Hyperprolactinemia and fertility

Female infertility is an issue that concerns many women worldwide. Unfortunately, it is a condition that is caused by many factors, including anatomy, hormones and even the lifestyle of women. Hyperprolactinemia seems to have a great impact onwomen’s fertility and it is one of the main causes ofinfertility.

What is defined as hyperprolactinemia?

Hyperprolactinemia is defined as the condition where the hormone prolactin is produced in large quantities (PRL, which is secreted by the pituitary gland of the brain). Prolactin is the main hormone which is normally secreted at high levels during breastfeeding in women.

What are the causes of hyperprolactinemia?

Prolactin levels in non-pregnant or non-lactating women should be low. In the majority of cases, the cause of prolactin overproduction (idiopathic) cannot be precisely identified. However, there are some factors that have been implicated as affecting its production. Thus, hyperprolactinemia can be due to factors, such as:

• Prolactinomas: prolactinomas are benign tumors of the pituitary gland that produce high levels of prolactin. They appear more often in women of reproductive age and are the most common cause of hyperprolactinemia. Their diagnosis is made with an MRI of the pituitary gland.
• Polycystic ovary syndrome
• Hypothyroidism
• Medication: administration of certain medications can cause hyperprolactinemia. Medications responsible for increased prolactin production are antidepressants, antipsychotics and blood pressure medications.
• Chronic stressful situations: stress has been blamed for the temporary increase in prolactin.

How does hyperprolactinemia affect fertility?

Considering the role of prolactin, it is clear that any problem with its production affects fertility. Hyperprolactinemia largely controls the menstrual cycle, since high prolactin levels reduce estrogen. The decrease in estrogen causes problems with ovulation, which results in disturbances in the cycle up to the complete absence of period.

Additionally, hyperprolactinemia also affects other hormones that are important for achieving pregnancy. More specifically, the increased amounts of prolactin inhibit the production of gonadotropins (GnRH). The reduced production of gonadotropins inhibits the production of follicle-stimulating hormone (FSH), which affects the quality and number of eggs produced.

Finally, hyperprolactinemia can also affect the function of the corpus luteum. The corpus luteum is a temporary organ formed in the middle of the cycle, which produces specific hormones. The main hormone it produces is progesterone, and hyperprolactinemia contributes to its reduced production, which has an impact on fertility.

What are the symptoms of hyperprolactinemia?

Hyperprolactinemia occurs mainly with the following symptoms:

• Lactorrhea (milk discharge from the breast)
• Vaginal dryness
• Oligomenorrhea, amenorrhea, anovulation
• Decreased sexual desire
• Acne
• Hair loss/hair growth
• Menstrual disorders
• Decrease in bone density

Hyperprolactinemia & Diagnosis

High prolactin levels can only be detected by blood tests. The examination should be carried out a few hours after waking up in the morning. In addition, it would be good to perform it at the beginning of the cycle, i.e. before ovulation, to avoid any laboratory errors.

How is it treated?

The treatment of hyperprolactinemia mainly depends on the cause responsible for it. More specifically, if hyperprolactinemia has been caused by the existence of a prolactinoma, then, it is necessary to administer medication that reduces prolactin production. In some cases, the prolactinoma may need surgical removal.

If the increased production of prolactin is due to other underlying diseases (e.g. hypothyroidism), then the medication should be adjusted.

More and more women “fight” against infertility and the “ally” they choose to have by their side plays an important role. The Obstetrician-Gynecologist Melina Stasinou has extensive experience in assisted reproduction methods. Her goal is to help women experience motherhood, applying the most modern methods. Contact the physician for any question you may have about assisted reproduction.