Prolactin is a hormone that influences the reproductive health of both men and women. It is produced by the pituitary gland at the brain's base. This hormone primarily stimulates milk production in women after childbirth. However, it also regulates the menstrual cycle in women and sperm production in men. Prolactin levels rise during the pregnancy and breastfeeding phase. If no such condition is there and the prolactin level is still elevated, it can result in irregular periods, infertility, etc. Also, this hormone plays a crucial role in developing the foetus's brain in the mother’s womb.
Causes of Elevated Prolactin Levels
Various causes trigger an elevation in the prolactin levels. Some of those causes are –
Physiological – Stress, pregnancy and lactation, chest wall stimulation (nerve impulses resulting from nipple injury or surgery), sleep (during REM phase).
Pathological – Polycystic ovary syndrome (PCOS), cirrhosis or liver disease, prolactinomas (benign tumours of the pituitary gland), hypothyroidism, pituitary disorders, and chronic renal failure.
Medications – Antipsychotic medications, antidepressants, antihypertensive agents, laxatives, anti-nausea medications, oestrogen and birth control pills.
Lifestyle – Intense physical activity, stress, poor sleeping habits, unbalanced diet, conditions like anorexia or abnormal weight loss.
Symptoms of High Prolactin
High prolactin levels cause a varying range of symptoms in both men and women.
Symptoms in Women - High Prolactin levels result in irregular or absent periods. They may also start producing breast milk (galactorrhoea) without pregnancy. Low sex drive and dryness in the vagina are few other symptoms. In old age, women may suffer from osteoporosis (thinning and weakening of bones).
Symptoms in Men - Men face low sex drive and erectile dysfunction, resulting in impotence due to high prolactin. They can also have enlarged breasts (gynecomastia). Their facial and body hair decreases along with their muscle mass and strength. High prolactin causes low testosterone. This makes them feel tired quickly and affects their mood.
Diagnosis of Hyperprolactinemia
Various processes are used to diagnose the level of prolactin, especially blood tests and imaging scans.
Blood Tests – Hyperprolactinemia is determined by taking a fasting and post-prandial blood sample and testing it. Normal prolactin levels vary according to gender. For women who are not pregnant, the normal prolactin level is 4-23 ng/mL. For men it is 2-18 ng/mL. However, for pregnant women, this level is high. The doctor might also examine the thyroid and other hormones, as their dysfunction can trigger prolactin levels.
Imaging Studies - A brain MRI is often done to check for a pituitary tumour (prolactinoma). This gives a better look for any unusual growths. A CT scan can be opted for if an MRI isn't available.
Differential Diagnosis – This is done mainly to rule out conditions that can contribute to raised prolactin levels. Some such conditions are pregnancy, chronic renal failure, liver cirrhosis, pituitary and endocrine disorders, medications like dopamine antagonists, antihypertensives, etc. Sometimes, prolactin levels elevate without any identifiable cause. It is called idiopathic hyperprolactinemia.
Consult Top Endocrinologist
Medications to Reduce Prolactin
The first choice to treat high prolactin levels is dopamine agonists. These lower prolactin by stimulating the dopamine receptors of the brain. Generally, Cabergoline and bromocriptine are used. Cabergoline is preferred since it has fewer side effects and has to be taken only once or twice a week. Bromocriptine involves a daily dosage and causes nausea or dizziness. These medications reduce the size of tumours in the case of prolactinomas and restore hormonal balance.
When medicines fail to work, the doctor switches to other pharmacological options like –
Aromatase inhibitors.
Oestrogen receptor modulators.
Gonadotropin-Releasing hormone agonists.
Metformin.
Somatostatin analogues.
Progestins.
Lifestyle and Natural Remedies
By making specific dietary and lifestyle changes and adopting natural remedies, prolactin levels can be controlled.
Some dietary changes that may help are –
Increasing protein intake.
Avoid excessive sugar, caffeine and refined carbohydrates.
Intake of healthy fats and magnesium-rich foods.
Consuming foods rich in vitamin B6.
Consuming herbal teas for relaxation.
Prolactin levels can be kept under control by managing the stress level with a balanced exercise routine. Some techniques to reduce stress are –
Deep breathing.
Meditation or mindfulness.
Yoga or Pilates.
Aerobic exercise.
Adequate sleep.
Several herbal supplements are there that can control excess prolactin secretion. However, it is wise to consult a healthcare provider before taking any herb as there may be side effects, especially if someone is taking medications for hyperprolactinemia. Some effective herbs are –
Vitex (Chaste Tree Berry)
Maca root
Fenugreek
Holy Basil (Tulsi)
Ashwagandha
Surgical Intervention
Healthcare professionals opt for surgery when medicines fail to control high prolactin levels. It happens mostly in case of a prolactinoma (pituitary tumour) getting out of control. Vision problems, severe headaches, or unmanageable hormone imbalances are a few symptoms that indicate exacerbation of this tumour. If it continues to grow despite treatment, surgery becomes the only option.
Various types of surgeries can treat prolactinoma. Some of those are –
Craniotomy (open surgery)
Transsphenoidal surgery
Endoscopic surgery (a transsphenoidal kind of surgery)
Radiotherapy
Monitoring and Follow-Up
Regular follow-ups and testing after surgery are crucial to ensure there are no further growths. If the prolactin level is too high, it means some tumour tissue may still be present, or the tumour itself may have relapsed. Even pituitary function may be affected. So, monitoring the patient’s condition post-surgery is essential.
If medication lowers the prolactin level abnormally or causes side effects, the dose may be changed. Still, different medicines or further surgery are needed if the levels keep rising. Hormonal tests help find out if the pituitary gland is working correctly. Thus, regular follow-ups help to maintain the balance in prolactin levels.
Potential Risks and Complications
Medications that are prescribed (especially dopamine agonists) to reduce elevated prolactin levels or after a tumour surgery have many side effects. So, the risk remains as they may cause other complications. Some medication side effects are –
Dizziness or light-headedness.
Mild to severe headaches.
Gastrointestinal issues like nausea, vomiting, bloating, etc.
Disturbed mood and mental health.
Cardiovascular risks.
Hormonal imbalance.
Fatigue and sleepiness.
However, if the prolactin level remains elevated for a long time, it may lead to several other complications like –
Unhealthy bones.
Irritability and mood swings.
Weight gain.
Vision problems.
Elevated blood pressure.
Inappropriate milk production.
Infertility-related complications.
Breast cancer.
Conclusion
Elevated prolactin can cause long-term impacts on fertility, health of bones, moods and overall quality of life and affect overall health. The factors that cause hyperprolactinemia can be physiological, medication-induced, or psychological. However, one of the common causes is prolactinoma (benign pituitary tumours). If not treated on time, then it may lead to menstrual problems, sexual dysfunction, infertility, etc. In some cases, there may be cardiovascular or vision-related issues as well. So, proper diagnosis and treatment are needed to detect and cure any abnormality before it gets worse. It is wise to consult a doctor if there are recurring symptoms. Only a medical intervention can cure such disorders. In case of an alarming tumour, surgery is the only option. However, early detection will help heal the disease by removing the tumour and preventing recurrence.
Consult Top Endocrinologist
Consult Top Endocrinologist
Dr. Nithin Reddy Modhugu
Endocrinologist
6 Years • MBBS, MD (General Medicine), DNB (Endocrinology)
Hyderabad
Dr. Nithin's Endocrine Clinic, Hyderabad
(75+ Patients)
Dr. Gayatri S
Endocrinologist
4 Years • Suggested Qualifictaion- MBBS, MD (Internal Medicine), DM (ENDOCRINOLOGY)
Nellore
Narayana hospital, Nellore
Dr. Shiva Madan
Endocrinologist
10 Years • MBBS , MD (General medicine) , DM (Endocrinology)
Bikaner
Sushma diabetes and Endocrine center, Bikaner
Dr. Venkata Rakesh Chintala
Endocrinologist
8 Years • MBBS,MD( GEN MEDICINE), DM ( ENDOCRINOLOGY)
Krishna district
Sanjeevani Hospital, Krishna district
Dr. M.a. Mujeeb Afzal
Endocrinologist
13 Years • MBBS , MD (General medicine) , DM (Endocrinology)
Hyderabad
Premier Hospital, Hyderabad
Consult Top Endocrinologist
Dr. Nithin Reddy Modhugu
Endocrinologist
6 Years • MBBS, MD (General Medicine), DNB (Endocrinology)
Hyderabad
Dr. Nithin's Endocrine Clinic, Hyderabad
(75+ Patients)
Dr. Gayatri S
Endocrinologist
4 Years • Suggested Qualifictaion- MBBS, MD (Internal Medicine), DM (ENDOCRINOLOGY)
Nellore
Narayana hospital, Nellore
Dr. Shiva Madan
Endocrinologist
10 Years • MBBS , MD (General medicine) , DM (Endocrinology)
Bikaner
Sushma diabetes and Endocrine center, Bikaner
Dr. Venkata Rakesh Chintala
Endocrinologist
8 Years • MBBS,MD( GEN MEDICINE), DM ( ENDOCRINOLOGY)
Krishna district
Sanjeevani Hospital, Krishna district
Dr. M.a. Mujeeb Afzal
Endocrinologist
13 Years • MBBS , MD (General medicine) , DM (Endocrinology)
Hyderabad
Premier Hospital, Hyderabad
