Overabundance Of Prolactin
One common cause for abnormalities of the menstrual cycle and infertility is hyperprolactinemia. This condition is often accompanied by a watery or milky discharge from the nipples that occurs on its own or can be squeezed out of the nipple. This discharge is called galactorrhea.
Hyperprolactinemia is the presence of too much prolactin, a natural hormone. Men and women can be affected by the condition and it can cause infertility in either sex. The condition is found in as many as one-third of all women who fail to menstruate.
Hyperporlactinemia is a disorder of the pituitary gland. The pituitary is meant to secrete prolactin when triggered by its release of the thyrotropin-releasing hormone (TRH).
Pregnant women use the prolactin as it is secreted by the pituitary gland for preparing their breasts for future milk production. The production of breast milk is called lactation, from the word "prolactin." When the breasts produce milk at times other than breastfeeding, it is usually due to hyperprolactinemia. The common causes of hyperprolactinemia are:
*Pituitary tumors such as prolactinomas, which may be smaller than 10 mm in diameter
*Primary hypothyroidism which results from too much TRH which in turn causes an increase in TSH and prolactin
*Medication, for instance phenothiazines, drugs for high blood pressure such as a-methyldopa, tranquilizers, opioids, anti-nausea medications, and oral contraceptives
*Chronic renal failure and other chronic medical conditions
Hyperprolactinemia often comes with hypogonadotropinism and hypogonadism.
Some of the symptoms that suggest a work-up for this condition include:
*The absence of menstrual periods
*Infrequent menstrual periods
*Corpus luteum dysfunction
*Visual disturbances and headaches
*Loss of libido and in men, sexual potency
*Decreased levels of LH and FSH
*Signs of an estrogen deficiency, for instance hot flashes, painful intercourse, even when estrogen production seems fine
*Increased levels of androgens in women
Hyperprolactinemia is diagnosed through the following diagnostic tests:
*Basal prolactin level—this can determine the size of a pituitary tumor
*Serum FSH, LH, and estradiol—this may be low to normal in hyperprolactinemia
*TSH—used to rule out hypothyroidism
*CT or MRI scans—used to find microadenomas
*Visual field exams—used when macroadenomas are found (tumors bigger than 10 mm in diameter) or in those patients who opt to be observed or given medication, only
The treatment for hyperprolactinemia depends on the results of these diagnostic tests. In patients with prolactin levels lower than 100 ng/mL and in conjunction with normal scans or in patients with microadenomas, treatment is with bromocriptine or the physician may take a wait and see approach. In cases where estrogen levels plummet, doctors may prescribe exogenous estrogen.