Hyperprolactinemia

Hyperprolactinemia is a high blood level of the hormone prolactin. Excess prolactin blunts the pulsed release of the brain hormone GnRH. The result is lower LH and FSH and disrupted ovulation.

Disrupted ovulation leads to anovulatory cycles, cycles in which no egg is released. The luteal phases become short or absent, and fertility is impaired. Galactorrhea, a milky discharge from the nipples, may accompany high prolactin, but not always.¹

One common cause is a prolactinoma, a benign, usually small growth on the pituitary gland that makes prolactin. Other causes include hypothyroidism and some drugs. Examples are antipsychotics, metoclopramide, and some blood pressure drugs. Prolactin also rises normally during pregnancy and breastfeeding.

Identifying the cause matters. When hypothyroidism drives the high prolactin, it resolves with thyroid treatment. When a drug causes it, it resolves once that drug is stopped.

Physicians treat a prolactinoma with a class of drugs, the dopamine agonists. A physician should oversee that care.¹ RRM clinicians may check prolactin as part of an infertility workup.

High prolactin is a serious finding. It is a known cause of luteal phase deficiency and infertility. It also responds to targeted treatment. The RRM approach finds the underlying cause and treats it directly, rather than going around the disrupted hormone system.¹