Irregular menstruation, lactation without pregnancy, beware of hyperprolactinemia!

With the increasing study and life pressures of many women of childbearing age and serious disruptions in their daily routines, many women are experiencing symptoms such as menstrual disorders, non-lactation galactorrhea, headaches, dizziness, and changes in sexual function. When the above symptoms occur, be alert to the presence of hyperprolactinemia.

1. What is hyperprolactinemia

Prolactin, also known as pituitary prolactin (PRL), is a hormone secreted by the pituitary gland. As the name suggests, the main function of prolactin is to promote breast development and milk production in women. Women secrete more prolactin in the late pregnancy and lactation period to promote breast development and lactation.

Hyperprolactinemia refers to various reasons that lead to abnormal increase in serum prolactin, which stimulates milk production and secretion, while inhibiting the secretion of pituitary gonadotropin, causing anovulation and amenorrhea. Therefore, hyperprolactinemia is often also called amenorrhea and lactation syndrome.

Why does hyperprolactinemia occur?

There are many factors that cause increased serum prolactin levels, which can be mainly divided into physiological, drug-related, pathological, idiopathic and other causes.

Physiological factors

For example, during pregnancy and lactation, there is an immediate and temporary increase in prolactin secretion when experiencing emotional stress, cold, anesthesia, surgery, hypoglycemia, sexual intercourse, and exercise.

Drug-related factors

Many drugs can increase prolactin, such as the antihypertensive drug reserpine, chlorpromazine, birth control pills and certain psychiatric drugs.

Pathological factors

Pituitary adenoma or microadenoma, hypothyroidism, cirrhosis, renal insufficiency, etc. may cause elevated prolactin.

Idiopathic factors

In fact, there is no cause, and it may also be a very early pituitary microadenoma.

3. What are the symptoms of hyperprolactinemia?

Menstrual disorders and infertility

More than 85% of patients have menstrual disorders. The symptoms vary among women of different ages. Patients in the reproductive period may not ovulate or have a shortened luteal phase, which manifests as scanty, infrequent, or even amenorrhea. Women before or in early puberty may experience primary amenorrhea, and after the reproductive period, it is mostly secondary amenorrhea. Anovulation can lead to infertility.

Non-lactation galactorrhea

Galactorrhea is one of the characteristics of this disease. About 2/3 of patients with amenorrhea and lactation syndrome have hyperprolactinemia, and 1/3 of them have pituitary microadenomas. Galactorrhea is usually manifested as non-bloody milky or transparent fluid flowing out of both breasts or being squeezed out.

Headache, dizziness and visual disturbances

When the pituitary adenoma grows significantly, symptoms such as headache, dizziness, vomiting, visual field loss and oculomotor nerve paralysis may occur due to cerebrospinal fluid reflux obstruction and compression of the surrounding brain tissue and optic nerve.

Female functional changes

Due to the inhibition of pituitary luteinizing hormone (LH) and follicle stimulating hormone (FSH) secretion, a low estrogen state occurs, which manifests as thinning or atrophy of the vaginal wall, decreased secretions, and decreased passion.

Treatment of hyperprolactinemia

The diagnosis of hyperprolactinemia requires a blood test to check the prolactin level. The serum prolactin level in non-pregnant women ranges from 4.79 to 23.3 ng/ml. When serum prolactin is elevated, further examinations such as pituitary magnetic resonance imaging should be performed to determine whether there is a pituitary microadenoma or adenoma.

For patients with hyperprolactinemia, the cause should be identified and symptomatic treatment should be given. For example, if it is caused by primary hypothyroidism, thyroxine should be supplemented, if pituitary macroadenoma should be operated on, and if it is caused by drugs, the dosage should be reduced or discontinued.

Treatment methods generally include medication, surgery, radiotherapy, acupuncture, etc.

Drug treatment

Bromocriptine is currently the first choice for the treatment of hyperprolactinemia. In addition, traditional Chinese medicine can improve irregular menstruation, amenorrhea, galactorrhea and other phenomena caused by high prolactin through Chinese medicine conditioning. During treatment, blood prolactin concentration should be checked regularly to guide dosage adjustments.

Surgery

It is mainly aimed at patients with rapidly growing pituitary macroadenomas, poor drug control, and obvious compression symptoms.

Radiation therapy

It is suitable for patients with invasive macroadenomas and residual tumors after surgery. Radiotherapy can effectively reduce the tumor burden and improve patient symptoms.

Acupuncture treatment

Acupuncture, as an auxiliary treatment method, helps regulate blood and qi and relieve symptoms such as amenorrhea and breast swelling.

When using bromocriptine to treat hyperprolactinemia, 90% of patients are expected to have normal menstruation and ovulation. The medication should not be stopped at will during the treatment period. After stopping the medication, prolactin may rise again and rebound. Therefore, it is necessary to find a minimum effective dose to maintain normal blood PRL levels for long-term use, generally for half a year to two years, and conduct regular follow-up.