Prolactin Hormone and Its Elevation in Women
The hormone prolactin, commonly referred to as the “milk hormone,” is produced by the pituitary gland in women during pregnancy and lactation. Typically, low levels of this hormone are found in men and in women who are not pregnant or nursing. Researchers have determined that the normal prolactin levels for women outside of pregnancy and breastfeeding should be below 25 ng/mL. For men, the acceptable level is below 17 ng/mL. Prolactin levels can be easily assessed through a simple blood test, which is often requested by healthcare professionals in specific circumstances such as abnormal milk secretion, pituitary gland disorders, irregular menstrual cycles, infertility, and other health issues. Notably, abnormalities often manifest as elevated levels of this hormone beyond the normal limit, whereas low levels are less common. If prolactin levels fall below the standard range, it is typically linked to certain medications or conditions like hypopituitarism. Polarized results where prolactin levels range between 30-200 ng/mL indicate a condition known as hyperprolactinemia.
Symptoms of Elevated Prolactin in Women
The symptoms of elevated prolactin levels in women, outside of the contexts of pregnancy and breastfeeding, can vary significantly from one individual to another. Some of the most common symptoms include:
- Irregular or absent menstrual cycles.
- Infertility or difficulties in conceiving.
- Milk discharge from the breast outside of pregnancy or lactation.
- Pain or tenderness upon breast palpation.
- Symptoms associated with menopause, such as hot flashes and vaginal dryness.
- Discomfort during intercourse due to vaginal dryness.
- Reduced sexual desire.
Causes of Elevated Prolactin in Women
Multiple factors can contribute to elevated prolactin levels in women outside of pregnancy and nursing. Some of the primary causes include:
- Prolactinoma, which is a benign tumor of the pituitary gland that leads to excess prolactin secretion and reduces other sexual hormone levels.
- Disorders affecting the hypothalamus, such as tumors, infections, or injuries, since this region links the nervous system with the pituitary gland.
- Hypothyroidism, characterized by low levels of thyroid hormones compared to normal ranges.
- Chronic kidney failure.
- Liver cirrhosis.
- Use of certain medications, including:
- Estrogen.
- Some antidepressants like clomipramine.
- Atypical antipsychotics, such as haloperidol and olanzapine.
- Medications for high blood pressure, such as verapamil.
- Anti-nausea drugs, like metoclopramide.
- H2 receptor antagonists, including ranitidine.
Treatment for Elevated Prolactin in Women
Treatment for high levels of prolactin in women depends on the underlying cause. It is essential to note that many cases may not require intervention, particularly if no symptoms are present or if they are minimal. For those requiring treatment, the options include:
- Medication: Treatment typically involves prescription medications, with the most commonly prescribed options being cabergoline and bromocriptine. These medications work by inhibiting prolactin production, especially in cases of prolactinoma. They may also be utilized for unexplained high prolactin levels. In situations where elevated prolactin is drug-induced, the physician may opt to prescribe an alternative medication.
- Surgery: Surgical intervention is considered when a prolactin-secreting tumor is present, particularly if medication fails to manage the condition or if the tumor is large enough to impact vision. Surgical options focus on tumor removal.
- Radiation Therapy: This option is rarely employed for elevated prolactin levels and is generally reserved for cases where both medication and surgical treatments have failed to manage the underlying tumor. The objective of radiation therapy is to reduce tumor size.