of the Brain: If your prolactin is significantly high or if you have headaches/vision changes, an MRI will be done to look for a pituitary tumour (prolactinoma).
- Other Tests: Kidney and liver function tests may be performed.
Management & Treatment Options
Treatment depends entirely on the underlying cause and whether you wish to become pregnant.
Observation (Watchful Waiting)
- If you have a very small tumour (microprolactinoma) and no bothersome symptoms, your gynaecologist may suggest regular monitoring with blood tests and MRI scans, with no immediate medication.
Medication (First-Line Treatment)
- Dopamine Agonists: These are the primary treatment. They mimic a brain chemical that tells your pituitary to produce less prolactin.
- Cabergoline: Usually the preferred choice. Taken once or twice a week. It is highly effective at lowering prolactin, shrinking tumours, and restoring periods and fertility.
- Bromocriptine: An older medication taken daily. It can have more side-effects (nausea, dizziness).
Surgery (Transsphenoidal Surgery)
- Considered if:
- Medication is not tolerated due to side effects.
- Medication does not shrink the tumour.
- The tumour is very large and pressing on the optic nerves, affecting vision.
- This is specialised neurosurgical keyhole surgery through the nose to remove the pituitary tumour.
Treating the Underlying Cause
- If caused by medication: Your doctor may switch you to a different drug.
- If caused by hypothyroidism: Thyroid hormone replacement therapy will normalise prolactin.
Possible Complications & Long-Term Outlook
- Infertility: The main concern for many women, but it is almost always reversible with treatment.
- Osteoporosis: Long-term absence of periods (and low oestrogen) can lead to bone thinning. Treatment that restores your cycle protects your bones.
- Tumour Growth: An untreated macroprolactinoma (large tumour) could grow and press on nearby structures.
- Pregnancy with a Prolactinoma: This requires special management. You will need to stop medication once pregnant but will be monitored closely as the tumour can grow due to hormonal changes.
Frequently Asked Questions (FAQs)
Q: Is a prolactinoma a type of brain cancer?
A: No. It is an almost always benign (non-cancerous), slow-growing tumour. It stays within the pituitary gland and does not spread to other parts of the body.
Q: Will I need to take medication forever?
A: Not necessarily. After several years of successful treatment, your doctor may try a gradual withdrawal of medication, especially if the tumour has shrunk or disappeared on MRI.
Q: Can I get pregnant if I have hyperprolactinaemia?
A: Yes, absolutely. In fact, restoring fertility is a primary goal of treatment. Once prolactin levels are normal, ovulation and periods usually return. You should discuss pregnancy planning with your doctor, as medication may need to be adjusted or stopped.
Q: Does stress really cause this?
A: Significant physical or emotional stress can cause a mild, temporary rise in prolactin.
Q: Is the nipple discharge a sign of breast cancer?
A: The milky discharge (galactorrhoea) from high prolactin is not typically associated with breast cancer. However, any new nipple discharge should always be evaluated by a doctor to rule out other causes.
eGynaecologist Advice
- You should seek a gynaecological or endocrine consultation if you experience irregular or absent periods, unexplained milky nipple discharge, or have difficulty conceiving.
- You must discuss your fertility and pregnancy intentions with your gynaecologist before starting treatment and as soon as you are considering trying to conceive, so your care can be planned accordingly.
- You should not stop taking prescribed dopamine agonist medication suddenly. Always take it as directed and discuss any side effects with your gynaecologist so they can adjust your dose or switch medications if needed.
