Increased prolactin in women: symptoms, treatment, causes, consequences
The content of the article:
- Causes of increased prolactin in women
- Symptoms of increased prolactin in women
- Diagnosis and treatment of elevated prolactin in women
- Consequences of increased prolactin in women
Elevated prolactin in women (hyperprolactinemia) is a condition characterized by an increase in the concentration of lactotropic hormone in the blood.
Prolactin (lactotropin, mammotropin, mammotropic hormone, lactotropic hormone LTH) is a peptide hormone that is synthesized by acidophilic cells of the anterior pituitary gland. Almost all of the known effects of prolactin are associated with reproductive function. It ensures the growth and development of the mammary glands, promotes the secretion and maturation of colostrum, as well as the conversion of the latter into mature milk.
In a woman's body, prolactin is responsible for lactation.
In blood, LTG is found in several forms (monomeric, dimeric, tetrameric). The biologically active form of the hormone is monomeric (consists of one peptide chain).
Increased prolactin in women is more often found in 25-40 years. In men of the same age category, this condition is recorded much less frequently.
Causes of increased prolactin in women
The reasons that cause an increase in the concentration of LTG in women are physiological, pharmacological and pathological.
The concentration of prolactin in the blood increases in women during pregnancy and lactation, with excessive physical exertion, during intercourse, sleep, stress, when eating protein foods. The production of the hormone has a wave-like character - clear changes in secretion were recorded throughout the day. Thus, a constant increase in the concentration of prolactin is observed during sleep (regardless of whether it is a daytime sleep or a nighttime sleep). The content of the hormone in the blood increases in an hour and a half after falling asleep, and after waking up it sharply decreases. The lowest values of this indicator are in the late morning hours; in the afternoon, the concentration of the hormone begins to increase. In the absence of stressful situations, daily fluctuations of prolactin in the blood, as a rule, do not go beyond the normal range.
Hyperprolactinemia can be triggered by taking medications, which include antidepressants, antipsychotics, antihistamines, contraceptives with a high estrogen content, antiemetic drugs.
The pathological increase in prolactin in women can be organic and functional. Organic hyperprolactinemia, as a rule, is caused by neoplasms of the pituitary gland or hypothalamus. Pituitary adenomas that secrete prolactin are called prolactinomas and are among the most common pituitary tumors. The level of LTH in prolactinoma is extremely high, it can exceed 200 ng / ml. But tumors that do not produce prolactin sometimes cause secondary prolactinemia by reducing the production or disrupting the transport of dopamine, a neurotransmitter that regulates prolactin synthesis.
Functional hyperprolactinemia develops against the background of a number of pathological processes. The hormone prolactin is increased in women with the following pathologies:
- empty Turkish saddle syndrome;
- diseases of the brain (neoplasms, encephalitis, meningitis);
- hypothyroidism;
- polycystic ovary syndrome;
- chronic renal failure (LTH increases in 65% of patients on hemodialysis);
- cirrhosis of the liver;
- systemic lupus erythematosus;
- an increase in the level of estrogen in the blood (since estrogens have a stimulating effect on the synthesis of prolactin);
- surgical interventions on the chest;
- frequent abortion and / or curettage of the uterus.
An idiopathic form of hyperprolactinemia is distinguished, in which the function of the pituitary cells increases without changing their number. Why this is happening has not yet been established.
Symptoms of increased prolactin in women
Increased prolactin in women often does not manifest itself in anything and is detected by chance during an examination for another reason. In other cases, the symptoms of hyperprolactinemia are:
- disorders of the menstrual cycle;
- the release of milk from the mammary glands outside the lactation period (galactorrhea);
- decreased sex drive, anorgasmia;
- atrophic changes in the mucous membrane of the vagina and urethra;
- virilization;
- seborrhea of the scalp, hair thinning on the head;
- a tendency to acne;
- increased salivation.
Hyperprolactinemia can cause various menstrual irregularities
Menstrual irregularities in women with hyperprolactinemia can take the following forms:
- amenorrhea - the absence of menstruation over several menstrual cycles;
- oligomenorrhea - shortening of the time of menstrual bleeding to one or two days;
- opsomenorrhea - an increase in the interval between menstruation more than 35 days;
- Menometrorrhagia - menstrual bleeding that is significantly longer than usual in duration or intensity;
- anovulatory cycles - menstrual cycles without ovulation and corpus luteum formation;
- shortening of the luteal phase of the menstrual cycle.
In some cases, with hyperprolactinemia, the patient's menstrual cycle is not disturbed.
If hyperprolactinemia has developed against the background of a pituitary neoplasm, as the tumor grows, patients begin to worry about headaches and visual impairments.
Diagnosis and treatment of elevated prolactin in women
Hyperprolactinemia is detected by laboratory tests that determine the amount of prolactin in the blood. In order to clarify the cause of the pathology, they resort to extended diagnostics, according to indications including:
- determination of the level of other hormones;
- X-ray examination of the Turkish saddle area (determination of the size of the pituitary gland);
- computed and / or magnetic resonance imaging (assessment of the state of the pituitary gland and surrounding tissues);
- ophthalmological examination;
- gynecological examination.
The norm of prolactin in the blood in women of reproductive age is 2.8–29.2 ng / ml, in postmenopausal women - 1.8–20.3 ng / ml, however, it may differ in different laboratories. It is recommended to take blood for analysis for prolactin in the morning, from 9 to 11.
Physiological hyperprolactinemia does not need to be treated.
If the increase in the concentration of prolactin is due to the intake of the drug, the drug is canceled. The menstrual cycle is usually restored within 4-5 weeks.
In the drug therapy of hyperprolactinemia, dopamine agonists are used. If LTH is elevated against a background of adrenal or thyroid insufficiency, hormone replacement therapy is indicated, which allows to normalize the level of the hormone in the blood and eliminate signs of hyperprolactinemia.
Surgical treatment is usually indicated for disorders of the visual analyzer and no effect of conservative treatment. Surgical intervention consists in removing the pituitary neoplasm.
Radiation therapy is used in rare cases (in case of ineffectiveness or intolerance to other types of treatment, as well as in case of refusal of patients with prolactinoma from surgery).
Consequences of increased prolactin in women
The consequences of long-term increased concentration of prolactin in women are unfavorable. Against the background of hyperprolactinemia, develop:
- hypoplasia of the uterus;
- involution of the mammary glands;
- malignant neoplasms of the breast;
- oncological processes in the ovaries.
Increased prolactin in women is responsible for about 30% of all cases of infertility.
Neuroleptic hyperprolactinemia in pregnant women can lead to a slowdown in fetal growth, as well as to premature termination of pregnancy, both in the early and late stages.
Obesity is observed in 40-60% of women with hyperprolactinemia
Elevated LTH often causes an increase in appetite and, accordingly, body weight, up to obesity, which is recorded in 40-60% of cases of hyperprolactinemia in women. At the same time, the level of total cholesterol, low and very low density lipoproteins increases, the concentration of high density lipoproteins decreases, which results in the development of arterial hypertension and coronary heart disease. A high level of prolactin in women is dangerous for the possibility of insulin resistance, which is explained by the direct stimulating effect of the hormone on the β-cells of the pancreas.
Long-term elevated LTH leads to a decrease in bone mineral density, which is the reason for the development of osteopenia and osteoporosis in the patient.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
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