High Prolactin and Infertility

Before we dive into this topic; High Prolactin and Infertility as it pertains to women health, let us undertand what Prolactin and infertility mean

What is Prolactin?

Prolactin is one of many hormones that is produced by the pituitary gland. Prolactin has many different roles throughout the body. The most important role of prolactin is perharps to stimulate milk production in women after the delivery of a baby.

Prolactin levels increase during pregnancy causing the mammary glands in a woman’s breast to enlarge in preparation for breastfeeding. Prolactin equally helps with the release of milk when the baby is nursing.

What is Infertility?

Infertility is defined as the inability to get pregnant (with frequent intercourse) after a period of at least a year of trying.

There are many causes of infertility in women, inability to ovulate, infection, blocked fallopian tubes, ovarian cyst, and in few cases fibroid.

High Prolactin and Infertility

High prolactin (hyperprolactinemia) levels may cause infertility. Women who are neither pregnant nor breastfeeding should have low levels of prolactin.

During the first several months that a woman is breastfeeding, the high prolactin levels also serve to inhibit ovulation. This is the reason why women who are breastfeeding do not get their periods and therefore do not often become pregnant.

However, as time goes on the prolactin levels do not stay as high with breastfeeding and the woman may start to ovulate

If a non-pregnant woman has abnormally high levels of prolactin, it may cause her difficulty in becoming pregnant.

The different Ways High Prolactin can cause infertility

  • high prolactin may stop a woman from ovulating
  • prolactin levels may only disrupt ovulation once in a while in less severe cases
  • mildest cases involving high prolactin levels may ovulate regularly but not produce enough of the hormone progesterone after ovulation. 
  • Note: Deficiency in the amount of progesterone after ovulation may result in a uterine lining that is less able to have an embryo implant. Some women with this problem may see their period come a short time after ovulation.

What are the Symptoms that you have High Prolactin

Some women with high prolactin levels may have no periods or have irregular periods.

Another possible symptom of high prolactin levels is breast discharge. The discharge is the result of prolactin trying to stimulate the breast to produce milk.

The occurrence of a milky discharge from the breast in a woman who has not recently been pregnant is called galactorrhea. Galactorrhea may occur spontaneously in some women. Others may see it only if they squeeze their nipples.

Treatment for high prolactin levels

If prolactin levels are persistently high, they can be effectively treated with a group of medications known as dopamine agonists.

Bromocriptine (Parlodel)

Parlodel is an effective and inexpensive medication for high prolactin levels.  Parlodel is usually taken at bedtime with a snack.

This is because Parlodel will occasionally cause dizziness or stomach upset. so taking it before sleep and with food will reduce those side effects. generally with time, the side effects stop anyway.

The prolactin levels can be rechecked in about three weeks. If the levels are still elevated the dose can be increased or a different medication can be tried.

The Parlodel can be stopped upon diagnosis of pregnancy. However, if a woman has a macroadenoma, Parlodel should be continue through pregnancy and delivery.

Due to the side effects, some women cannot tolerate Parlodel. For these women, they may try inserted the pills vaginally instead of taking them orally.

Cabergoline (Dostinex)

Because it is more expensive, cabergoline is not usually the first choice for treatment of high prolactin levels. It is usually used when Parlodel is ineffective or a woman cannot tolerate the side effects.

Cabergoline is a longer acting medication. It is usually given twice a week instead of every day.

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