The causes of hyperprolactinemia and what is the danger of increased prolactin? What is prolactin? What kind of hormone is this

Prolactin- a hormone produced by the anterior lobe of the pituitary gland, the main functions of which are to stimulate the growth of the mammary glands and milk production. It is also involved in maintaining maternal instinct, regulating the menstrual cycle and immune reactions. During pregnancy, the hormone promotes the functioning of the corpus luteum. In the medical literature, prolactin has the following names: mammotropin, lactotropic hormone and LTG.

Elevated prolactin in the blood is called hyperprolactinemia. This pathology entails many unpleasant consequences, but its main symptoms are changes in the menstrual cycle and, which leads to the inability to conceive a child.

Reasons for increased prolactin

In the body, the hormone prolactin is produced in the pituitary gland, this process is regulated by another gland of the endocrine system - the hypothalamus. It collects information from various organs (ovaries, uterus, mammary glands, blood), which contributes to the synthesis of either prolactoliberin or dopamine in it. The first hormone stimulates the production of LTG in the pituitary gland, the second, on the contrary, suppresses it. This process is called the “feedback principle” and is based on the fact that with an increased concentration of prolactin in the blood, its production decreases, and with a decrease, it increases.

High LTG can be observed for physiological and pathological reasons. The first include nipple irritation, pregnancy and lactation. Also, physiological reasons for an increase in prolactin in a woman are emotional stress, sexual intercourse, prolonged sleep, and a diet high in protein.

The pathological causes of increased LTG are extremely diverse, the most common include:

• diseases of the hypothalamus (tumors, mechanical damage and others);
• diseases of the pituitary gland (adenoma, sarcoidosis and others);
• shingles;
• cirrhosis of the liver;
• chronic renal failure;
• hypothyroidism;
• gynecological diseases (polycystic ovary syndrome).

A separate group of etiological factors for the development of hyperprolactinemia includes the use of certain medications. Quite often, prolactin is elevated in women taking oral contraceptives. The higher the dose of estrogen in them, the more pronounced hyperprolactinemia.

Increased LTG can be observed while taking drugs that reduce the amount of dopamine or block its receptors. Such drugs include verapamil, estrogens, reserpine. Hyperprolactinemia is a common side effect during phenothiazine therapy.

Symptoms and consequences

Elevated prolactin in women affects many body functions. But most of all, hyperprolactinemia affects the mammary glands and ovaries. Usually, with an increased amount of hormone in the blood, the patient looks absolutely normal, sometimes she may not show any complaints, pathology is detected only when attempts to conceive a child are unsuccessful. The most common symptoms of increased prolactin in women include:

Galactorrhea- the appearance of secretions from the mammary glands, unrelated to feeding the child. The amount released is not always directly proportional to the level of increase in lactotropic hormone. Typically, less milk is produced over time if left untreated. The amount of discharge from the mammary gland varies from a few milliliters with pressure to spontaneous secretion of large amounts of colostrum.

Sometimes this symptom may be the only complaint with increased LTG in the blood. Changes in the cycle range from delays of several days to complete cessation of menstruation - amenorrhea. This symptom is leading in the diagnosis of hyperprolactinemia.

Infertility. Due to disturbances in the hormonal status of a woman, ovulation does not occur, due to which she cannot conceive a child. Infertility is almost always diagnosed due to changes in the menstrual cycle.

Hyperestrogenism– increased amount of estrogen in the blood. This syndrome manifests itself as vaginal dryness and decreased libido. Against the background of long-term hormonal imbalance, a woman can develop uterine fibroids, endometriosis, and osteoporosis.

Hyperandrogenism– increased levels of male sex hormones (testosterone) in the blood. This condition is accompanied by the appearance of acne, male pattern hair growth, increased oiliness of hair and skin, and deposition of fat on the abdomen.

Obesity. An increase in mammotropin in the blood contributes to excessive appetite and increased development of subcutaneous fat.

Deterioration of vision. With prolonged hyperprolactinemia, an increase in the cells of the pituitary gland occurs, which is localized near the optic nerves. The gland begins to compress them, which leads to deterioration of vision. With a long-standing excess of prolactin, memory impairment and sleep problems may occur.

Diagnostics

Diagnosis and treatment of high levels of lactotropic hormone in the blood is carried out by an endocrinologist or gynecologist-endocrinologist. During the examination, he collects the woman’s medical history, learns about her complaints, and conducts a visual examination. Next, laboratory and instrumental diagnostics are carried out.

Blood for analysis of the amount of prolactin is taken from a vein in the morning on an empty stomach on days 5-8 of the menstrual cycle. A few days before the expected laboratory diagnosis, a woman should abstain from sexual activity and excessive exercise. The norm of prolactin in females is 252 – 504 mIU/l. In some laboratories, mammotropin is measured in other units, then physiological values ​​​​correspond to 4.5 - 23 ng/ml. After ovulation, prolactin in women can be increased by 100 units, then its norm becomes 299 – 612 mIU/l (4.9 – 30 ng/ml).

Attention! The leading symptoms in the clinic of hyperprolactinemia are menstrual irregularities and reduced fertility, therefore, with delays, scanty discharge, amenorrhea, or inability to conceive, a woman should consult a doctor for an extensive diagnosis, during which an increase in LTG may be detected.

Sometimes, for a complete diagnostic picture of the disease, it is necessary to know the amount of other hormones; most often, a test of the endocrine function of the thyroid gland is required. This study is based on the fact that in addition to LTG, the pituitary gland synthesizes thyrotropin, which regulates the activity of the organ. Therefore, in some diseases there are changes in the amount of not only prolactin, but also TSH, T3 and T4 (hormones that reflect the functioning of the thyroid gland).

For a detailed laboratory diagnosis of elevated LTG, tests can be performed to measure the amount of prolactin in the blood after intravenous administration of dopamine antagonists. Normally, these substances block the inhibitory effect of dopamine, so the amount of mammotropin in the blood will increase sharply due to its increased synthesis. For this method, metoclopramide is used in an amount of 10 mg. After its intravenous administration, blood is drawn at time intervals of 15, 30, 60 and 120 minutes. With physiological hyperprolactinemia, the concentration of prolactin increases; with the pathological type of the disease, the hormone values ​​remain at the original level.

Among instrumental diagnostic methods, CT and MRI of the skull are of great importance. These methods are used only for primary hyperprolactinemia. They allow you to assess the size of the pituitary gland and identify its tumor. If a pituitary adenoma is suspected, an ophthalmological examination is performed to identify vascular changes in the retina and reduce color fields.

Treatment methods

Treatment of this syndrome depends on its type, so if hyperprolactinemia is secondary, therapy should be aimed at the underlying pathology. When it disappears, the amount of prolactin in the blood returns to normal.

Quite often, hyperprolactinemia occurs with hypothyroidism (a disease caused by insufficient levels of thyroid hormones in the body), which is corrected by treatment with replacement therapy. Also, often elevated LTG is a consequence of polycystic ovary syndrome (a disease in which the ovary contains many immature follicles that turn into cysts); in this case, the woman is advised to use oral contraceptives with an antiandrogenic effect.

For primary hyperprolactinemia, drug therapy is used. It includes the use of dopamine agonist drugs. The most common drug is Bromocriptine. It suppresses the secretion of prolactin, activating the release of dopamine. Cancellation of this drug is possible after 2-3 years of treatment. During pregnancy, it can be used in small courses. Bromocriptine helps reduce the size of the adenoma by 30% every 6 months.

However, with all the advantages of Bromocriptine therapy, this drug is not suitable for all women, as it causes unpleasant consequences: headaches, loss of consciousness, vomiting. At the moment, there are its modern analogues: Lisurid, Tergurid, Hinagolide. Dostinex is a popular drug for high prolactin in women. It has fewer side effects and is a modern alternative to Bromocriptine. Its active ingredient Cabergoline is a dopamine agonist of the third, newest generation.

If conservative therapy is ineffective, surgical treatment is performed - removal of the pituitary tumor. Surgery is required for persistent vision loss and steady progression of the adenoma. Surgical treatment should be carried out in a specialized hospital, since the risk of complications is high. But surgery does not guarantee the absence of relapses in the future; they occur in about a third of cases.

Do not forget about changing your lifestyle if you have hyperprolactinemia. A patient with this pathology should try to reduce physical and emotional stress, which increases the level of lactotropic hormone. There is a diet for high prolactin in women, based on the consumption of foods with a high content of folic acid and vitamin B12. For hyperprolactinemia, you should eat a lot of liver, lean meat, parsley leaves, spinach, eggs, and vegetables.

List of used literature

Tkachenko B.I. Normal human physiology. 2012

Beskrovny S.V.. Baybuz D.V. “Dynamics of prolactin levels in the blood of women during the menstrual cycle.” // Journal of Obstetrics and Women's Diseases. No. 3. Volume LIV. 2005

Tikhomirov A.L., Lubnin D.M., Oleinik Ch.G. Hyperprolactinemia: diagnosis and modern methods of treatment with bromocriptine // Breast Cancer. 2002. No. 15. P. 634

Increased prolactin (hyperprolactinemia) is a common problem faced by women of reproductive age. There can be many reasons for this condition.

The doctor’s task is to find out through examination exactly where the pathology is and how treatment should be carried out. An increase in the concentration of the hormone poses a serious health hazard if measures are not taken in time.

What is the hormone responsible for?

Prolactin is a hormone of the polypeptide family. It is formed in the anterior lobe of the pituitary gland (“sella turcica”) and in some other organs and tissues.

It is synthesized throughout the body, affects the reproductive and reproductive system of women.

Thanks to increased concentration, promotes gestation, delayed ovulation, lactation period etc.

Its role is very great, and scientists are still studying its chemical properties.

This polypeptide responsible for the following biological conditions of a woman:

• absence of menstruation during lactation to avoid re-pregnancy;
• protecting the unborn child from the mother’s immunity;
• reduction of pain and sensitivity threshold;
• stimulation of breast growth for feeding;
• formation of colostrum, increased secretion of it with subsequent release of milk;
• stimulation of the hormone progesterone during pregnancy;
• feeling of orgasm during sexual intercourse;
• development and formation of the child’s respiratory system;
• support of water-salt balance and metabolic processes;
• regulation of the third phase of the menstrual cycle (luteal).

Prolactin is responsible for all reproductive and sexual mechanisms that occur in a woman at the physiological level.

Its laboratory diagnosis is not difficult. In private laboratories and public clinics conduct a study of venous blood using immunoassay techniques.

In commercial medical clinics Such a diagnosis may be called a “prolactin test.” In government agencies, this is a routine test - screening for all sex hormones.

No other laboratory technique is capable of calculating its exact concentration.

When interpreting the results, it is imperative to focus on reference values, which may vary in each laboratory. This is a very sensitive hormone Therefore, it is necessary to carefully prepare for the study.

The test is taken on an empty stomach in phase 1 of the menstrual cycle.. It is better that 2-3 hours pass after waking up in the morning, since its effect is activated during sleep.
The results can be inflated and unreliable, so you should pay attention to this point.

What does an increased level of prolactin in women mean, why is it dangerous, how to treat this condition:

Why is the level rising?

Prolactin may increase for physiological and pathological reasons. In the first case, no treatment is required, only observation.

A slight increase in the hormone in the analysis is not dangerous. There's a good chance this happened within the framework of physiological reasons:

• severe stress;
• pregnancy or lactation period;
• psychosis;
• age (newborns);
• alcohol consumption;
• physical activity or training;
• visiting a bathhouse or sauna;
• smoking;
• sexual intercourse on the eve of the study;
• taking psychotropic medications.

Prolactin is often called the “stress hormone”, since during such a period its concentration increases sharply. If a woman is terrified of injections or having blood taken from a vein, then most likely she will have elevated hormone levels.

Excessively high values ​​indirectly indicate the presence of a serious disease.

Laboratory numbers may vary. In addition, a lot depends on the units of measurement.

Normal values ​​for a non-pregnant woman are from 4 to 40 ng/ml (depending on the phase of the menstrual cycle) or from 105 to 560 mU/ml.

In various pathologies, the level of prolactin increases greatly. This is usually a consequence of certain diseases.

If prolactin in women is higher than normal, further diagnosis is required to understand exactly where the disease is located.

Pathological causes of hyperprolactinemia:

• diseases or tumors of the hypothalamus of the brain;
• tumors and pathologies of the anterior pituitary gland (adenoma, cyst, prolactinoma);
• thyroid dysfunction;
• polycystic ovary syndrome;
• renal or adrenal insufficiency;
• liver diseases (cirrhosis).

Hyperprolactinemia in women:

High content during pregnancy and lactation

This the hormone increases greatly during pregnancy and lactation. This is a normal condition for an expectant mother and does not require correction or treatment.

The upper limit is values ​​up to 10,000 mU/l. It increases gradually, starting from the 8th week of pregnancy. By the 38th week, the indicators can be very high.

This indicates activation of the hormone, it promotes normal pregnancy and child development.

With the help of prolactin, the lungs, fetal respiratory system, and immunity are formed, so sudden surges in the hormone should not surprise doctors.

During pregnancy, the secretion of estrogen increases sharply, which leads to an increase in prolactin. But right away after childbirth everything evens out and he reaches normal.

During feeding, the hormone rises again, its increased concentration promotes the formation of milk, enlargement of the breast and its ducts.

Doctors usually do not study it during pregnancy, because it is pointless.

Diagnosing pathology with physiological elevation is very difficult. That's why doctors wait until the end of pregnancy and lactation.

Symptoms and signs

Excessively high concentration of the hormone has its own symptoms. For many, it is quite “erased”, so few of them go to the doctor.

The presence of symptoms does not mean that high prolactin is immediately to blame. It is necessary to examine the woman and take note of her complaints.

Usually hyperprolactinemia accompanied by the following symptoms:

• absence of menstruation or its incomplete onset;
• inability to conceive a child (infertility);
• milk discharge from the breast not associated with lactation (galactorrhea);
• lack of ovulation;
• weight gain;
• strong;
• deterioration of visual acuity.

Such clinical manifestations can occur in any other pathology, which is the difficulty of the examination. It is likely that the woman may not have any symptoms or they will be completely insignificant.

Many women complain of the inability to conceive, which is facilitated by hyperprolactinemia.

Hormonal infertility can be successfully treated, since the increased concentration of prolactin simply blocks the onset of ovulation, and the hormone progesterone decreases sharply.

Why is an increase dangerous, possible consequences?

The danger of hyperprolactinemia depends on the underlying disease, which provoked an increase in the indicator.

Elevated prolactin in itself is not dangerous. if it is caused by physiological reasons.

A long course of severe depression or neurosis can cause an increase in values. This stress load indirectly harms the female reproductive system, causing ovarian dysfunction.

In this case it will be observed disruptions of the menstrual cycle, milk discharge from the breast not associated with the feeding period (galactorrhea). This is typical with hyperprolactinemia.

Then diseases of the pelvic organs may appear.

Usually the cause of increased prolactin is a tumor, a cyst in the anterior lobe of the pituitary gland.

Types of brain tumors:

• prolactinoma;
• microadenoma;
• cyst;
• craniopharyngioma;
• “empty sella” syndrome.

They have a benign course, but the possibility of a change to a malignant form cannot be excluded. In most cases there is no serious threat to life, but extremely painful consequences are possible.

Tumors produce large amounts of prolactin, which causes unpleasant symptoms. The woman experiences severe headaches in the frontal region and serious visual impairment.

Without treatment, complete blindness may occur. Less common are cerebral hemorrhages or heart attacks.

The tumor begins to grow and this is indicated by impressive laboratory values. In such a situation, it is necessary to take action.

When and which doctor to go to, diagnosis

Endocrinology deals with hormonal problems, but this hormone usually manifests itself in the reproductive sphere. Therefore, it is checked by gynecologists, but it is possible that an endocrinologist can also do this.

There is also such a narrow medical specialization as gynecologist-endocrinologist. He deals only with hormonal disorders in women. The task of such a doctor is to find an explanation for hyperprolactinemia.

If there is no such specialist in the area, then A woman can consult a regular gynecologist. He will direct you to take tests and decipher their results.

You will have to take tests or undergo a thorough diagnosis from a mammologist, neurologist, ophthalmologist, neurosurgeon, etc.

MRI examination of the brain, as well as blood testing, is included in the list of mandatory diagnostic methods if there is serious suspicion of the neurohormonal nature of the disease.

Ultrasound of the pelvic organs, mammary glands and thyroid gland also used as a diagnostic method.

Typically, women find out about increased prolactin by chance during an examination or as a result of planning pregnancy.

The reason for contacting may be severe symptoms such as absence of menstruation or irregular menstrual cycle. However, You can consult a doctor in any case, even if the complaints seem minor.

Treatment

The main treatment for elevated prolactin in women is aimed at eliminating the causes of hyperprolactinemia.

Usually a tumor of the pituitary gland. For such purposes, you need to do an MRI of the brain to accurately determine the size and location of the tumor.

Based on the data obtained, you can determine exactly what to do next. Treatment is predominantly medicinal, but radical methods such as surgery are less commonly used.

There is a group of drugs that reduce the concentration of the hormone. These are popular medications that, in their pharmacological basis, are dopamine agonists or dopaminomimetics.

Dopamine is a neurohormone, the biological activity of which is aimed at regulating prolactin.

Doctors correcting hormonal levels use such drugs:

• bromocriptine;
• pergolide;
• cabergoline;
• quinagolide;
• dostinex;
• norprolac.

These drugs will have to be used for quite a long time, and the therapeutic effect is achieved after 2 months.

Such drugs eliminate the symptoms caused by hyperprolactinemia. After taking them, the menstrual cycle should normalize and the size of the tumor should decrease. Milk secretion from the breast also stops.

When prescribing treatment, the doctor selects therapy depending on the patient’s condition.

All medications are equally effective, but bromocriptine is usually used when planning pregnancy. This is a less toxic medicine.

If drug treatment does not help or the brain tumor increases in size, squeezing blood vessels, then surgery or radiation therapy indicated.

The operation is performed through the sinuses without affecting the skull. However, even after surgery there is a high risk of recurrence.

Diet for hyperprolactinemia

Diet is little used in the treatment of hyperprolactinemia, since it has not been precisely proven which products are useful for such a clinical picture.

There are no clear diet therapy regimens, but it is believed that certain foods should be limited in the diet.

Excessive consumption of protein foods slightly increases the rate. Therefore, doctors recommend giving up some delicacies.

Protein foods include:

• meat (beef, chicken, rabbit, liver, pork);
• eggs;
• cheeses;
• beans;
• fish;
• bird;
• cottage cheese.

You shouldn't completely ignore these products, but you need to eat a balanced diet. It is better to eat low-fat varieties of meat, cottage cheese, and cheese.

You can compensate for protein deficiency with folic acid and vitamins, which are abundant in spinach, broccoli, lettuce, and Brussels sprouts.

Eating greens, vegetables and fruits has a beneficial effect on hormonal secretion.

What not to do

For any illness, you must follow your doctor's instructions. Hyperprolactinemia does not automatically mean a brain tumor or other terrible pathology.

Ordinary stress can greatly increase the hormone, but in this case no medications need to be taken.

Self-medication in such situations is unacceptable; self-administration of medications can cause metabolic disorders.

In medical practice existrestrictions that a woman must follow:

1. Quitting alcohol and smoking.
2. Reducing physical activity and training.
3. Stop taking strong psychotropic medications and antipsychotics.
4. Limiting protein foods.
5. Avoiding stress.

These are the minimum requirements to restore hormonal balance. The basis of everything is the normalization of lifestyle and sleep.

If prolactin levels rise regularly, you need to be systematically checked by a doctor to avoid unpleasant consequences.

In conclusion, it must be said that prolactin is a dangerous hormone that needs to be systematically studied.

Its increased content may indicate for serious diseases that, if not properly treated, cause severe symptoms and painful consequences.

Modern medicine has all the means and skills to normalize the level of any hormones, therefore no reason to panic. In most cases, patients successfully cope with hyperprolactinemia.

Prolactin(luteotropin, mammotropin) is a pituitary hormone that is responsible for the growth of the mammary glands and ensures the production of breast milk in women. It is found in small quantities in the body of men.

A distinctive feature of prolactin is sharp fluctuations, which may be associated with sleep, medication, active sexual stimulation, or chest trauma. In healthy people, hormone levels return to normal within a few hours. Long-term increases in prolactin levels in the blood require adjustment, as they can cause health problems.

Hyperprolactinemia– high levels of prolactin in the blood, occurs in 1% of women. Increased production of the hormone outside of pregnancy and lactation can have serious consequences, including cessation of menstruation and infertility. An increase in prolactin in men is extremely rare.
To determine the level of prolactin, you need to donate blood from a vein.

The role of prolactin in the body

Prolactin produced by the anterior lobe of the pituitary gland. Its synthesis is regulated by another hormone - dopamine, which is secreted by the nuclei of the hypothalamus. Entering the pituitary gland through the bloodstream, it blocks the release of prolactin. Progesterone, produced by the corpus luteum of the ovaries in the second half of the menstrual cycle, also reduces the secretion of prolactin.

Daily rhythm of secretion

The highest level of the hormone is observed in the deep sleep phase and immediately after waking up, then its concentration decreases. In this regard, it is recommended to take the test approximately 3 hours after waking up.

How does prolactin work?

Breast cells have receptors that bind to prolactin molecules. The result of this interaction is active cell division, due to which the growth of lobules and ducts of the mammary glands occurs, as well as milk production. The same receptors are found in the cells of other organs, but the effect of prolactin on them has not been fully established.

Forms of prolactin

There are several forms of prolactin in the human body.

Monomeric– the most active, it causes corresponding changes in the body.
Dimeric form of prolactin does not bind to cell receptors.
Polymer the form does not pass through the capillary wall due to the large size of the molecule and has no effect on the body. In the presence of a polymeric and dimeric form, a prolactin test shows an excess of the norm, but symptoms of hyperprolactinemia do not occur and treatment is not required.

Functions of prolactin in the body
Women	Men
Development of the mammary glands during puberty. Growth of the mammary glands due to enlargement of the lobules and ducts. Production of colostrum and milk Regulation of estrogen production. Regulation of the phase of the corpus luteum and the menstrual cycle. Preventing pregnancy during lactation. Formation of attachment to a child. Normalization of metabolism. Strengthening bone tissue, enriching it with calcium.	Regulation of water-salt balance. Normalization of metabolism. Maintaining normal testosterone levels. Normal sperm maturation, increased motility. Growth of seminal vesicles and prostate. Increased muscle mass. Strengthens bones, improves calcium absorption.

Prolactin release during pregnancy and after childbirth

During pregnancy, prolactin levels increase 20-fold, which is caused by high levels of estrogen and progesterone. High doses of prolactin provoke breast enlargement and darkening of the areola in pregnant women. In this case, estrogen and progesterone block the production of breast milk, despite high progesterone levels. Immediately after birth, the concentration of estrogen and progesterone drops and colostrum and then milk begin to be released.

Prolactin stabilizes 4-6 weeks after birth. But its level remains consistently high for several more months due to stimulation of the nipples during feeding, which allows maintaining lactation. This mechanism explains the fact that frequent breastfeeding increases milk supply.
A high level of prolactin in a nursing mother protects her from re-pregnancy. It suppresses the formation of gonadotropic hormones of the pituitary gland and prevents ovulation and the development of the corpus luteum, which is manifested by the absence of menstruation in the first months of breastfeeding. Occasionally, pregnancy can still occur under such conditions.

Why is a prolactin test prescribed? (main indications for this analysis)

Indications for prolactin testing
Women	Men
Breast pathologies. Galactorrhea is the secretion of milk not associated with breastfeeding. Amenorrhea is the absence of menstruation. Signs of hyperandrogenism (excess male sex hormones) – acne, excess body hair. Infertility. Miscarriage - miscarriages, premature births. Hypothyroidism is a disease associated with low levels of thyroid hormones. Suspicion of a pituitary tumor Neoplasms in the ovaries - cysts, tumors.	Gynecomastia is enlargement of the mammary glands. Infertility. Lack of sperm in the ejaculate. Suspicion of a pituitary tumor.

Signs of elevated prolactin levels at different ages

The main signs of increased prolactin in women– this is discharge from the nipples and delayed menstruation. The symptoms of elevated prolactin are closely related to its ability to block the action of female sex hormones - estrogen and progesterone. In men, on the contrary, prolactin enhances the effect of estrogen, but blocks testosterone.

Girls	Boys
Late periods or their absence is primary amenorrhea. Menstrual irregularities. Underdevelopment of the external genitalia and mammary glands. Discharge of fluid from the nipples.	Delayed puberty. Enlargement of the mammary glands. Characteristic body proportions: long arms and legs, high waist, hips wider than shoulders, fat deposits in the nipples, lower abdomen and lower back. Weak muscles. High voice. Testicles (testicles) are reduced. There is no sexual desire and interest in sex.

Long-term exposure to high doses of prolactin in adults causes disturbances in the functioning of various organs and systems.

Signs of increased prolactin
Women	Men
Discharge from the mammary glands. The fluid released may be clear or resemble breast milk. The amount varies from a few drops when pressed to several milliliters and spontaneous discharge. Enlargement of the mammary glands due to the growth of the epithelium of the lobules and ducts. Mastopathy - compactions in the mammary glands, the formation of cysts and adenomas. Menstrual dysfunction: irregular menstruation, heavy and painful bleeding. Amenorrhea is the cessation of menstruation for 6 months or more. Infertility. High levels of prolactin block ovarian hormones, disrupting egg maturation and ovulation. This makes pregnancy impossible. Miscarriage. Frigidity is a lack of desire to have sex. Polycystic ovary syndrome. High prolactin disrupts the ovulation process, as a result, numerous cysts form in place of mature follicles. Increased body weight associated with water retention and increased fat deposits. Acne on the face and upper body. Frequent bone fractures and multiple caries due to leaching of calcium salts. Impaired peripheral vision, double vision due to compression of the optic nerves by the pituitary adenoma. Emotional stability and sleep disturbances.	Decreased sexual desire and impaired potency, which is caused by a decrease in testosterone. Gynecomastia is the growth of the mammary glands. Obesity. Frequent fractures and multiple caries. Visual impairment due to large pituitary adenomas compressing the optic nerves. Decreased vitality, chronic fatigue.

Signs of low prolactin levels

A decrease in prolactin is a rather rare phenomenon. It may be associated with damage to the anterior lobe of the pituitary gland of various natures or with increased sensitivity of the body to dopamine, which interferes with the production of prolactin.

Symptoms of low prolactin levels
Women	Men
Infertility. Menstrual irregularities. Miscarriages in early pregnancy. Lack of milk during the lactation period. Migraine attacks. Depressed state, obsessive fears. Hypertensive crises. Increased hair growth on the face and back.	Deterioration in sperm quality, decreased sperm motility. Decreased potency. Prostatitis. Emotional instability, anxiety.

How to prepare for a prolactin test

To obtain the most accurate test results, you must stop taking medications that affect prolactin synthesis at least 3 days in advance. Their list is presented in the following sections of the article. If it is not possible to discontinue the medications, then it is necessary to inform the laboratory staff about the medications being taken and their dosage.

The day before the study, if possible, refrain from:

• injuries;
• smoking;
• alcohol;
• psychotropic substances;
• abundance of protein and carbohydrate foods;
• sexual intercourse;
• irritation of the nipples and areolas - sexual stimulation, tight underwear;
• thermal procedures - baths, hot baths;
• lack of sleep;
• physical activity.

If these factors cannot be avoided, it is recommended to postpone the test for 3 days.
On the morning of the test, you must avoid food, tea and coffee.
Blood testing for prolactin must be done in the morning: from 9 to 11.

On what day of the menstrual cycle is blood taken for analysis?

The level of prolactin in the blood does not depend on the day of the menstrual cycle. Therefore, you can take a prolactin test any day.

However, some endocrinologists indicate that the best period for taking a prolactin test is days 5-8 of the menstrual cycle.

Normal prolactin values

Categories	Normal values ​​ng/ml
Women
Non-pregnant over 17 years of age	4,79-23,3
Pregnancy 1st trimester	23,5-94,0
Pregnancy II trimester	94,0-282,0
Pregnancy III trimester	188,0-470,0.
Men
Over 17 years old	4,04-15,2

It must be taken into account that the level of prolactin is not stable and significant physiological fluctuations are possible in a healthy person. If the prolactin level is increased by 1.5-2 times, but there are no symptoms, then it is recommended to retake the test after 10-14 days.

In what pathologies are prolactin levels elevated?

Situations in which prolactin may increase in healthy people (physiological hyperprolactinemia):

• pregnancy;
• breastfeeding period;
• infants from birth to 3 months;
• chest injury;
• abortion;
• previous surgical operations on the chest;
• sexual contact, intense nipple stimulation;
• stress;
• hypoglycemia – low blood sugar;
• high protein diet;
• overheating, visiting a sauna, bathhouse;
• heavy physical training;
• injuries;
• pain;
• hypovitaminosis of vitamin B6 (pyridoxine);
• taking medications:

• hormonal drugs containing estrogen and contraceptives;
• dopamine blockers - sulpiride, domperidone;
• neuroleptics – haloperidol, sulpiride, perphenazine;
• antiemetics – cerucal, chlorpromazine, aeron;
• tricyclic antidepressants – haloperidol, imipramine, amitriptyline;
• antihypertensive drugs – reserpine, verapamil;
• cocaine, opiates, promedol.

In what pathologies are prolactin levels reduced?

• Pituitary apoplexy(Sheehan syndrome) is an acute circulatory disorder leading to necrosis in the pituitary adenoma.
• Massive blood loss over 500 ml, for example, bleeding after childbirth.
• Brain tumors leading to compression of the pituitary gland.
• Pituitary tuberculosis– a rare form of tuberculosis.
• Radiation therapy, which caused the destruction of pituitary cells;
• Traumatic brain injuries accompanied by swelling or damage to the pituitary gland.

Situations in which prolactin decreases in healthy people:

• post-term pregnancy beyond 41 weeks;
• smoking and alcoholism;
• starvation;
• age over 50 years;
• long-term use of medications:

• antiepileptics - valproic acid, phenytoin, carbamazepine;
• dopaminergic drugs - levodopa, bromocriptine, dopamine;
• hormonal drugs - terguride, dexamethasone, nafarelin, danazol, cyproterone, epostane, calcitonin, tamoxifen, mifepristone;
• anti-tuberculosis - rifampicin;
• antihypertensive – nifedipine;
• opioids - morphine.

How to reduce prolactin levels in a woman?

Before starting treatment for elevated prolactin, it is necessary to establish the cause of hyperprolactinemia. Medical examination consists of several stages.

1. Computed tomography CT, magnetic resonance imaging MRI or x-ray of the skull in 2 projections to exclude a pituitary tumor.
2. Study of thyroid function to exclude hypothyroidism - ultrasound.
3. Pregnancy test for women of reproductive age. If there is a possibility that the woman does not know that she is pregnant.
4. Biochemical blood test to determine the condition of the liver and kidneys.
5. Hormone tests to exclude diseases of the endocrine system accompanied by an increase in prolactin:

• TSH is thyroid stimulating hormone of the thyroid gland.
• IGF-1 is insulin-like growth factor 1, which regulates somatotropin secretion.
• FSH is follicle-stimulating hormone of the anterior pituitary gland.
• Determination of the level of macroprolactin (inactive forms) using the polyethylene glycol precipitation method.

Treatment of hyperprolactinemia depends on the reasons that caused the increase in prolactin

1. Treatment of diseases of the endocrine system leads to normalization of hormonal status and a decrease in prolactin. Sometimes medications have to be taken for life. Depending on the detected pathology, the following is prescribed:

• analogues of the thyroid hormone thyroxine (euthyrox, L-thyroxine);
• adrenal hormones (hydrocortisone, prednisolone, fludrocortisone);
• Estrogen antagonists (tamoxifen) increase the sensitivity of estrogen receptors.

Indications: hypothyroidism, polycystic ovary syndrome and adrenal insufficiency.
Contraindications: individual intolerance to the components of the drug, myocardial infarction, myocarditis.
Efficiency. With properly selected hormonal therapy, the effectiveness of treatment is high.

1. Suppression of prolactin synthesis. Dopamine D2 receptor agonists are used. Parlodel 2.5-3.5 mg per day, lisuride 0.05-0.075 mg, Dostinex 0.5 mg once a week. These drugs bind to dopamine receptors in the brain, causing the pituitary gland to release fewer prolactin molecules. The hormonal activity of the tumor and its size are reduced, lactation is suppressed and the menstrual cycle is normalized. The dosage and duration of administration are determined individually, based on test results.

Indications: prolactinomas, micro- and macroadenomas of the pituitary gland.
Contraindications: hypersensitivity to the components of the drug, hypertension, myocardial infarction, myocarditis, benign tumors of the mammary glands.
Efficiency high. In most patients, it avoids surgery to remove a pituitary tumor.

1. Radiation therapy. Destruction of a pituitary tumor by ionizing radiation. It is combined with drug therapy or performed after surgical treatment.

Indications: large pituitary tumors that are not amenable to drug therapy.
Contraindications lymphopenia, leukopenia, thrombocytopenia, anemia, diseases of the nervous system, diseases accompanied by fever, purulent or inflammatory processes in the area of ​​irradiation, diseases of the cardiovascular and respiratory systems, renal failure.
Efficiency

1. Surgery. Removal of a pituitary tumor is carried out through the nasal sinuses.

Indications: visual impairment, ineffectiveness of drug treatment.
Contraindications. Pregnancy, childhood and old age, inflammatory diseases (sinusitis, sinusitis, tonsillitis), acute diseases and exacerbation of chronic diseases.
Efficiency high for microadenoma, tumors less than 10 mm. With large adenomas, the probability of tumor reappearance is 20-40%.
Asymptomatic macroprolactinemia in women does not require specific treatment. If the amount of inactive forms of prolactin in the blood is increased, which do not bind to cell receptors, then there are no symptoms - a regular menstrual cycle, no discharge from the nipples. In this case, the analysis shows that prolactin levels are exceeded. With macroprolactinemia, there is no need to reduce prolactin levels.

How to reduce prolactin levels in a man?

An examination algorithm to determine the cause of increased prolactin in men.

1. X-ray of the skull in 2 projections, CT or MRI to detect a tumor in the pituitary gland.
2. Ultrasound of the thyroid gland for the diagnosis of hypothyroidism.
3. Biochemical blood test to detect signs of liver and kidney disease.
4. Hormone tests to identify diseases of the endocrine system:

• TSH – thyroid stimulating hormone of the thyroid gland
• IGF-1 is an insulin-like growth factor 1 that regulates the secretion of somatotropin.
• LH is the luteinizing hormone of the anterior pituitary gland.
• FSH – follicle stimulating

Treatment is prescribed based on the patient's examination results.
Indications: prolactinomas, pituitary adenomas, brain injuries and other pathologies that provoke an increase in prolactin.
Contraindications: individual intolerance to drugs, hypertension, myocardial infarction, myocarditis, benign tumors of the mammary glands.
Efficiency high. In most patients, it avoids surgery.

1. Hormone replacement therapy. For hypothyroidism, synthetic thyroid hormone (euthyrox, L-thyroxine) is prescribed. If adrenal function is impaired, analogues of their hormones (hydrocortisone, prednisolone, fludrocortisone) are taken. Restoring hormonal balance leads to normalization of prolactin.

Indications: hypothyroidism, conditions after thyroid surgery and adrenal insufficiency.
Contraindications: individual intolerance to the components of the drug, myocardial infarction, myocarditis.
Efficiency high with proper selection of the dose of the drug. Lifelong medication may be required.

1. Radiation therapy. Exposure of a pituitary tumor to ionizing radiation. Combined with drug therapy or after surgical removal of the tumor. Perhaps remote irradiation or the introduction of isotopes into tumor tissue.

Indications: pituitary tumors 1-3 cm, not amenable to drug therapy.
Contraindications the distance to the optic nerves is less than 5 mm, increased levels of lymphocytes, leukocytes, platelets, diseases of the nervous system, increased temperature, purulent or inflammatory foci in the area of ​​irradiation, diseases of the respiratory system, renal and heart failure.
Efficiency high, in combination with other treatment methods.

1. Surgery. Removal of a pituitary tumor through the sinuses using an endoscopic surgical instrument. Macroadenomas larger than 2 cm are removed by craniotomy.

Indications: visual impairment, ineffectiveness of drug treatment, hemorrhage into the tumor.
Contraindications. Senile age, foci of inflammation in the head area (sinusitis, sinusitis, tonsillitis), acute diseases and exacerbation of chronic diseases, uncompensated heart defects and renal failure.
Efficiency high for microadenoma, tumors less than 10 mm. For large adenomas over 2 cm, the probability of tumor reappearance is 15%.

Irregular menstruation, decreased libido, frequent problems with hair and skin, infertility - this is how increased prolactin levels manifest themselves in women.

What kind of hormone is this?

It is produced by the anterior lobe of the pituitary gland. Prolactin stimulates the development and growth of mammary glands in growing girls and controls milk production during lactation in women. During pregnancy, sleep, stress and in the presence of certain diseases (liver or lungs), increased secretion of prolactin is observed. The hormone is involved in the regulation of water-salt metabolism, prolongs the corpus luteum phase and during lactation actively suppresses hormones that stimulate ovulation. 30 ng/ml or 600 mU/l is the normal level of prolactin in the blood. In certain cases, it may increase, thereby causing hyperprolactinemia.

If women

The symptoms of this disorder in the body are obvious:

• Infertility.
• Hirsutism - hair begins to grow in the area around the nipple, on the white line of the abdomen and face.
• Obvious menstrual irregularities.
• Significant decrease in libido.
• Galactorrhea is the release of milk with gentle pressure.
• Acne.
• Visual impairment. A pituitary tumor is the reason why prolactin is elevated in women.
• Symptoms of secondary osteoporosis as a consequence of decreased bone density.
• Obesity as a result of increased appetite.

Causes

Consequences

Violation of the level of prolactin in the blood makes it impossible to conceive. Its increased content in the body suppresses the synthesis of luteinizing agents and those responsible for ovulation.

Diagnostics

If prolactin is elevated in women, the symptoms are similar to those listed above, then the doctor is obliged to conduct a thorough examination and find out family and life history. The doctor will ask the patient about past thyroid diseases, operations on the pituitary gland, chest and ovaries. In addition, he will clarify the presence of attacks of insomnia and depression, and pathological fractures. For an accurate diagnosis, carry out:

• ultrasound examination of the liver, thyroid gland, kidneys, mammary glands, ovaries;
• radiography and MRI of the skull to identify pathologies of the hypothalamus and pituitary gland, the same procedures for skeletal bones;
• blood chemistry;
• prolactin test.

Treatment

If there is no pituitary tumor, doctors use conservative treatment. The most commonly used drugs are Bromocriptine and Dostinex. Remember that if the symptoms are similar to those listed above, then only a qualified specialist can carry out diagnosis and treatment. Be healthy!

The hormone prolactin is a neurotransmitter, a biologically active chemical substance through which an electrical impulse is transmitted from a nerve cell. Together with the hormones cortisol and insulin, it is responsible for the growth of the mammary glands and milk production during breastfeeding, which is why it is often called the lactogenic hormone. Normal prolactin levels are directly related to the course of the menstrual cycle. An increase in prolactin levels can lead to hyperprolactinemia, characterized by cycle disruption and disappearance of ovulation.

How does prolactin work?

The hormone prolactin is produced in the pituitary gland (an endocrine gland located in the brain). Prolactin interferes with the production of the hormone GnRH, which controls and regulates the release of other hormones - follicle-stimulating and luteinizing hormones, which are responsible for egg maturation and ovulation. Accordingly, the concentration of prolactin immediately before menstruation is especially high, and after it ends, the level of prolactin decreases.
Throughout the entire period of breastfeeding, prolactin levels also remain at a fairly high level (this is due to regular breast stimulation during feeding), which significantly reduces the likelihood of getting pregnant at this time. However, it is important to remember that even while a woman is breastfeeding, she still has a small chance of getting pregnant!

Causes of elevated prolactin levels

• Mechanical damage and infections of the mammary glands. The production of prolactin is triggered in the pituitary gland when the breast is stimulated. This is how, for example, milk is produced during breastfeeding. If the breast is damaged or inflamed, the production of the hormone may be disrupted, and then the level of prolactin in the blood begins to increase.
• Disorders of the pituitary gland. Such disorders can be caused by taking medications, for example, psychotropic drugs or certain types of contraceptives, painkillers, blood pressure medications, etc.
• Tumors in the hypothalamus region. There are different types of tumors that contribute to increased production of prolactin. Due to their location, some of them block the production of dopamine in the pituitary gland, which is responsible for the release and production of prolactin. In addition, there are so-called prolactinomas, which independently produce prolactin and, therefore, increase its level in the body. These tumors are rare and are usually benign.
• Reduced thyroid function. With reduced thyroid function, so-called hypothyroidism, the hypothalamus produces more hormones, which automatically lead to a more intense release of prolactin.

Other reasons for increased prolactin production may be stress or severe pain. Prolactin levels also increase after sex and a heavy meal. In addition, hyperprolactinemia can occur against the background of polycystic ovary syndrome. If the cause of the increase in prolactin levels cannot be identified, they speak of idiopathic hyperprolactinemia.

What symptoms indicate elevated prolactin levels?

• Irregular cycle. A symptom that often forces women to be examined by a doctor is an unstable menstrual cycle and, as a result, infertility. Since cycle disruption can have many causes, a woman needs to undergo a thorough medical examination.
• Breast milk release. A symptom that clearly indicates an increased level of prolactin in the blood is the release of breast milk outside the period of breastfeeding. This symptom can also occur in nulliparous women!
• Androgenization. Increased production of prolactin contributes to the release of male hormones in the adrenal glands and difficulty producing female hormones due to lack of ovulation. As a result, a woman may experience increased hair growth on her face and chest.

In addition, elevated levels of prolactin can cause decreased libido, a feeling of tightness in the chest and pronounced premenstrual syndrome.

How is hyperprolactinemia treated?

Hyperprolactinemia is a serious hormonal disorder, but it is effectively treated with medication. Such treatment is especially important when planning pregnancy to ensure normal maturation of the egg.
To make a diagnosis, it is necessary to conduct a blood test to determine the level of hormones in it. Moreover, blood sampling should be carried out strictly in the morning. There are a number of reasons for this:

• Prolactin levels vary at different times of the day. It rises at night and drops to normal levels in the morning.
• Prolactin levels increase after eating, so the test must be done on an empty stomach.

It is also important to note that a breast examination should not be performed before blood sampling, since this procedure can also affect the test results. The anxiety that a woman experiences when taking a blood test is itself an additional factor that can affect the level of prolactin in the blood. Therefore, if the readings are slightly elevated, it is recommended to take the test again.
As soon as the cause of hyperprolactinemia is established, it is necessary to begin treatment. For functional reasons, medications that reduce the production of prolactin are usually used; they are also prescribed to some women at the end of breastfeeding. The dosage of the drugs is calculated step by step to reduce possible side effects. The effect of the treatment becomes noticeable after a few days.
If functional causes of hyperprolactinemia are excluded, the woman may be given a magnetic resonance imaging scan to determine a possible tumor, and an examination of the organs of vision may also be performed, since some tumors (depending on size) can put pressure on the optic nerve. However, this is quite a rare occurrence. As a rule, tumors can be effectively treated with drugs using drugs that stimulate the production of dopamine.