Prolactin(luteotropin, mammotropin) is a pituitary hormone that is responsible for the growth of the mammary glands and ensures the production of breast milk in women. It is found in small quantities in the body of men.
A distinctive feature of prolactin is sharp fluctuations, which may be associated with sleep, medication, active sexual stimulation, or chest trauma. In healthy people, hormone levels return to normal within a few hours. Long-term increases in prolactin levels in the blood require adjustment, as they can cause health problems.
Hyperprolactinemia– high levels of prolactin in the blood, occurs in 1% of women. Increased production of the hormone outside of pregnancy and lactation may have serious consequences, up to the cessation of menstruation and infertility. An increase in prolactin in men is extremely rare.
To determine the level of prolactin, you need to donate blood from a vein.
The role of prolactin in the body
Prolactin produced by the anterior lobe of the pituitary gland. Its synthesis is regulated by another hormone - dopamine, which is secreted by the nuclei of the hypothalamus. Entering the pituitary gland through the bloodstream, it blocks the release of prolactin. Progesterone, produced by the corpus luteum of the ovaries in the second half of the menstrual cycle, also reduces the secretion of prolactin.Daily rhythm of secretion
The highest level of the hormone is observed in the phase deep sleep and immediately after rising, then its concentration decreases. In this regard, it is recommended to take the test approximately 3 hours after waking up.How does prolactin work?
Breast cells have receptors that bind to prolactin molecules. The result of this interaction is active cell division, due to which the growth of lobules and ducts of the mammary glands occurs, as well as milk production. The same receptors are found in the cells of other organs, but the effect of prolactin on them has not been fully established.Forms of prolactin
There are several forms of prolactin in the human body.Monomeric– the most active, it causes corresponding changes in the body.
Dimeric form of prolactin does not bind to cell receptors.
Polymer the form does not pass through the capillary wall due to the large size of the molecule and has no effect on the body. In the presence of a polymeric and dimeric form, a prolactin test shows an excess of the norm, but symptoms of hyperprolactinemia do not occur and treatment is not required.
| Functions of prolactin in the body | |
| Women | Men |
| Development of the mammary glands during puberty. Growth of the mammary glands due to enlargement of the lobules and ducts. Production of colostrum and milk Regulation of estrogen production. Regulation of the phase of the corpus luteum and menstrual cycle. Preventing pregnancy during lactation. Formation of attachment to a child. Normalization of metabolism. Strengthening bone tissue, enriching it with calcium. | Regulation of water-salt balance. Normalization of metabolism. Maintenance normal level testosterone. Normal sperm maturation, increased motility. Growth of seminal vesicles and prostate. Strengthens bones, improves calcium absorption. |
Prolactin release during pregnancy and after childbirth
During pregnancy, prolactin levels increase 20-fold, which is caused by high levels of estrogen and progesterone. High doses of prolactin provoke breast enlargement and darkening of the areola in pregnant women. In this case, estrogen and progesterone block the production of breast milk, despite high progesterone levels. Immediately after birth, the concentration of estrogen and progesterone drops and colostrum and then milk begin to be released. Prolactin stabilizes 4-6 weeks after birth. But its level remains consistently high for several more months due to stimulation of the nipples during feeding, which allows maintaining lactation. This mechanism explains the fact that frequent breastfeeding increases milk supply.
A high level of prolactin in a nursing mother protects her from re-pregnancy. It suppresses education gonadotropic hormones pituitary gland and prevents ovulation and development of the corpus luteum, which is manifested by the absence of menstruation in the first months breastfeeding. Occasionally, pregnancy can still occur under such conditions.
Why is a prolactin test prescribed? (main indications for this analysis)
| Indications for prolactin testing | |
| Women | Men |
| Breast pathologies. Galactorrhea is the secretion of milk not associated with breastfeeding. Amenorrhea is the absence of menstruation. Signs of hyperandrogenism (excess male sex hormones) – acne, excessive body hair. Infertility. Miscarriage - miscarriages, premature births. Hypothyroidism is a disease associated with low hormone levels thyroid gland. Suspicion of a pituitary tumor Neoplasms in the ovaries - cysts, tumors. | Gynecomastia is enlargement of the mammary glands. Infertility. Lack of sperm in the ejaculate. Suspicion of a pituitary tumor. |
Signs of elevated prolactin levels at different ages
The main signs of increased prolactin in women– this is discharge from the nipples and delayed menstruation. Symptoms elevated prolactin are closely related to its ability to block the action of female sex hormones - estrogen and progesterone. In men, on the contrary, prolactin enhances the effect of estrogen, but blocks testosterone.| Girls | Boys |
| Late periods or their absence is primary amenorrhea. Menstrual irregularities. Underdevelopment of the external genitalia and mammary glands. Discharge of fluid from the nipples. | Delayed puberty. Enlargement of the mammary glands. Characteristic body proportions: long arms and legs, high waist, hips wider than shoulders, fat deposits in the nipples, lower abdomen and lower back. Weak muscles. High voice. Testicles (testicles) are reduced. There is no sexual desire and interest in sex. |
Long-term exposure to high doses of prolactin in adults causes dysfunction various organs and systems.
| Signs of increased prolactin | |
| Women | Men |
| Discharge from the mammary glands. The fluid released may be clear or resemble breast milk. The amount varies from a few drops when pressed to several milliliters and spontaneous discharge. Enlargement of the mammary glands due to the growth of the epithelium of the lobules and ducts. Menstrual dysfunction: irregular menstruation, heavy and painful bleeding. Amenorrhea is the cessation of menstruation for 6 months or more. Infertility. High levels of prolactin block ovarian hormones, disrupting egg maturation and ovulation. This makes pregnancy impossible. Frigidity is a lack of desire to have sex. Increased body weight associated with water retention and increased fat deposits. Acne on the face and upper body. Violation peripheral vision, double vision when squeezed optic nerves pituitary adenoma. Emotional stability and sleep disturbances. | Decreased sexual desire and impaired potency, which is caused by a decrease in testosterone. Gynecomastia is the growth of the mammary glands. Frequent fractures and multiple caries. Visual impairment due to large pituitary adenomas compressing the optic nerves. Decreased vitality, chronic fatigue. |
Signs of low prolactin levels
A decrease in prolactin is a rather rare phenomenon. It may be associated with damage to the anterior lobe of the pituitary gland of various natures or with hypersensitivity the body to dopamine, which prevents the production of prolactin.| Symptoms reduced level prolactin | |
| Women | Men |
| Infertility. Menstrual irregularities. Miscarriages on early stages pregnancy. Lack of milk during the lactation period. Migraine attacks. Depressed state, obsessive fears. Hypertensive crises. Enhanced growth hair on the face and back. | Deterioration in sperm quality, decreased sperm motility. Decreased potency. Prostatitis. Emotional instability, anxiety. |
How to prepare for a prolactin test
To get the maximum accurate results analysis, it is necessary to stop taking medications that affect prolactin synthesis at least 3 days in advance. Their list is presented in the following sections of the article. If it is not possible to discontinue the medications, then it is necessary to inform the laboratory staff about the medications being taken and their dosage. The day before the study, if possible, refrain from:
- injuries;
- smoking;
- alcohol;
- psychotropic substances;
- abundance of protein and carbohydrate foods;
- sexual intercourse;
- irritation of the nipples and areolas - sexual stimulation, tight underwear;
- thermal procedures - baths, hot baths;
- lack of sleep;
- physical activity.
If these factors cannot be avoided, it is recommended to postpone the test for 3 days.
On the morning of the test, you must avoid food, tea and coffee.
Blood testing for prolactin must be done in the morning: from 9 to 11.
On what day of the menstrual cycle is blood taken for analysis?
The level of prolactin in the blood does not depend on the day of the menstrual cycle. Therefore, you can take a prolactin test any day.However, some endocrinologists indicate that best period to take a prolactin test - 5-8 days of the menstrual cycle.
Normal prolactin values
| Categories | Normal values ng/ml |
| Women | |
| Non-pregnant over 17 years of age | 4,79-23,3 |
| Pregnancy 1st trimester | 23,5-94,0 |
| Pregnancy II trimester | 94,0-282,0 |
| Pregnancy III trimester | 188,0-470,0. |
| Men | |
| Over 17 years old | 4,04-15,2 |
It must be taken into account that prolactin levels are not stable and healthy person Significant physiological changes are possible. If the prolactin level is increased by 1.5-2 times, but there are no symptoms, then it is recommended to retake the test after 10-14 days.
In what pathologies are prolactin levels elevated?
Situations in which prolactin may increase in healthy people (physiological hyperprolactinemia):- pregnancy;
- breastfeeding period;
- infants from birth to 3 months;
- chest injury;
- abortion;
- transferred surgical operations on chest;
- sexual contact, intense nipple stimulation;
- stress;
- hypoglycemia – low level blood sugar;
- high protein diet;
- overheating, visiting a sauna, bathhouse;
- heavy physical training;
- injuries;
- pain;
- hypovitaminosis of vitamin B6 (pyridoxine);
- reception medicines:
- hormonal drugs containing estrogen and contraceptives;
- dopamine blockers – sulpiride, domperidone;
- neuroleptics – haloperidol, sulpiride, perphenazine;
- antiemetics – cerucal, chlorpromazine, aeron;
- tricyclic antidepressants – haloperidol, imipramine, amitriptyline;
- antihypertensive drugs– reserpine, verapamil;
- cocaine, opiates, promedol.
In what pathologies are prolactin levels reduced?
- Pituitary apoplexy(Sheehan syndrome) – acute disorder blood circulation, leading to necrosis in the pituitary adenoma.
- Massive blood loss over 500 ml, for example, bleeding after childbirth.
- Brain tumors leading to compression of the pituitary gland.
- Pituitary tuberculosis– a rare form of tuberculosis.
- Radiation therapy, which caused the destruction of pituitary cells;
- Traumatic brain injuries accompanied by swelling or damage to the pituitary gland.
- post-term pregnancy beyond 41 weeks;
- smoking and alcoholism;
- starvation;
- age over 50 years;
- long-term use medicines:
- antiepileptics - valproic acid, phenytoin, carbamazepine;
- dopaminergic drugs - levodopa, bromocriptine, dopamine;
- hormonal drugs - terguride, dexamethasone, nafarelin, danazol, cyproterone, epostane, calcitonin, tamoxifen, mifepristone;
- anti-tuberculosis - rifampicin;
- antihypertensive – nifedipine;
- opioids - morphine.
How to reduce prolactin levels in a woman?
Before starting treatment for elevated prolactin, it is necessary to establish the cause of hyperprolactinemia. Medical examination consists of several stages.- Computed tomography CT, magnetic resonance imaging MRI or x-ray of the skull in 2 projections to exclude a pituitary tumor.
- Study of thyroid function to exclude hypothyroidism - ultrasound.
- Pregnancy test for women reproductive age. If there is a possibility that the woman does not know that she is pregnant.
- Biochemical analysis blood to determine the condition of the liver and kidneys.
- Hormone tests to rule out diseases endocrine system accompanied by an increase in prolactin:
- TSH is thyroid stimulating hormone of the thyroid gland.
- IGF-1 is insulin-like growth factor 1, which regulates somatotropin secretion.
- FSH is follicle-stimulating hormone of the anterior pituitary gland.
- Determination of the level of macroprolactin (inactive forms) using the polyethylene glycol precipitation method.
- Treatment of diseases of the endocrine system leads to normalization of hormonal status and a decrease in prolactin. Sometimes medications have to be taken for life. Depending on the detected pathology, the following is prescribed:
- analogues of the thyroid hormone thyroxine (euthyrox, L-thyroxine);
- adrenal hormones (hydrocortisone, prednisolone, fludrocortisone);
- Estrogen antagonists (tamoxifen) increase the sensitivity of estrogen receptors.
Contraindications: individual intolerance to the components of the drug, myocardial infarction, myocarditis.
Efficiency. With correctly selected hormone therapy the effectiveness of treatment is high.
- Suppression of prolactin synthesis. Dopamine D2 receptor agonists are used. Parlodel 2.5-3.5 mg per day, lisuride 0.05-0.075 mg, Dostinex 0.5 mg once a week. These drugs bind to dopamine receptors in the brain, causing the pituitary gland to release fewer prolactin molecules. The hormonal activity of the tumor and its size are reduced, lactation is suppressed and the menstrual cycle is normalized. The dosage and duration of administration are determined individually, based on test results.
Contraindications: hypersensitivity to the components of the drug, hypertension, myocardial infarction, myocarditis, benign tumors mammary glands.
Efficiency high. In most patients, it avoids surgery to remove a pituitary tumor.
- Radiation therapy. Destruction of a pituitary tumor ionizing radiation. Combined with drug therapy or carried out after surgical treatment.
Indications: large pituitary tumors that are not amenable to drug therapy.
Contraindications lymphopenia, leukopenia, thrombocytopenia, anemia, diseases nervous system, diseases accompanied by fever, purulent or inflammatory processes in the field of radiation, cardiovascular disease and respiratory system, kidney failure.
Efficiency
- Surgery. Removal of a pituitary tumor is carried out through the nasal sinuses.
Contraindications. Pregnancy, children and old age, inflammatory diseases(sinusitis, sinusitis, tonsillitis), acute diseases and exacerbation of chronic diseases.
Efficiency high for microadenoma, tumors less than 10 mm. For large adenomas, the likelihood reappearance tumors account for 20-40%.
Asymptomatic macroprolactinemia in women does not require specific treatment. If the amount of inactive forms of prolactin in the blood is increased, which do not bind to cell receptors, then there are no symptoms - a regular menstrual cycle, no discharge from the nipples. In this case, the analysis shows that prolactin levels are exceeded. With macroprolactinemia, there is no need to reduce prolactin levels.
How to reduce prolactin levels in a man?
An examination algorithm to determine the cause of increased prolactin in men.- X-ray of the skull in 2 projections, CT or MRI to detect a tumor in the pituitary gland.
- Ultrasound of the thyroid gland for the diagnosis of hypothyroidism.
- Biochemical blood test to detect signs of liver and kidney disease.
- Hormone tests to identify diseases of the endocrine system:
- TSH – thyroid stimulating hormone of the thyroid gland
- IGF-1 is an insulin-like growth factor 1 that regulates the secretion of somatotropin.
- LH is the luteinizing hormone of the anterior pituitary gland.
- FSH – follicle stimulating
Indications: prolactinomas, pituitary adenomas, brain injuries and other pathologies that provoke an increase in prolactin. Contraindications: individual intolerance to drugs, hypertonic disease, myocardial infarction, myocarditis, benign tumors of the mammary glands.
Efficiency high. In most patients, it avoids surgery.
- Hormone replacement therapy. For hypothyroidism, synthetic thyroid hormone (euthyrox, L-thyroxine) is prescribed. If adrenal function is impaired, analogues of their hormones (hydrocortisone, prednisolone, fludrocortisone) are taken. Recovery hormonal balance leads to normalization of prolactin.
Contraindications: individual intolerance to the components of the drug, myocardial infarction, myocarditis.
Efficiency high at correct selection drug dose. Lifelong medication may be required.
- Radiation therapy. Exposure of a pituitary tumor to ionizing radiation. Combined with drug therapy or after surgical removal tumors. Perhaps remote irradiation or the introduction of isotopes into tumor tissue.
Contraindications distance to optic nerves less than 5 mm, increased levels of lymphocytes, leukocytes, platelets, diseases of the nervous system, increased temperature, purulent or inflammatory foci in the area of irradiation, diseases of the respiratory system, kidney and heart failure.
Efficiency high, in combination with other treatment methods.
- Surgery. Removal of a pituitary tumor through the sinuses using endoscopic surgical instrument. Macroadenomas larger than 2 cm are removed by craniotomy.
Contraindications. Senile age, foci of inflammation in the head area (sinusitis, sinusitis, tonsillitis), acute diseases and exacerbation of chronic diseases, uncompensated heart defects and renal failure.
Efficiency high for microadenoma, tumors less than 10 mm. For large adenomas over 2 cm, the probability of tumor reappearance is 15%.
Prolactin is one of the main hormones of the pituitary gland. Its effect on the body cannot be overestimated.
Prolactin regulates fat metabolism, immune system and kidney function.
Hormone functions in women:
- stimulates the growth of breast tissue;
- stimulates the development of ducts in the gland;
- participates in the formation and maintenance of breast milk secretion;
- supports normal course pregnancy;
- participates in the emergence of maternal attachment to the baby;
- suppresses the maturation of eggs in nursing mothers.
In men, prolactin:
- supports testosterone secretion;
- stimulates sperm maturation.
If too much of the hormone is produced, a state of hyperprolactinemia develops. High levels of prolactin occur normally and in various diseases.
Normal prolactin levels
To identify hyperprolactinemia, a laboratory test is performed to determine the concentration of the hormone in the blood.
The hormone reacts very strongly to the patient’s emotional mood and well-being. Excess prolactin can be detected in a completely healthy person if stress factors influenced the body on the day of the test and the day before.
Causes of functional hyperprolactinemia:
- psychological stress;
- active physical exercise;
- fear of a medical institution;
- pain;
- sleep disturbance;
- sexual intercourse;
- a hearty dinner;
- smoking;
- starvation.
To exclude an increase in the hormone due to these random effects, it is advisable to measure the indicator at least twice on different days.
The norm for prolactin in women is 40–530 mU/l, and in men - 53–400 mU/l. During some periods of women, the level of the hormone increases significantly.
The normal reasons for an increase in the hormone are pregnancy, childbirth and breastfeeding. Why is prolactin measurement not recommended during these periods? This is due to the fact that standards for these patient groups have not been approved.
Signs of elevated prolactin levels
Symptoms of increased prolactin are detected when the hormone level is from 1000 mU/l.
Signs of high blood hormone:
- increase in the volume of the mammary glands;
- discharge of colostrum from the breast;
- weight gain;
- decreased sex drive;
- impotence in men;
- cessation of menstruation in women;
- infertility;
- bone fractures with minimal trauma;
- multiple caries;
- high blood sugar;
- constant depressed mood;
- sleep disturbance.
What diseases cause prolactin to increase?
Pathological hyperprolactinemia is 10 times more common in women than in men.
The main reasons for increased prolactin:
- pituitary adenoma;
- brain tumors;
- chest injuries;
- polycystic ovary syndrome;
- renal failure;
- cirrhosis and liver cancer;
- hypothyroidism
Besides, medicinal substances and drugs can lead to increased blood prolactin concentrations.
The hormone levels are most affected by:
- antidepressants (imipramine, amitriptyline, haloperidol);
- dopamine blockers (sulpiride, metoclopramide, domperidone, antipsychotics);
- antihypertensive drugs (reserpine);
- drugs against arrhythmia (verapamil);
- estrogens (including contraceptives);
- opiates (morphine, heroin, promedol);
- cocaine.
Diagnosis of elevated prolactin
A detected high level of the hormone prolactin is the reason for mandatory examination by an endocrinologist.
Diagnosis usually begins with repeated determination of prolactin concentration. If hyperprolactinemia persists, an in-depth examination is recommended for the patient.
To search for a tumor that secretes prolactin, an X-ray of the skull in a lateral projection, magnetic resonance imaging or computed tomography is performed.
The adenoma is best seen on a magnetic resonance imaging scanner. It is advisable to examine small neoplasms using contrast agents. These solutions are administered intravenously. Contrasts contain a large number of iodine, so they are contraindicated if you are allergic to this chemical element and for diseases of the thyroid gland.
X-ray examination has low sensitivity. It can only help diagnose a large pituitary tumor.
Signs of adenoma on an x-ray:
- destruction of the wall of the pituitary gland;
- double contour of bone tissue.
What tests should be performed for hyperprolactinemia?
If prolactin is elevated, the patient should have thyroid function examined. To do this, it is recommended to test thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4). High TSH speaks in favor of hypothyroidism. This disease may cause hyperprolactinemia.
Also, with high prolactin and pituitary adenoma, it is necessary to determine the level of all tropic hormones in the blood. These substances affect the functional activity of all endocrine glands. Tropic hormones are secreted by the pituitary gland. With hyperprolactinemia, there can be either an increase in their concentration or a decrease.
- adrenocorticotropic (ACTH);
- somatotropic (GH);
- follicle-stimulating (FSH);
- luteinizing (LH).
Additionally, the patient is prescribed blood biochemistry tests. Doctors are interested in metabolic rates and kidney and liver function.
Hyperprolactinemia can cause high levels of:
- blood sugar;
- cholesterol;
- triglycerides;
- bilirubin;
- creatinine;
- urea.
Why exactly this or that indicator changes is determined by medical specialists (therapist, nephrologist, gastroenterologist).
In some cases, a patient with high levels of the hormone is recommended to study an immunogram.
Ultrasound for high prolactin
Ultrasound can help:
- establish the cause of high prolactin concentrations;
- consequences of hyperprolactinemia.
Patients are prescribed an ultrasound of the mammary glands. In men, this study confirms the presence of a large volume glandular tissue. In women, many milk ducts are diagnosed, with an active blood supply to the tissue.
Ultrasound of the thyroid gland is prescribed if hypothyroidism is suspected. During the study, a decrease in the size of the organ, a heterogeneous tissue structure, and a low number of blood vessels may be detected.
Ultrasound of the gonads provides a lot of information when high level prolactin. In men, the test often reveals a decrease in the size of the testicles. In women, an ultrasound can be diagnosed with polycystic ovary syndrome, a decrease in the thickness of the endometrium.
Treatment of patients with high prolactin
High prolactin requires monitoring or active treatment.
When can you get by with just follow-up visits to an endocrinologist?
Treatment of elevated prolactin is not carried out if:
- hormone concentrations up to 1000 mU/l;
- normal structure of the pituitary gland;
- preserved function of the reproductive system;
- normal body weight.
If patients have symptoms of increased prolactin or a pituitary adenoma is detected, then therapy is mandatory.
The most effective remedy- tablets based on ergot alkaloid. There are two main drugs - cabergoline and bromocriptine. The doctor selects the dose individually, taking into account body weight and the level of the hormone in the blood.
Ergot alkaloids bring the hormone concentration back to normal within 1–2 months. The big advantage of these drugs is their ability to reduce the volume of pituitary tumors. Treatment is prescribed for a long period (12–36 months).
In the event that the adenoma is insensitive to treatment with cabergoline and bromocriptine, the option of surgery or radiation treatment. Both methods are quite effective, but damage the pituitary gland tissue and brain vessels.
Folk remedies in medical institutions not recommended. The safety of such treatments has not been studied. A dangerous consequences people's councils can be quite large. First of all, self-medication prevents patients from receiving effective medical care on time.
Katya was excitedly preparing for the wedding; she kept turning over fragments of her future family life in her head. Even at the beginning of the relationship, the young couple discussed that they would not have children right away, so Katya turned to a gynecologist with questions about family planning.
In order to choose a suitable contraceptive, the doctor suggested taking hormone tests. However, the results obtained unexpectedly became a cause for concern. One of the hormones, prolactin, had very high levels. As the doctor explained, this level of prolactin is observed in women who are in the 3rd month of pregnancy. However, Katya was never sexually active, so pregnancy was ruled out. The doctor stated that she could not recommend any contraception except for condoms. And then she added: “You need to be treated, otherwise in the future the child may be born with disabilities.” It is not difficult to imagine the anxiety that gripped Katya. Excitement for the upcoming family life and this happened a lot, and now there is such a nuisance.
What kind of hormone prolactin is, how does it affect the female body, is it really dangerous to increase its level - we will find out together with an endocrinologist highest category, candidate medical sciences Kurmanova Anel Kamelevna.
EZ: How does the hormone prolactin affect a woman’s health?
Anel Kamelevna: The hormone prolactin is produced in the anterior lobe of the pituitary gland (the pituitary gland is part of the brain). Prolactin has great importance For female body, since it affects reproductive function. It controls the formation of progesterone, supporting corpus luteum(this is a temporary gland internal secretion in a woman’s body, which is formed after ovulation to produce female hormone– progesterone). Prolactin promotes the process of implantation of a fertilized egg, because it increases the number of receptors sensitive to progesterone. However, the role of prolactin in the regulation of ovarian function is still not fully understood. Prolactin is known to affect lactation in nursing mothers. In addition, this hormone has anabolic and metabolic effects, that is, it affects metabolism and accelerates protein synthesis. It should be noted that it has a characteristic immunoregulatory effect. In addition, prolactin may influence behavioral responses. It inhibits thyroid function by disrupting the feedback between thyroxine and thyroid-stimulating hormone (TSH), and TSH levels may be elevated.
The above indicates the importance of normal prolactin levels in the female body.
Long before visiting the doctor, Katya noted that her menstrual cycle was irregular, but did not attach much importance to it. In addition, she was very worried excess weight, which she struggled with intensely. Strict restrictions on food still allowed her to maintain physical fitness, which could not be said about emotional sphere: she was often overcome by painful thoughts, which were accompanied by tearfulness, and she constantly wanted to sleep. I had to force myself to work. In addition, she noted a deterioration in memory and vision, however, she attributed all these symptoms to lack of sleep.
EZ: Why is an elevated prolactin level in a woman a reason to be wary?
Anel Kamelevna: If prolactin production is higher than normal, we can talk about hyperprolactinemia. In women with hyperprolactinemia, the menstrual cycle may be disrupted in the form of its lengthening, up to complete absence menstrual flow for several months, or maybe years (amenorrhea). In women with increased level prolactin may be primary and secondary infertility, sometimes dysfunctional uterine blood loss is observed. In some cases, such women are overweight or obese, some patients experience headaches, emotional instability. IN special attention Women with mastopathy, galactorrhea (discharge from the mammary glands), and fibroids need doctors.
EZ: What examination is required in these cases?
Anel Kamelevna: Prolactin levels are determined on the 3rd–4th or 5th day of the menstrual cycle. Since the level of prolactin directly affects emotional lability (an inverse relationship is also observed), a woman should try to remain calm when taking the test. In addition, the day before the study, it is necessary to exclude sex and heat exposure. If necessary, especially in emotionally unstable women, prolactin levels should be determined twice or even three times (every other day). The full scope of research includes:
● , pituitary gland;
● research functional state thyroid gland - determination of TSH, FT4, FT3 levels;
● in overweight women, cholesterol and lipoprotein levels are determined high density, low-density lipids, triglycerides, as well as blood sugar levels on an empty stomach and 2 hours after consuming 75 g of glucose (glucose tolerance test);
● if a pathology is detected on an MRI of the brain, an examination by an ophthalmologist is required (field of view, fundus of the eye).
EZ: What are the possible treatment options?
Anel Kamelevna: For hyperprolactinemia, drugs related to dopamine agonists are prescribed.
Doses and duration of use of drugs are individual, treatment is carried out under regular monitoring of prolactin levels. If a pituitary microadenoma (prolactinoma) is detected, then a repeat MRI of the pituitary gland is necessary every 6 months. If prolactinomas are present, observation by an endocrinologist is mandatory. The issue of taking medications is decided individually. When thyroid function decreases, thyroid medications are prescribed.
EZ: What is the prognosis for recovery?
Anel Kamelevna: In each case, the duration of treatment is determined individually. With persistent normalization of prolactin levels, gradual withdrawal of drugs is necessary (planned dose reduction until complete discontinuation). If a microadenoma is present, regular MRI of the brain is required. Consultation with a neurosurgeon may be required.
It should be noted that Katya’s fiancé was sympathetic to her health problems. To begin full treatment, they found an experienced endocrinologist. The endocrinologist did not confirm the colleague’s opinion that with high prolactin, the fetus is at risk of developmental abnormalities. But he said that with such levels of prolactin, Katya is at risk of infertility. And then he added that when rational treatment In 80–90% of women, reproductive function is restored. The endocrinologist also warned Katya that even after a course of successful therapy, a relapse of the disease could occur. According to him, hyperprolactinemia should not be perceived as an insurmountable pathology. Regular screenings and appropriate treatment will help keep prolactin levels in check.
What is prolactin? This is a hormone produced by the pituitary gland and is responsible for proper development mammary glands, female reproductive function. It helps the immune system fight harmful pathogens, turns on the maternal instinct, and reduces stress levels.
In addition, prolactin is an essential element in the process of implantation of a fertilized egg, increasing the number of receptors sensitive to progesterone.
In the body of men, prolactin is contained in minimal quantities and promotes the synthesis of male sex hormones, spermatogenesis, and also plays the role of an important immunostimulant.
Physical labor, sports activities, eating meat dishes, active sex life affect the concentration of the hormone in the blood, causing fluctuations in its level.
The causes of such a phenomenon as increased prolactin, or hyperprolactinemia, can be constant stress, taking medications, benign and malignant neoplasms and even chronic diseases(polycystic disease, adrenal insufficiency, etc.).
Advice! Conduct a preventive medical examination once a year.
Elevated prolactin: symptoms and consequences
The first is diagnosed in pregnant and recently given birth representatives of the fair half of humanity. This is not scary, because the reasons why prolactin is elevated in women are clear (the need to bear a fetus and breastfeed a baby).
The second type provokes a malfunction of the body. One of the reasons for high prolactin in women (and men) can be a tumor of the pituitary gland. There is no need to be scared ahead of time: only a doctor, after thorough examination, will be able to clarify the cause of the disease.
So, hyperprolactinemia - what is it? This is a condition of the body in which increased prolactin is recorded in the blood. In women, symptoms indicating an increase in hormone concentrations are as follows:
- galactorrhea (discharge of milk from the breast not related to pregnancy and lactation);
- decreased libido, lack of orgasm, even frigidity;
- hirsutism (hair growth in women all over the body, near the nipple, on the face, abdomen);
- acne (blackhead rash);
- increased appetite and, consequently, the appearance of overweight and even obesity;
- malfunction of the thyroid gland;
- blurred vision;
- frequent depression, excessive fatigue;
- inability to conceive, impossibility of fertilization (due to anovulatory cycles), repeated miscarriages in early pregnancy;
- leaching of calcium from bone tissue.
Prolactin control is the basis of women's health
The symptoms of hyperprolactinemia in women are clear. It is worth noting that not only representatives of the fair half of humanity suffer from such changes in the body. In men, increased prolactin can manifest itself as follows: potency weakens, interest in the opposite sex disappears.
Advice! If you notice any of the above manifestations of hyperprolactinemia, consult a doctor, because high prolactin can also occur with tumors.
Consequences of high prolactin in men:
- changes in the shape and size of the mammary glands (gynecomastia);
- overweight;
- long-term depression;
- impotence and infertility;
- lack of sleep;
- sexual infantilism.
Men are more sensitive to the manifestations of hyperprolactinemia, their mood drops sharply, irritability appears, and motivation decreases. As a result, poor psychological well-being negatively affects the quality of life.
Diagnostics
To understand the reasons for the development of hyperprolactinemia, you need to undergo a medical examination.
There are several types of laboratory and instrumental studies, allowing you to find the cause of the hormonal surge:
- MRI of the brain, in particular the pituitary gland (this manipulation allows us to identify the presence of malignant and benign neoplasms);
- X-ray of the skeleton (to assess changes in the condition of bone tissue);
- checking thyroid function (ultrasound plus additional tests);
- Ultrasound vital important organs(to identify their pathology);
- glucose tolerance test (especially if you are overweight - blood sugar concentration);
- visit to an ophthalmologist.
Important! The normal prolactin level ranges from 120 to 600 mU/l.
To get results, you need to donate blood from a vein in the morning, on an empty stomach (you can only drink water). You should not smoke 1 hour before the test. Before donating blood, the patient needs to be in a relaxed state: try to avoid depression, sexual intercourse and thermal influences (sauna, solarium) at least 24 hours before.
Proper preparation is the key to correct analysis results
Prolactin levels are normal
In women, the level of this hormone in the blood can range from 4.5-49 ng/ml to 136-1483 µIU/ml, as it depends on what day of the cycle the test is taken. There are phases:
- Follicular: 4.5-33 ng/ml or 136-999 µIU/ml.
- Ovulatory: 6.3-49 ng/ml or 190-1484 µIU/ml.
- Luteal: 4.9-40ng/ml or 148-1212 µU/ml.
During pregnancy, a woman’s prolactin is increased (the hormone changes its level depending on the period):
- 1st trimester: 3.2-43.0 ng/ml;
- 2nd trimester: 13.0-166.0 ng/ml;
- 3rd trimester: 13.0-318.0 ng/ml.
In men, hormone levels are normally lower than in women: the concentration ranges from 2.5-17 ng/ml, or 75-515 µIU/ml.
Treatment of hyperprolactinemia
How to lower prolactin in women? Modern science offers several treatment options:
- Medication.
- Surgical.
- Usage folk remedies(using soothing infusions a couple of hours before bedtime or using dietary supplements).
Drug treatment
Drugs are used that reduce the production of prolactin. There are two groups of medicines:
- Ergoline (ergot alkaloids): Bromocriptine, Lactodel, Parlodel, Serocriptine, Bromergon, Abegreen, Dostinex. Therapy is generally well tolerated by patients. side effects mildly expressed (some people complain of low blood pressure and headaches after taking the pills).
Dostinex is the most effective drug among the entire range of medications. Active substance- cabergoline. Available in the form of tablets of 0.5 mg, 8 pieces in a package. Dostinex blocks the production of prolactin, allowing the follicle to mature in time and restore the menstrual cycle. As a result, ovulation occurs and pregnancy becomes possible.
Dostinex is a drug that reduces prolactin production and restores the menstrual cycle.
- Non-ergoline (quinagolide preparations): Sebergin (for mastopathy), Norprolac, etc.
Important! All these drugs are prescribed individually by the attending physician. And you, in turn, are obliged to adhere to all recommendations.
Surgical intervention
Surgery is prescribed if hyperprolactinemia is caused by tumor growth, and treatment medicines did not give good results. Removal of tumors is carried out by neurosurgeons, the route is transnasal, without craniotomy. For oncology it is required radiation therapy, but complications are possible in 90-100% of cases.
Nutrition for high prolactin
In addition to the treatment methods discussed, the patient is prescribed a strict diet. Then the next question arises: “What can you eat if you have high prolactin?”
If you have obvious symptoms of elevated prolactin, you should eat foods rich in folic acid. This approach helps to better absorb proteins, improves hematopoiesis, and increases estrogen levels. Folic acid is found in required quantities in meat products, liver, greens, eggs, and vegetables.
Important! A huge percentage of folic acid is lost during cooking (during cooking). Therefore it is necessary regular use fresh fruits and vegetables.
Intestinal diseases reduce digestibility important substance, and medications even change its structure. Determined that folic acid will not be able to be absorbed into the blood without vitamin B12. Therefore, the diet of women with high prolactin should include not only vegetables and herbs, but also low-fat varieties meat.
In this case, it is necessary to exclude gluten-containing products: bread made from white flour, biscuits, cakes, as well as smoked sausages and sausages.
In order not to treat elevated prolactin in women or men, it is necessary to carry out prevention, namely:
- Correctly distribute loads, observe labor regime(get full rest), because a clear routine and sleep will improve general state body.
- Eliminate strong coffee and alcohol from your diet.
- Eliminate possible reasons increasing prolactin (to cure existing diseases).
- Have a medical examination every year.
Important! When a doctor concludes “prolactin is elevated,” you should not despair, because hyperprolactinemia is not a death sentence, but a condition that can be eliminated with a competent, timely approach.
Treatment with modern and effective drugs allows you to achieve in 90% of cases positive results: normalization of the menstrual cycle and even elimination of infertility. Take full responsibility for your health, and your body will thank you!
endocrinologist, Ph.D.
Prolactin is one of the most mysterious hormones in the body. Its name reflects the most striking effect of its increase - lactation, that is, the release of milk into mammary glands in women after childbirth. In fact, prolactin is either responsible for breastfeeding or is a stress hormone.
For reference: Hyperprolactinemia is a condition in which the level of prolactin in the blood is increased. Prolactin is secreted by the pituitary gland, a gland located in the very center of the brain, which is the most important or “controlling” endocrine gland of the body. Lactotroph cells are located in the anterior lobe of the pituitary gland, and their activity is controlled by a substance called dopamine.
So, what happens in the body if the level of prolactin in the blood is really very high?
Among women This leads to suppression of the hormones that control the menstrual cycle (LH and FSH), resulting in periods becoming irregular or stopping completely. In addition, lactation not associated with childbirth may occur.
In men hyperprolactinemia causes a decrease in the concentration of male sex hormones, and can cause erectile dysfunction and decreased libido.
Increased prolactin in children is detected extremely rarely, and if this is a true increase in prolactin caused by a pituitary tumor, then the manifestations may be delayed growth and sexual development.
Hyperprolactinemia is quite common. Among the general population, the incidence of this disease is 0.4%, and among women with infertility - 9-17%. Most often, this problem is detected in women 25-34 years old, but there is reason to believe that this is due to the fact that it is at this age that manifestations of excess prolactin have symptoms in the form of menstrual irregularities and problems with pregnancy.
It should also be noted that prolactin in our body varies. Monomeric prolactin is active, and it is its increase that, as a rule, leads to consequences in the form of all of the above symptoms. Macroprolactin, which is large prolactin molecules consisting of several “small” ones, is an inactive hormone. It has no effects, and in most cases, if there are no manifestations, does not require treatment. Most laboratories now use kits that distinguish macroprolactin from monomeric prolactin, and then this is indicated as a separate item in the analysis result.
How is an increase in prolactin expressed in numbers?
Different laboratories may specify different units of measurement. The most “standard” units are mU/l, when expressed in which prolactin should be no more than 400. An increase within 1000 mU/l is insignificant. From 1000 to 2000 it really begins to be alarming, and more than 5000 is the level that occurs with pituitary tumors. You can often find prolactin expressed in ng/ml, then its greatest normal value- about 30.
Thus, if the examination revealed moderately elevated prolactin, then, first of all, the analysis should be repeated. If we are not talking about a significant increase (more than 1000 mU/l), then we can talk about the problem of hyperprolactinemia only after 3 tests, passed correctly in accordance with all the rules. A significant increase (more than 2000 mU/l) in most cases requires an MRI of the brain. Again, the analysis must be done correctly.
The following reasons often lead to a moderate increase in prolactin - less than 1000 mU/l:
- pregnancy;
- postpartum period(which can last about a year);
- stimulation of the mammary glands (breastfeeding, injury or intimate relationships);
- physical stress (for example, active training on the eve of the test) or psychological (for young children, the very act of drawing blood from a vein often becomes such stress);
- food - after eating, the level of this hormone increases;
- the level of prolactin in women strongly depends on the phase of the menstrual cycle, all of the above norms refer to the first phase, or more precisely to the period from 2 to 7 days of the menstrual cycle; Prolactin does not have a norm for other phases of the cycle except the first, so its study in the middle or at the end of the cycle is not always inherently correct. In men, the level of this hormone is stable and practically does not change.
Moderate and sometimes significant increases in prolactin may be a consequence of other diseases. These include :
- hypothyroidism (thyroid hormone deficiency);
- polycystic ovary syndrome in women;
- chronic serious illnesses kidneys and liver;
- Celiac disease (possibly).
Prolactin may increase when taking the following medications:
- dopamine receptor antagonists (neuroleptics, metoclopramide, domperidone, etc.), methyldopa, antidepressants (tricyclic, from the group of MAO inhibitors and serotonin reuptake inhibitors), opiates;
- verapamil, bezafibrate;
- omeprazole, some antiallergic drugs;
- sex hormones (contraceptives, testosterone preparations) and their antagonists.
An increase in prolactin may accompany various severe conditions– injuries, fractures, condition after radiation, radiation or chemotherapy, after an attack of convulsions, etc.
Most rare cause increasing prolactin is pituitary tumor– prolactinoma. Small adenomas up to 1 cm in diameter are most common - about 90% of cases. Large ones are much less common. In addition, any brain tumor that displaces the pituitary infundibulum - structurally it connects the pituitary gland and the hypothalamus - will lead to a significant increase in prolactin, since it is through the pituitary infundibulum that the substance dopamine, a natural inhibitor of prolactin production, enters.
The main indications for determining the level of prolactin are menstrual irregularities, infertility in both women and men, lactorrhea (in women). There are many reasons for determining this hormone, but if they do not belong to the above “main” ones, then it is better to consult with an endocrinologist about the need and advisability of studying prolactin.
Treatment of hyperprolactinemia should only be carried out in conjunction with an endocrinologist. Very often, a patient with elevated prolactin is monitored by two doctors at once, for example, a gynecologist and an endocrinologist. Not all cases of elevated prolactin, especially if it is a slight increase, require therapy.
Doctor's advice:
- If you have accidentally detected an increase in prolactin, you first need to make sure that the test was done correctly, then find out whether it recurs.
- In any case, if prolactin increases, it is better to consult with a general practitioner or endocrinologist about whether any further examinations and actions are required.
- Prolactinomas are one of the rare tumors that can disappear with proper treatment drugs, in a third of women, small prolactinomas can go away on their own after the birth of a child or during menopause.
- You should never leave an already identified prolactinoma without attention - even if after long-term treatment it was not found, further observation and verification of the fact that the disease has not returned is required.
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