A high prolactin (PRL) is a common finding in a fertility practice.
Prolactin is also called luteotropic hormone. If you google this topic, you will find that high PRL is associated with galactorrhea (discharge from the nipples) and vision changes.
But most subfertile women with high PRL won’t have these findings. Some women with high PRL will have irregular cycles, but again, not all.
What causes high PRL levels?
Under normal circumstances, PRL is produced when you are pregnant or breastfeeding. Certain antidepressants can raise your PRL levels, as can stress or exercise.
A high PRL can be associated with an adenoma – a normally non-cancerous tumour in your pituitary gland. An adenoma can overstimulate your brain into producing higher than normal levels of prolactin and can decrease your estrogen levels. Surgery may be an option but most likely medications will return your prolactin level to normal.
When your PRL level is >100 on two occasions, we order an MRI so we can look at your pituitary gland. I have ordered MRIs when PRL levels are <100, but this is on a case-by-case basis. Usually the repeated blood test is all that is necessary.
We need to contemplate treatment when PRL is >20 twice in a row, and other explanations have been ruled out.
What treatments are available?
Elevated PRL may compromise implantation. Subfertility is such a complicated business, we hate to see anything outside of the normal range that could potentially cause a problem. So we tend to treat everybody.
2.5mg/d of bromocryptine is the standard treatment.
Many women experience heartburn, indigestion/dyspepsia, bloating and constipation while taking bromocryptine. If you are experiencing GI distress than does not subside after more than 3 weeks, ask your doctor about taking the medication vaginally instead of orally. You can also ask about cabergoline. It has fewer side effects, but it’s a newer medication and we can’t promise the same safety level.
If there is an adenoma in your brain, and the medications are ineffective or cannot be taken, surgery is an option. But in all likelihood, the medications will be sufficient.
What happens once you are pregnant?
Once pregnant, most –but not all– women are asked to stop their bromocryptine. It can be difficult for clinics to remember who is taking bromo and who isn’t. Once you are pregnant, please remember to ask your doctor to reassess your need for the medication.