It is an essential factor for secretion of breast milk after child birth, it has a negative effect on the pituitary function, such as production of LH and FSH this we have discussed in the menstrual cycle.
An excess of prolactin is called Hyperprolactinemia , can be caused from some medications such as the drug used for underactive thyroid and the drug used for pituitary itself. Drugs used for mental disorders can also cause an increase in prolactin.
Increased levels of prolactin can be found in ten percent of the population. The women usually present with small periods , absent periods, infertility and galactorrhea (milk secretion from the breast).
Men can also get this problem with low gonadal function.
There is a complex physiological control of the pituitary prolactin secretion.
This includes many drugs and thyroid function.
One of the most important causes of increased prolactin is a pituitary tumour called Prolactinoma, they are usually benign. The thyroid underactivity also causes the increases in prolactin levels, there are several mechanisms which are involved however these are dealt with by an endocrinologist.
As gynaecologists we mainly deal with period problems and infertility.
To start with we should try and find out the cause of the increased prolactin level, asses their other medical history, drugs they are on and thyroid function.
The pituitary gland is located in the brain at the cross junction of the two optic nerves called optic chiasma.
When the pituitary gland is enlarged it puts pressure on the optic nerves and cause headaches, nausea, and disturbance in the visual field.
So this should be investigated by a CT or MRI if it is available. It is often a good idea to have the eyes checked by a good ophthalmologist.
If a prolactin level is not high and there is a macroadenoma (enlarged pituitary tumour) then it is often treated by an endocrinologist.
The drugs we commonly use for alleviated prolactin levels are Bromocriptin 50 to 100mgs used twice daily, this usually brings their periods back and helps them to get pregnant.
The other drug that is used, is called Dopamine Agonist and it is used once a week. It is often used when patients do not respond to Bromocriptin.
The surgery is only carried out if the prolactin level does not respond to drugs or pituitary macroadenoma is present or if their are any other tumours present in the surrounding area and this decision is taken by neurosurgeons.
This is a very simplified version of a condition called Hyperprolactinemia.
This mainly causes secondary amenorrhea and infertility in women, however it is easy to diagnose and treat, so do not despair, have yourself checked out if you have infrequent periods , no periods, infertility and milk secretion from the breast.
