What does high prolactin mean in women? Treatment of elevated prolactin

Some couples plan a pregnancy for a very long time, but they do not take into account the obvious manifestations of hormonal imbalance.

Today you will learn about the symptoms of elevated prolactin levels, what signs occur most often in men and women, when the hormone is elevated and what it leads to.

Using the material in this article, you can compare your feelings and possibly confirm your fears.

In this article we will talk about the main striking manifestations of the disease, which is characterized by an increase in prolactin. Moreover, here the signs in women and men will be presented separately, because there is some difference.

High prolactin levels are medically called hyperprolactinemia. This is one of the most common endocrine diseases, after thyroid diseases and diabetes. So what are the symptoms of elevated prolactin?

Prolactin is elevated: symptoms in men and women

Since the hormone prolactin has a multifaceted effect on the human body, the symptoms will also be numerous. In order to somehow systematize, it is customary to combine symptoms into syndromes.

All symptoms can be divided into several syndromes:

Metabolic disorders
Psycho-emotional disorders
Signs of a volumetric process in the hypothalamic-pituitary region.

Reproductive and sexual disorders

The most common and significant manifestation of excess prolactin is disturbances in the functioning of the reproductive organs, both in women and men. Let's first look at the signs of the fair sex, and then move on to men.

Symptoms of high prolactin in women

Women may experience the following symptoms:

Menstrual irregularities: amenorrhea, oligomenorrhea. That is, menstruation is very rare or absent altogether. This is the most common symptom. Occurs in 60-90% of cases. About one in five women report that their periods were irregular from the very beginning, and their onset was always somewhat delayed. Also, the development of amenorrhea often coincides with the onset of sexual activity, the abolition of oral contraceptives, abortion, childbirth, surgery, and the introduction of intrauterine devices.

Infertility is associated with the absence of ovulation or a shortening of the luteal phase (phase 2 of the cycle). Sometimes women have miscarriages in the early stages of pregnancy (8-10 weeks).

Galactorrhea, i.e. secretion of milk from the nipples of the mammary glands. Occurs in approximately 70% of cases. The longer the disease, the less galactorrhea becomes. There are degrees of galactorrhea: 1st degree - single drops with strong pressure on the nipple, 2nd degree - stream or copious drops with gentle pressure, 3rd degree - spontaneous separation of milk. This phenomenon is described in great detail in a separate article.

Decreased libido, lack of orgasm, frigidity.

Hirsutism and acne are observed in 20-25% of women, i.e. Excessive hair growth on the face, around the nipples and along the linea alba. If you have this problem, I recommend reading the article, where I talk about common causes of unwanted hair growth and methods of dealing with them.

Elevated prolactin in men: signs of damage to reproductive function

The following symptoms can be found in men:

Decreased or absent libido and potency. The most common complaint and occurs in 50-85% of cases. It is with her that men first seek medical help.

Reduction of secondary sexual characteristics. Reduced hair growth occurs in 2-21% of men.

Infertility due to oligospermia occurs in 3-15%. Infertility occurs much less frequently than in women, and therefore such men rarely seek help.

Gynecomastia occurs in 6-23% of men. Gynecomastia is a benign enlargement of the mammary glands in men. Externally, the breasts look like small-sized female breasts. There is true and false gynecomastia.

Psycho-emotional disorders

Psycho-emotional disorders usually in the form of depression and sleep disturbances. This occurs in approximately 20-30% of all patients.

Patients also complain of increased fatigue, weakness, memory loss, and pain in the heart area without clear localization. This is observed in 15-25% of patients.

Signs of a volumetric process in the hypothalamic-pituitary region

The spread of the tumor to neighboring brain structures leads to the development of severe symptoms of elevated prolactin, such as:

Destruction of the anterior lobe of the pituitary gland leads to a decrease in reproductive function in 10% of cases. Spontaneous hemorrhages into the tumor occur in 15-20%, but symptoms appear in only a third of patients. Symptoms include headaches, decreased vision, and paralysis of the eye muscles.

Compression of the optic chiasm, which results in limited visual fields. With prolonged compression, irreversible processes occur.

Increased intracranial pressure and papilledema.

Compression of the pituitary stalk and posterior lobe of the pituitary gland results.

When the bottom of the sella turcica grows, liquorrhea occurs—the leakage of cerebrospinal fluid.

Palsy of cranial nerves (3,4,6 pairs), which are responsible for the movement of the eyeball.

Other nonspecific signs of increased prolactin

In addition to the above changes in the condition of a person suffering from prolonged excess prolactin levels, there are other less specific symptoms that may accompany other diseases. These signs include:

drowsiness
acne
hair loss
change in body temperature
facial redness
chest pain
sweating
nausea
buzzing in my head

Let me remind you that these manifestations do not clearly indicate a problem with prolactin, and therefore should not be the basis for making a diagnosis, without the presence of the most important disorders, namely problems with the reproductive function of the body.

What does an increase in hormone lead to?

In itself, an increase in the hormone does not lead to serious consequences and death, but can significantly worsen the quality of life. Regardless of the cause of the disease, there will be problems with childbirth and sex; metabolic disorders in the form of obesity are less common. If there is a pituitary adenoma, then the gradual growth of the tumor can compress areas of the brain, which leads to certain consequences.

In any case, if prolactin is higher than normal, you should not delay treatment and eliminate the problem.

These numerous symptoms of elevated levels of the hormone prolactin arise due to reasons that must be identified before prescribing adequate treatment. In the next article you will learn about methods of diagnosing and treating this disease.

A hormone that is produced by certain cells of the pituitary gland and partially ensures the reproductive functions of the female body is called.

It is found in both humans and animals. The role of prolactin in the female body: development of the mammary glands, stimulation of the lactation process, the emergence of maternal instinct.

Despite the importance of prolactin in the process of procreation and the birth of a child, it is necessary to constantly monitor the level of this hormone in the human body. If it is too high, this may indicate the development of health problems.

Level norm

When the hormone level increases from 700 mU/l. and higher, hyperprolactinemia is diagnosed - an increase in the concentration of prolactin in the blood.

Normally, this indicator should have a value from 120 to 600 mU/l. in women of reproductive age.

During breastfeeding and pregnancy, prolactin levels may change. In women over 45 years of age and children, the hormone concentration should not exceed 400 mU/l.

Causes of hyperprolactinemia in women

High prolactin in women is observed for reasons that can be divided into three types.

Causes of hyperprolactinemia:

Physiological - natural causes associated with a woman’s lifestyle and health.
Pathological - the presence of serious diseases that affect the level of prolactin in the female body.
Iatrogenic - an increase in prolactin levels, as a side effect of certain drugs.

Physiological reasons for increased prolactin in women include:

pregnancy and lactation;
psychological stress, stress;
hormonal imbalances;
sex;
surgical intervention.

Pathological causes of hyperprolactinemia include the following diseases and conditions of the body:

presence of a tumor of the pituitary gland or hypothalamus;
cirrhosis of the liver;
liver failure;
renal failure;
tuberculosis;
polycystic ovary syndrome;
vitamin B6 deficiency;
thyroid diseases;
sleep disturbance and insomnia;
radioactive exposure of the body.

Iatrogenic causes of increased prolactin levels in women include the body’s reaction to the following drugs:

antidepressants;
oral contraception;
neuroleptics;
antihypertensive drugs.

Good to know: Repeated abortions or curettage of the uterus can also lead to disruption of hormones in the body. It is most often observed in women of reproductive age, approximately 25 to 40 years old. During menopause, this problem occurs much less frequently.

As a rule, the level of the hormone prolactin increases in the blood every month in the second phase of the menstrual cycle. Physiological causes of elevated prolactin do not require medical attention, unlike pathological ones. All diseases that lead to hormonal imbalance often need to be treated in a hospital setting.

Symptoms of elevated hormones

Regardless of the reason that led to an increase in prolactin, the symptoms of this condition manifest themselves in all women in approximately the same way.

Signs of excess prolactin:

reproductive dysfunctions: miscarriages, infertility;
menstrual irregularities;
weight gain;
enlargement of the mammary glands, or discharge from them;
loss of interest in intimacy;
hair growth on the chest and abdomen;

Note: signs of hyperprolactinemia can accompany other serious diseases, so a specialist should diagnose this problem.

acne;
psychoemotional disorders;
visual disturbances: sweating, nausea, headaches, dizziness, high temperature, drowsiness.

Consequences of an increase

A slight increase in prolactin, which has returned to normal, does not pose any particular danger.

But in cases where the hormone in the blood is much higher than normal, and the necessary treatment is not carried out, this problem can lead to serious consequences.

Consequences of increased prolactin:

lack of ovulation;
blockage of the mammary gland ducts;

The name of the medicine and its dosage are prescribed by the doctor. After two months of treatment, you need to be examined again. If necessary, change the dose of the drug.

As a rule, such treatment lasts for 2–3 years. Treatment of concomitant diseases is carried out by appropriate doctors. What to do if prolactin is elevated in a woman, watch the doctor’s advice in the following video:

Katya was excitedly preparing for the wedding; she kept turning over fragments of her future family life in her head. Even at the beginning of the relationship, the young couple discussed that they would not have children right away, so Katya turned to a gynecologist with questions about family planning.

In order to choose a suitable contraceptive, the doctor suggested taking hormone tests. However, the results obtained unexpectedly became a cause for concern. One of the hormones, prolactin, had very high levels. As the doctor explained, this level of prolactin is observed in women who are in the 3rd month of pregnancy. However, Katya was never sexually active, so pregnancy was ruled out. The doctor stated that she could not recommend any contraception to her patient other than condoms. And then she added: “You need to be treated, otherwise in the future the child may be born with disabilities.” It is not difficult to imagine the anxiety that gripped Katya. There was already a lot of excitement about the upcoming family life, and now there was such a nuisance.

What kind of hormone prolactin is, how does it affect the female body, is it really dangerous to increase its level - we will find out together with an endocrinologist of the highest category, candidate of medical sciences Kurmanova Anel Kamelevna.

EZ: How does the hormone prolactin affect a woman’s health?
Anel Kamelevna: The hormone prolactin is produced in the anterior lobe of the pituitary gland (the pituitary gland is part of the brain). Prolactin is of great importance for the female body, as it affects reproductive function. It controls the formation of progesterone by maintaining the corpus luteum (this is a temporary endocrine gland in a woman’s body, which is formed after ovulation to produce the female hormone progesterone). Prolactin promotes the process of implantation of a fertilized egg, because it increases the number of receptors sensitive to progesterone. However, the role of prolactin in the regulation of ovarian function is still not fully understood. Prolactin is known to affect lactation in nursing mothers. In addition, this hormone has anabolic and metabolic effects, that is, it affects metabolism and accelerates protein synthesis. It should be noted that it has a characteristic immunoregulatory effect. In addition, prolactin may influence behavioral responses. It inhibits thyroid function by disrupting the feedback between thyroxine and thyroid-stimulating hormone (TSH), and TSH levels may be elevated.

The above indicates the importance of normal prolactin levels in the female body.

Long before visiting the doctor, Katya noted that her menstrual cycle was irregular, but did not attach much importance to it. In addition, she was very worried about excess weight, which she struggled with. Strict restrictions on food still allowed her to maintain physical fitness, which could not be said about the emotional sphere: she was often overcome by painful thoughts, which were accompanied by tearfulness, and constantly wanted to sleep. I had to force myself to work. In addition, she noted a deterioration in memory and vision, however, she attributed all these symptoms to lack of sleep.

EZ: Why is an elevated prolactin level in a woman a reason to be wary?
Anel Kamelevna: If prolactin production is higher than normal, we can talk about hyperprolactinemia. In women with hyperprolactinemia, the menstrual cycle may be disrupted in the form of its lengthening, up to the complete absence of menstrual flow for several months, and maybe even years (amenorrhea). Women with elevated prolactin levels may have primary and secondary infertility, and dysfunctional uterine blood loss is sometimes observed. In some cases, such women are overweight or obese; some patients are bothered by headaches and emotional instability. Women with mastopathy, galactorrhea (discharge from the mammary glands), and fibroids need special attention from doctors.

EZ: What examination is required in these cases?
Anel Kamelevna: Prolactin levels are determined on the 3rd–4th or 5th day of the menstrual cycle. Since the level of prolactin directly affects emotional lability (an inverse relationship is also observed), a woman should try to remain calm when taking the test. In addition, the day before the study, it is necessary to exclude sex and heat exposure. If necessary, especially in emotionally unstable women, prolactin levels should be determined twice or even three times (every other day). The full scope of research includes:
● , pituitary gland;
● study of the functional state of the thyroid gland - determination of the level of TSH, FT4, FT3;
● in overweight women, the level of cholesterol, high-density lipoproteins, low-density lipids, triglycerides, as well as blood sugar levels on an empty stomach and 2 hours after consuming 75 g of glucose are determined (glucose tolerance test);
● if a pathology is detected on an MRI of the brain, an examination by an ophthalmologist is required (field of view, fundus of the eye).

EZ: What are the possible treatment options?
Anel Kamelevna: For hyperprolactinemia, drugs related to dopamine agonists are prescribed.
Doses and duration of use of drugs are individual, treatment is carried out under regular monitoring of prolactin levels. If a pituitary microadenoma (prolactinoma) is detected, then a repeat MRI of the pituitary gland is necessary every 6 months. If prolactinomas are present, observation by an endocrinologist is mandatory. The issue of taking medications is decided individually. When thyroid function decreases, thyroid medications are prescribed.

EZ: What is the prognosis for recovery?
Anel Kamelevna: In each case, the duration of treatment is determined individually. With persistent normalization of prolactin levels, gradual withdrawal of drugs is necessary (planned dose reduction until complete discontinuation). If a microadenoma is present, regular MRI of the brain is required. Consultation with a neurosurgeon may be required.

It should be noted that Katya’s fiancé was sympathetic to her health problems. To begin full treatment, they found an experienced endocrinologist. The endocrinologist did not confirm the colleague’s opinion that with high prolactin, the fetus faces developmental abnormalities. But he said that with such levels of prolactin, Katya is at risk of infertility. And he immediately added that with rational treatment, reproductive function can be restored in 80–90% of women. The endocrinologist also warned Katya that even after a course of successful therapy, a relapse of the disease could occur. According to him, hyperprolactinemia should not be perceived as an insurmountable pathology. Regular screenings and appropriate treatment will help keep prolactin levels in check.

Menstrual irregularities and inability to conceive are typical indicators of problems with the reproductive system in women. They are the most common reasons for visiting a gynecologist. Almost always, these conditions are associated with a violation of the normal values of the hormone prolactin. What causes the rise of this hormone and how to deal with it?

An increase in prolactin levels in the blood is medically called hyperprolactinemia. Most often, hyperprolactinemia occurs in young women (under 40 years of age), less often in men of the same age.

Causes of elevated prolactin levels in women

High prolactin levels in women have different causes:

Physiological - do not pose a danger, they accompany normal processes.
Pathological - are a consequence of the disease.

An increase in prolactin levels in the blood is completely normal:

during sleep at any time of the day;
with severe physical activity in its anaerobic part;
in the late phase of the menstrual cycle;
with nipple irritation and sexual intercourse;
when eating protein foods;
during pregnancy and immediately after childbirth. At this time, prolactin levels increase 150-200 times, and a real hormonal change occurs in the body, characteristic only for this period.

The causes of pathological increase, in turn, are divided into primary and secondary:

Primary hyperprolactinemia is caused by diseases of the brain, primarily the hypothalamus and pituitary gland (for example, tumors).
Secondary hyperprolactinemia is caused by endocrine disorders and a number of medications (contraceptives, antipsychotics, antiemetics, cimetidine). In the latter case, hyperprolactinemia is called drug-induced.

Secondary hyperprolactinemia may result from:

thyroid diseases;
diabetes;
ovarian cysts and tumors;
liver cirrhosis;
lesions of the adrenal cortex;
chronic renal failure;
herpes zoster.

Common to all forms of hyperprolactinemia is the unbalanced functioning of the hypothalamic-pituitary-reproductive system, which has a negative impact on a woman’s reproductive function.

Prolactin in the blood exists in several forms:

monomeric;
dimeric;
macroprolactin (polymer);
glycosylated.

Of clinical importance is the biologically active fraction - monomeric prolactin with a low molecular weight. The total content of prolactin in the blood may increase due to other fractions, for example, macroprolactin, but this increase is not accompanied by clinical symptoms. If a woman has increased monomeric prolactin, we can talk about the signs and consequences of hyperprolactinemia.

Symptoms and consequences of elevated prolactin in women

Clinical symptoms of hyperprolactinemia can be very different. The leading complaints are:

for irregularity or absence of the menstrual cycle;
inability to get pregnant;
complete frigidity;
galactorrhea - the release of milk from the mammary glands, not associated with feeding the child.

However, there may be no symptoms at all.

Short-term effects of high prolactin levels include:

galactorrhea;
menstrual disorder;
swelling and tenderness of the mammary glands;
increased appetite and body weight.

Over time, the following diseases may develop:

osteoporosis;
heart diseases;
cancer of the pituitary gland and ovaries.

High prolactin levels increase cholesterol levels, which increases the risk of coronary heart disease, hypertension, obesity and diabetes during pregnancy.

With age, prolactin levels decrease, which leads to the appearance of “panic attacks.” During crises during menopause, panic attacks manifest themselves in the form of a feeling of fear of death, chills, agitation, and pressure changes.

Increased prolactin in women when planning pregnancy necessarily requires consultation with an obstetrician-gynecologist. As stated above, high level This hormone can cause infertility. Lack of pregnancy and disrupted menstrual cycle are common complaints of women when visiting doctors. The most common cause is pituitary prolactinoma. In this case, women are usually prescribed an annual treatment course and recommend protection against pregnancy.

How to treat elevated prolactin in women

For pituitary prolactinomas, different types of treatment are used:

surgical;
medicinal;
irradiation.

Prolactin levels are well normalized with medication. For this purpose, dopamine receptor stimulants are used. There are three generations of them:

The first generation - "Bromocriptine" - is gradually becoming a thing of the past due to its short period of action. To reduce side effects, the drug should be taken with small doses, usually before bedtime;
II generation - “Quinagolide”;
III generation - “Dostinex” or “Cabergoline”. They have fewer side effects, all undesirable symptoms are mild and disappear after 10 days of treatment, so Dostinex can be used for a long time and in large doses for elevated prolactin in women.

All drugs effectively normalize or significantly reduce prolactin, which is reflected in the size of the tumor, which gradually regresses during treatment.

Bromocriptine is the only drug that allows pregnancy during therapy. During treatment with other drugs, including Dostinex, pregnancy is contraindicated. These medications should be stopped one month before conception.

Is it possible to lower prolactin with folk remedies?

Among the variety of medicines, there is an effective and officially recognized one - this plant Agnus castus. Among his people also called twig, "monk's pepper", "Abraham's tree". The fruits of this plant form the basis of the drug "Cyclodinone".

“Cyclodinone” is so effective that when the hormone level is elevated to 1000 mIU/l, it independently copes with the pathology. Higher levels of the hormone require the addition of other dopamine agonists.

Dosage example: 40 drops orally or 1 tablet 1 time per day in the morning. The course of treatment is 3 months without a break during menstruation.

Dear women! Drug and dosage information is provided for informational purposes only. The issue of normalizing hormonal levels should be dealt with by a specialist who will have to solve many problems, from diagnosing and identifying the cause of the disease to constructing a treatment regimen. It is the doctor who must explain to the patient how to overcome the pitfalls that occur during treatment with dopamine receptor agonists in the form of adverse reactions.

Lyubov Maslikhova, therapist, especially for the site

Useful video

Prolactin is a hormone that primarily regulates breastfeeding. This active substance is produced in the pituitary gland (a part of the brain).

During pregnancy and after childbirth, increased prolactin in women stimulates the growth and development of the milk ducts in the mammary glands. After the baby is born, the hormone activates and maintains the secretion of breast milk. Throughout breastfeeding, the level of prolactin in the mother’s body remains quite high and this is a normal physiological increase.

A violation is considered to be a high concentration of the hormone not related to pregnancy and breastfeeding.. Such changes can be short-term (functional) or persistent (pathological).

Normal hormone levels in women

Different laboratories use different methods for determining the concentration of prolactin in the blood. Standards may vary slightly among different medical institutions. An increase in hormone concentration is called hyperprolactinemia.

On average, a hormone level from 120 to 600 mU/l is considered normal.

Prolactin should be within these limits for every woman from the first menstruation to menopause, excluding periods of pregnancy and breastfeeding.

The norm for girls and women after menopause is lower. Usually their hormone levels do not exceed 400 mU/l.

Hormone testing during pregnancy is most often impractical. If the analysis is still carried out, then values up to 10,000 mU/l are considered normal. The concentration of prolactin begins to increase already in the first trimester and remains high until almost childbirth. A few days before the baby is born, the hormone level decreases slightly. In the future, each time the baby is applied to the breast provokes the release of prolactin in the pituitary gland. The more often feedings occur, the more hormone and breast milk are produced.

Functions of prolactin in the female body

Prolactin affects more than just milk production. It has other important functions as well. The main ones:

stimulates the development of secondary sexual characteristics;
regulates sexual behavior;
suppresses ovulation in nursing women (causes temporary infertility);
supports the formation of maternal instinct;
activates the fight of the immune system against microorganisms;
maintains normal values of calcium, sodium and water in the body;
promotes weight gain.

It is known that the hormone affects the functioning of all endocrine organs, including the adrenal glands, pancreas and thyroid glands.

Prolactin helps adapt to stress, including psychological stress.

Functional disorders and prolactin

A slight increase in the hormone in a woman can be associated with various factors. Typically, functional disorders are manifested by an excess of the hormone up to 1000 mU/l.

What factors can increase prolactin in a healthy woman?

First of all, the hormone is sensitive:

to lack of sleep over the past 24 hours;
to sexual contact in the last 24 hours;
to a large meal the day before;
to fear of medical manipulation of blood sampling.

In addition, prolactin should be taken only in the morning (8.00–10.00) and 3 hours after waking up.

Any experiences and ailments may affect the results of the study. Therefore, before starting treatment, your doctor may advise you to undergo the test again.

Pathological causes of increased prolactin

Some serious diseases also lead to an increase in the hormone prolactin in women. The most common of them is pituitary adenoma. This is a growth of normal cells in the brain that produces excess amounts of the hormone.

Pituitary adenoma can be large (more than 1 cm in diameter) and small (up to 1 cm). Large tumors are called macroprolactinoma, and small ones are called microprolactinoma. These tumors respond quite well to treatment with tablets.

In addition to pituitary adenoma, an increase in the hormone can be caused by:

hypothyroidism;
polycystic ovary syndrome;
liver cirrhosis;
kidney diseases.

It is known that taking various drugs also affects prolactin levels. Excess hormone is recorded in women using:

estrogens (for example, as part of contraceptives);
antidepressants (amitriptyline);
cardiovascular drugs (reserpine, verapamil).

Drugs (amphetamine, opiates, cocaine) also lead to an increase in the concentration of the hormone in the blood.

Manifestations of elevated hormone levels

Everyone has characteristic complaints, regardless of the exact cause of the increase in prolactin.

The main signs of hormone excess:

enlargement of the mammary glands;
discharge from the mammary glands (spontaneously or when the areola is compressed);
absence of menstruation;
infertility;
increase in body weight.

If the prolactin level is not significantly increased (up to 1000 >mU/l), then there may be no complaints at all. In this case, the menstrual cycle may be disrupted (delays of more than 7–10 days, shortening of the period of discharge, etc.). Infertility is usually observed because the eggs do not mature and there is a deficiency of the corpus luteum.

Signs of increased hormone levels are often combined with other symptoms of the underlying disease. So, if the cause of hyperprolactinemia is a large tumor of the pituitary gland, then the patient may have a headache, blurred vision, nausea, weakness and severe thirst.

If an increase in prolactin is caused by hypothyroidism, then women complain of drowsiness, decreased ability to work, memory loss, dry skin, hair loss, low pulse and low blood pressure.

Liver cirrhosis can manifest itself as yellowish skin, ascites (fluid in the abdominal cavity), and bleeding.

Kidney diseases cause swelling of soft tissues, increased blood pressure, and pain.

Treatment of hyperprolactinemia

Only pathological hyperprolactinemia requires treatment. Functional and physiological increases in hormone concentrations do not require medical intervention.

Ergot-based medications are used to reduce prolactin. Currently, cabergoline and bromocriptine are actively used. Both drugs must be taken long-term. Most often, endocrinologists recommend tablets for 2–3 years. Every 1.5–3 months, patients re-determine prolactin and adjust the dose of the drug.