Hyperprolactinemia and the menstrual cycle

Top things to know

• Prolactin is a hormone that is most known for stimulating lactation (breast milk production), but it’s also involved in functions including ovulation, reproduction, immunity, and blood cell formation
• Hyperprolactinemia is a condition where there is an abnormally high amount of prolactin the body
• People with hyperprolactinemia may experience irregular or absent menstrual periods, abnormal breast milk discharge, infertility, and sexual side effects

What is hyperprolactinemia?

Hyperprolactinemia (hyper - prolactin - emia) is a condition where there is more prolactin in the body than is normal. Prolactin is a hormone which is mostly produced in the pituitary gland—a small hormone-secreting gland at the base of the brain (1,2). Prolactin plays a role in many of the body’s functions including ovulation, reproduction, immunity, and blood cell formation, but is primarily known for its role in stimulating lactation (breast milk production) (1,2).

Unmanaged hyperprolactinemia can impact fertility and bone density, leading to osteoporosis (1,2). It can also cause neurological symptoms in some cases (1,3). Early diagnosis and treatment can help reduce risks and complications connected with this condition.

Symptoms: What you might notice if you have hyperprolactinemia

Hyperprolactinemia tends to most noticeably affect reproductive organs and function. This occurs because prolactin suppresses luteinizing hormone (LH) and follicle stimulating hormone (FSH) (2). [For a refresher on LH, FSH, and ovulation, check out this post].

A person with hyperprolactinemia may experience:

• long or irregular cycles
• anovulation (when an egg is not released during a menstrual cycle
• amenorrhea (absence of periods)
• oligomenorrhea (irregular periods)
• infertility
• the production and discharge of breast milk
• sexual side effects
• hirsutism (abnormal hair growth)
• neurological symptoms, such as headaches or problems with their vision (rare)(1-3).

Postmenopausal people and people of all genders can also have hyperprolactinemia, though their symptoms may differ (1).

Causes: Why hyperprolactinemia happens

Hyperprolactinemia can be caused by other medical conditions that produce hormonal imbalances in the body, growths on the pituitary gland, and some medications (1,3). About 2 in 5 cases of hyperprolactinemia don’t have a known cause (1).

Pituitary gland

Hormonal interference with or damage to the pituitary gland can cause hyperprolactinemia (2) (1,3). The pituitary gland and hypothalamus (your brain’s hormone command center) work together to regulate many hormones in the body, including prolactin. Some people develop a small tumor in their pituitary gland called a prolactinoma, which can cause more prolactin to be released. These tumors are rare. About 3 to 5 people out of every 10,000 people have a prolactinoma (4-8).

Damage to the pituitary gland can be caused by tumors or cysts, physical trauma, or other syndromes or illnesses, such as Cushing’s disease (1,3).

Hormonal and metabolic conditions

Damage to other parts of the body can also affect prolactin production. In particular, illnesses of or damage to the kidneys, liver, and thyroid can cause hyperprolactinemia (1,3).

Hyperprolactinemia is also associated with other reproductive disorders, such as amenorrhea and polycystic ovary syndrome (PCOS) (1). Almost 1 in 6 people with PCOS have hyperprolactinemia (1,9,10).

A person’s behavior can cause hyperprolactinemia. Stress, lack of sleep, and intense exercise can interfere with the normal function of your hormones, leading to the disorder (1,3,11).

Medications

Medications can cause hyperprolactinemia. These include:

• Psychotropic drugs, such as dopamine-blocking psychotropic/antipsychotic drugs
• Narcotics, such as opioids
• Drugs taken to treat ulcers or high levels of stomach acid
• Estrogen-containing medications, though this is only slight and rarely needs treatment (1-3).

Pregnancy and breastfeeding

A high level of prolactin in the body is normal during and after pregnancy, and while breastfeeding (1-3).

How is hyperprolactinemia diagnosed?

Hyperprolactinemia is typically diagnosed through blood tests (1,3). If a person tests positive for hyperprolactinemia but has no clinical symptoms, it’s possible the test is picking up macroprolactins, or prolactins molecules that are larger than normal (3,11). This form of prolactin affects your body differently, so management and treatment may differ or not be necessary, depending on the situation.

Hyperprolactinemia treatments

Medication: For hyperprolactinemia caused by medication, a healthcare provider may recommend trying a new medication, or adding another medication to balance out some of the effects of the first medication (3). In these cases, it’s important to discuss concerns and preferences regarding side effects and management of other health issues.

For hyperprolactinemia caused by a benign tumor on the pituitary gland (prolactinoma), a healthcare provider may recommend medications that affect dopamine function (dopamine agonists). They may also suggest hormone therapy, either in the form of hormonal contraceptives or hormone replacement therapy (HRT) (1,3).

Surgery: In cases where medication or hormones can’t treat the tumor, a healthcare provider may recommend surgery (1,3). When treating this cause of hyperprolactinemia, it is important for the healthcare provider to know about a person’s pregnancy status and pregnancy intentions, as some medications used to treat the tumors may affect the pregnancy or the developing fetus (1,3).

What to track in Clue

Essential to track

• Bleeding patterns
• Headache

Helpful to track

• Custom tabs: abnormal breast discharge

Download Clue to track your menstrual cycle