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 amounts in the body of men.
A distinctive feature of prolactin are sharp fluctuations, which may be associated with sleep, medication, active sexual stimulation, breast trauma. In healthy people, hormone levels return to normal within a few hours. Long-term increases in the level of prolactin 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, until the cessation of menstruation and infertility. An increase in prolactin in men is extremely rare.
To determine the level of prolactin, it is required to donate blood from a vein.
The role of prolactin in the body
Prolactin produced by the anterior pituitary gland. Its synthesis is regulated by another hormone - dopamine which is secreted by the nuclei of the hypothalamus. Getting through the bloodstream to the pituitary gland, 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.circadian rhythm of secretion
The highest level of the hormone is observed in the phase deep sleep and immediately after the rise, 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 lobules and ducts of the mammary glands grow, 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 does not affect the body. In the presence of the polymeric and dimeric form, the analysis for prolactin shows an excess of the norm, but there are no symptoms of hyperprolactinemia, and no treatment is required.
| Functions of prolactin in the body | |
| Women | Men |
| Breast development during puberty. The growth of the mammary glands due to the increase in lobules and ducts. Production of colostrum and milk Regulation of estrogen production. Regulation of the corpus luteum phase and menstrual cycle. Prevention of pregnancy during lactation. Formation of attachment to the child. Normalization of metabolism. strengthening bone tissue enrichment with calcium. | Regulation of water-salt balance. Normalization of metabolism. maintenance normal level testosterone. Normal maturation of spermatozoa, increase in their mobility. Growth of seminal vesicles and prostate. Strengthening bones, improving calcium absorption. |
Prolactin release during pregnancy and postpartum
During pregnancy, prolactin levels rise 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. At the same time, estrogen and progesterone block the production of breast milk, despite the high levels of progesterone. Immediately after childbirth, the concentration of estrogen and progesterone drops and colostrum begins to be released, and then milk. Prolactin stabilizes 4-6 weeks after the baby is born. But its level remains consistently high for several more months due to the stimulation of the nipples during feeding, which allows you to maintain lactation. This mechanism explains the fact that frequent attachment to the breast increases the amount of milk.
A high level of prolactin in a nursing mother protects her from re-pregnancy. He 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 in such conditions can still occur.
Why is a prolactin test ordered? (main indications for this analysis)
| Indications for prolactin testing | |
| Women | Men |
| Pathology of the mammary gland. Galactorrhea is milk secretion not associated with breastfeeding. Amenorrhea is the absence of menstruation. Signs of hyperandrogenism (excess male sex hormones) - acne, excessive body hair. Infertility. Miscarriage - miscarriage, premature birth. Hypothyroidism is a disorder associated with low hormone levels. thyroid gland. Suspicion of a pituitary tumor Neoplasms in the ovaries - cysts, tumors. | Gynecomastia is an enlargement of the mammary glands. Infertility. The absence of spermatozoa in the ejaculate. Suspicion of a pituitary tumor. |
Signs of elevated prolactin levels at different ages
The main signs of increased prolactin in women are 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 action of estrogen, but blocks testosterone.| Girls | boys |
| Late periods or their absence is primary amenorrhea. Menstrual disorders. Underdevelopment of the external genital organs and mammary glands. Discharge of fluid from the nipples. | Delayed puberty. Breast enlargement. Characteristic proportions of the body: long arms and legs, high waist, hips wider than shoulders, fat deposition in the nipples, lower abdomen and lower back. Weak muscles. High voice. Testicles (testicles) are reduced. Lack of sexual desire and interest in sex. |
Prolonged exposure to high doses of prolactin in adults causes disturbances in performance various bodies and systems.
| Signs of an increase in prolactin | |
| Women | Men |
| Discharge from the mammary glands. The secreted fluid may be clear or resemble breast milk. The amount varies from a few drops with pressure to several milliliters and spontaneous expiration. Enlargement of the mammary glands due to the growth of the epithelium of the lobules and ducts. Violation of menstrual function: irregular menstruation profuse and painful bleeding. Amenorrhea is the cessation of menstruation for 6 or more months. Infertility. High levels of prolactin block ovarian hormones, disrupting the processes of egg maturation and ovulation. This makes pregnancy impossible. Frigidity is the lack of desire to have sex. Weight gain associated with water retention and increased body fat. Acne on face and upper body. Violation peripheral vision, double vision when squeezed ophthalmic nerves pituitary adenoma. Emotional stability and sleep disorders. | Decreased sexual desire and potency disorders, which is caused by a decrease in testosterone. Gynecomastia is the growth of the mammary glands. Frequent fractures and multiple caries. Visual impairment in large pituitary adenomas that compress 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 pituitary gland of various nature or with hypersensitivity body to dopamine, which prevents the production of prolactin.| Symptoms reduced level prolactin | |
| Women | Men |
| Infertility. Menstrual disorders. miscarriages on early dates 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 of sperm quality, decrease in sperm motility. Decreased potency. Prostatitis. Emotional instability, anxiety. |
How to Prepare for a Prolactin Test
To get the maximum accurate results analysis at least 3 days in advance, it is necessary to stop taking drugs that affect the synthesis of prolactin. Their list is presented in the following sections of the article. If it is not possible to cancel the drugs, then it is necessary to inform the laboratory staff about the drugs taken and their dosage. The day before the study, if possible, refrain from:
- injuries;
- smoking;
- alcohol;
- psychotropic substances;
- an 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 loads.
If these factors could not be avoided, then it is recommended to postpone the test for 3 days.
On the morning of the test day, you must refuse food, tea and coffee.
Blood for prolactin is required to be taken 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 an analysis for prolactin at any time.However, some endocrinologists point out that best period for testing for prolactin - 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 I 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 the level of prolactin is not stable and in healthy person significant physiological jumps are possible. If the rate of prolactin is increased by 1.5-2 times, but there are no symptoms, then it is recommended to retake the test after 10-14 days.
What pathologies cause elevated prolactin levels?
Situations in which prolactin may increase in healthy people (physiological hyperprolactinemia):- pregnancy;
- the period of breastfeeding;
- infants from birth to 3 months;
- chest injury;
- abortion;
- transferred surgical operations on the chest;
- sexual contact, intense stimulation of the nipples;
- stress;
- hypoglycemia - low level blood sugar;
- high protein diet;
- overheating, visiting saunas, baths;
- heavy physical training;
- trauma;
- pain;
- hypovitaminosis of vitamin B6 (pyridoxine);
- reception medicines:
- hormonal preparations 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's syndrome) - acute disorder 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.
- Tuberculosis of the pituitary gland is a rare form of tuberculosis.
- Radiation therapy that caused the destruction of pituitary cells;
- Traumatic brain injury accompanied by swelling or damage to the pituitary gland.
- prolongation of pregnancy over 41 weeks;
- smoking and alcoholism;
- starvation;
- age over 50 years;
- long-term use medicines:
- antiepileptic - valproic acid, phenytoin, carbamazepine;
- dopaminergic agents - levodopa, bromocriptine, dopamine;
- hormonal drugs - terguride, dexamethasone, nafarelin, danazol, cyproterone, epostane, calcitonin, tamoxifen, mifepristone;
- anti-tuberculosis - rifampicin;
- hypotensive - nifedipine;
- opioids - morphine.
How to reduce the level of prolactin in a woman?
Before you start treating elevated prolactin, you need 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.
- Examination of thyroid function to rule out hypothyroidism - ultrasound.
- Pregnancy test for women reproductive age. If there is a possibility that a woman does not know about the onset of pregnancy.
- 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.
- IGF-1 is an insulin-like growth factor 1 that regulates somatotropin secretion.
- FSH is a follicle-stimulating hormone from the anterior pituitary gland.
- Determination of the level of macroprolactin (inactive forms) by polyethylene glycol precipitation.
- Treatment of diseases of the endocrine system leads to the normalization of hormonal status and a decrease in prolactin. Sometimes drugs 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 the right choice hormone therapy treatment efficiency is high.
- Suppression of prolactin synthesis. Dopamine D 2 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 decrease, lactation is suppressed and the menstrual cycle is normalized. The dosage and duration of administration is determined individually, based on the results of the tests.
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 the pituitary tumor.
- Radiation therapy. Destruction of the pituitary tumor ionizing radiation. Fit with drug therapy or performed after surgery.
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 sinuses.
Contraindications. Pregnancy, children and old age, inflammatory diseases(sinusitis, sinusitis, tonsillitis), acute diseases and exacerbation of chronic diseases.
Efficiency high with microadenoma, tumors less than 10 mm. For large adenomas, the likelihood reappearance tumors is 20-40%.
Asymptomatic macroprolactinemia in women does not require specific treatment. If the amount of inactive forms of prolactin that do not bind to cell receptors is increased in the blood, then there are no symptoms - a regular menstrual cycle, there is no discharge from the nipples. In this case, the analysis shows an excess of the norm of prolactin. With macroprolactinemia, there is no need to reduce the level of prolactin.
How to reduce the level of prolactin in men?
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 neoplasm 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.
- Tests for hormones to detect diseases of the endocrine system:
- TSH - thyroid stimulating hormone
- 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, t allows to avoid surgery.
- Replacement hormone therapy. In hypothyroidism, a synthetic thyroid hormone (euthyrox, L-thyroxine) is prescribed. In case of impaired adrenal function, analogues of their hormones are taken (hydrocortisone, prednisolone, fludrocortisone). 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 doses. You may need lifelong medication.
- Radiation therapy. Impact on the pituitary tumor by ionizing radiation. Combined with drug therapy or after surgical removal tumors. Perhaps remote irradiation or the introduction of isotopes into tumor tissues.
Contraindications distance to optic nerves less than 5 mm, increased levels of lymphocytes, leukocytes, platelets, diseases of the nervous system, fever, purulent or inflammatory foci in the area of irradiation, diseases of the respiratory system, kidney and heart failure.
Efficiency high, in combination with other methods of treatment.
- Surgery. Removal of a pituitary tumor through the sinuses using endoscopic surgical instrument. Macroadenomas larger than 2 cm are removed by craniotomy.
Contraindications. Old age, foci of inflammation in the head area (sinusitis, sinusitis, tonsillitis), acute diseases and exacerbation of chronic diseases, uncompensated heart defects and kidney failure.
Efficiency high with microadenoma, tumors less than 10 mm. With large adenomas over 2 cm, the probability of recurrence of the tumor 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.
Functions of the hormone in women:
- stimulates the growth of breast tissue;
- stimulates the development of ducts in the gland;
- participates in the formation and maintenance of the secretion of breast milk;
- supports normal flow pregnancy;
- participates in the emergence of maternal attachment to the baby;
- inhibits the maturation of eggs in nursing mothers.
In men, prolactin:
- supports the secretion of testosterone;
- stimulates the maturation of spermatozoa.
If the hormone is produced too much, then a state of hyperprolactinemia develops. High levels of prolactin are normal and in various diseases.
normal prolactin levels
To detect hyperprolactinemia, a laboratory study is carried out - determining the concentration of the hormone in the blood.
The hormone reacts very strongly to the emotional mood and well-being of the patient. An excess of prolactin can be detected in a perfectly healthy person if stress factors influenced the body on the day of the analysis and the day before.
Causes of functional hyperprolactinemia:
- psychological stress;
- active physical exercises;
- fear of a medical institution;
- pain;
- sleep disturbance;
- sexual intercourse;
- plentiful 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 of prolactin in women is 40-530 mU / l, and in men - 53-400 mU / l. In some periods of women, the level of the hormone rises significantly.
The reasons for the increase in the hormone are normal pregnancy, childbirth and breastfeeding. Why are prolactin measurements not recommended during these periods? This is due to the fact that the standards for these groups of patients have not been approved.
Signs of elevated prolactin levels
Symptoms of an increase in prolactin are detected at a hormone level of 1000 mU / l.
Signs of high blood hormone:
- increase in the volume of the mammary glands;
- secretion of colostrum from the breast;
- weight gain;
- decrease in sexual desire;
- impotence in men;
- cessation of menstruation in women;
- infertility;
- bone fractures with minimal trauma;
- multiple caries;
- increased blood sugar;
- persistent depressed mood;
- sleep disturbance.
What diseases cause increased prolactin?
Pathological hyperprolactinemia is 10 times more common in women than in men.
The main reasons for the increase in prolactin:
- pituitary adenoma;
- brain tumors;
- chest trauma;
- polycystic ovaries;
- kidney failure;
- cirrhosis and liver cancer;
- hypothyroidism.
Besides, medicinal substances and drugs can lead to an increase in the concentration of prolactin in the blood.
Most of all, hormone levels are affected by:
- antidepressants (imipramine, amitriptyline, haloperidol);
- dopamine blockers (sulpiride, metoclopramide, domperidone, antipsychotics);
- antihypertensive drugs (reserpine);
- drugs against arrhythmias (verapamil);
- estrogens (including contraceptives);
- opiates (morphine, heroin, promedol);
- cocaine.
Diagnosis of elevated prolactin
The revealed high level of prolactin hormone is the reason for a mandatory examination by an endocrinologist.
Diagnosis usually begins with a repeated determination of the concentration of prolactin. In the event that hyperprolactinemia persists, the patient is recommended an in-depth examination.
To look for a prolactin-secreting tumor, a lateral skull x-ray, magnetic resonance imaging, or computed tomography is performed.
The adenoma is best seen on magnetic resonance imaging. Small neoplasms should be examined with contrast agents. These solutions are administered intravenously. Contrasts contain a large number of iodine, so they are contraindicated in case of allergy to this chemical element and in diseases of the thyroid gland.
X-ray examination has low sensitivity. It can only help diagnose a large pituitary tumor.
Signs of adenoma on x-ray:
- destruction of the wall of the pituitary bed;
- double contour of bone tissue.
What tests should be done for hyperprolactinemia?
If prolactin is elevated, then the patient should examine the function of the thyroid gland. For this, it is recommended to take thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4). High TSH speaks in favor of hypothyroidism. This disease can be the cause of 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 both an increase in their concentration and a decrease.
- adrenocorticotropic (ACTH);
- somatotropic (STG);
- follicle-stimulating (FSH);
- luteinizing (LH).
Additionally, the patient is prescribed tests for blood biochemistry. Doctors are interested in metabolic indicators 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, specialist doctors (therapist, nephrologist, gastroenterologist) find out.
In some cases, a patient with a high level of the hormone is recommended to study the immunogram.
Ultrasound for high prolactin
Ultrasound can help:
- to establish the cause of the high concentration of prolactin;
- consequences of hyperprolactinemia.
Patients are prescribed ultrasound of the mammary glands. In men, this study confirms the presence of a large volume glandular tissue. Women are diagnosed with many milk ducts, active blood supply to the tissue.
Ultrasound of the thyroid gland is prescribed for suspected hypothyroidism. During the study, a decrease in the size of the organ, a heterogeneous tissue structure, and a low number of blood vessels can be detected.
Ultrasound of the gonads provides a lot of information when high level prolactin. In men, testing often reveals a decrease in the size of the testicles. In women, ultrasound can be diagnosed with polycystic ovaries, a decrease in the thickness of the endometrium.
Treatment of patients with high prolactin
High prolactin requires observation or active treatment.
When can I get by with just follow-up visits to an endocrinologist?
Treatment of elevated prolactin is not carried out with:
- hormone concentrations up to 1000 mU / l;
- normal structure of the pituitary gland;
- preserved function of the reproductive system;
- normal body weight.
In the event that patients have symptoms of an increase in prolactin or a pituitary adenoma is detected, then therapy is mandatory.
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 concentration of the hormone back to normal within 1-2 months. A big plus of these drugs is their ability to reduce the volume of the pituitary tumor. 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 surgical or radiation treatment. Both methods are quite effective, but damage the pituitary gland tissue and brain vessels.
Folk remedies in medical institutions do not recommend. The safety of these treatments has not been studied. BUT dangerous consequences people's councils can be quite large. First of all, self-treatment prevents patients from receiving effective medical care in time.
Katya was anxiously preparing for the wedding, she continually scrolled through fragments of her future family life in her head. Even at the beginning of the relationship, the young people discussed that they would not have children right away, so Katya turned to a gynecologist with questions of family planning.
In order to find the right contraceptive, the doctor suggested taking tests for hormones. 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 never lived a sexual life, so pregnancy was excluded. The doctor stated that she could not recommend her patient any contraceptives except for condoms. And then she added: “You need to be treated, otherwise in the future the child may be born with deviations.” It is not difficult to imagine the anxiety that gripped Katya. Excitement with the upcoming family life and so it was a lot, and then there is such a nuisance.
What is this hormone prolactin, how does it affect the female body, is it really dangerous to increase its level - we will find out together with an endocrinologist the 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, as it affects reproductive function. It controls the formation of progesterone, maintaining corpus luteum(this is a temporary gland internal secretion in the body of a woman, 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 that are 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 breastfeeding mothers. In addition, this hormone has an anabolic and metabolic effect, i.e., it affects the metabolism and accelerates protein synthesis. It should be noted its characteristic immunoregulatory effect. In addition, prolactin may influence behavioral responses. It inhibits thyroid function by disrupting the feedback between thyroxin and thyroid-stimulating hormone (TSH), while TSH levels may be elevated.
The foregoing indicates the importance of a normal level of prolactin in the female body.
Long before visiting the doctor, Katya noted the irregularity of the menstrual cycle, but did not attach much importance to this. In addition, she was very worried excess weight with which she fought hard. Severe food restrictions still allowed her to maintain physical form which could not be said about emotional sphere: she was often overcome by painful thoughts, which were accompanied by tearfulness, 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 elevated prolactin in a woman a cause for concern?
Anel Kamelevna: If the production of prolactin is higher than normal, we can talk about hyperprolactinemia. In women with hyperprolactinemia, a violation of the menstrual cycle is possible in the form of its lengthening, up to total absence menstrual flow for several months, and maybe years (amenorrhea). In women with increased level prolactin can be primary and secondary infertility, sometimes there are dysfunctional uterine blood loss. In some cases, these women are overweight or obese, some patients suffer from headaches, emotional instability. AT special attention doctors need women with mastopathy, galactorrhea (discharge from the mammary glands), fibroids.
EZ: What examination is required in these cases?
Anel Kamelevna: The level of prolactin is determined on the 3rd-4th or 5th day of the menstrual cycle. Since the level of prolactin directly affects emotional lability (there is also an inverse relationship), 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 thermal effects. If necessary, especially in emotionally unstable women, the level of prolactin must be determined twice or even three times (every other day). The full scope of research includes:
● , pituitary gland;
● study functional state thyroid gland - determination of the level of TSH, SvT4, SvT3;
● in overweight women determine the level of cholesterol, lipoproteins high density, low-density lipids, triglycerides, as well as fasting blood sugar 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 (field of view, fundus of the eye) is required.
EZ: What are the possible treatment options?
Anel Kamelevna: In case of 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 repeated MRI of the pituitary gland is necessary every 6 months. In the presence of prolactinomas, observation by an endocrinologist is mandatory. The issue of taking drugs is decided individually. With a decrease in thyroid function, thyroid drugs are prescribed.
EZ: What is the prognosis for recovery?
Anel Kamelevna: In each case, the terms of treatment are determined individually. With a stable normalization of the level of prolactin, a gradual withdrawal of drugs is necessary (a systematic decrease in the dose until complete abolition). In the case of a microadenoma, a regular MRI of the brain is mandatory. A consultation with a neurosurgeon may be required.
It should be noted that Katya's fiance was sympathetic to her health problems. To begin a full-fledged treatment, they found an experienced endocrinologist. The endocrinologist did not confirm the opinion of his colleague that with high prolactin, the fetus is threatened with developmental deviations. But he said that with such indicators of prolactin, Katya is threatened with infertility. And then he added that rational treatment 80-90% of women manage to restore reproductive function. The endocrinologist also warned Katya that even after a course of successful therapy, a relapse of the disease may occur. According to him, hyperprolactinemia should not be perceived as an insurmountable pathology. Regular check-ups and appropriate treatment will help keep prolactin levels in check.
What is prolactin? It is a hormone produced by the pituitary gland and is responsible for proper development mammary glands, the reproductive function of women. It helps the immune system fight harmful pathogens, “turns on” the maternal instinct, and reduces stress levels.
In addition, prolactin is an indispensable 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 amounts and promotes the synthesis of male sex hormones, spermatogenesis, and also plays the role of an important immunostimulant.
Physical labor, sports activities, consumption of 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, adrenal insufficiency, etc.).
Advice! Conduct a preventive medical examination once a year.
Elevated prolactin: symptoms and consequences
The first is diagnosed in pregnant women and those who have recently given birth to the representatives of the beautiful half of humanity. This is not scary, because the reasons why prolactin is elevated in women are clear (the need to carry the fetus and breastfeed the baby).
The second variety provokes a malfunction in the body. One of the causes of high prolactin in women (and in men) can be a pituitary tumor. No need to be scared ahead of time: only a doctor, after thorough examination, can determine the cause of the disease.
So, hyperprolactinemia - what is it? This is a condition of the body in which increased prolactin is fixed in the blood. In women, symptoms indicating an increase in the concentration of the hormone are as follows:
- galactorrhea (excretion of milk from the breast without regard to pregnancy and lactation);
- decreased sexual desire, lack of orgasm, up to frigidity;
- hirsutism (hair growth in women all over the body, near the nipple, on the face, abdomen);
- acne (pimples);
- increased appetite and, consequently, the appearance of overweight and even obesity;
- malfunctions of the thyroid gland;
- blurred vision;
- frequent depression, excessive fatigue;
- impossibility of conception, impossibility of fertilization (due to anovulatory cycles), recurrent miscarriages in early pregnancy;
- leaching of calcium from bone tissue.
Prolactin control is the foundation of women's health
The symptoms of hyperprolactinemia in women are clear. It is worth noting that not only the representatives of the beautiful half of humanity suffer from such changes in the body. In men, elevated prolactin can manifest itself as follows: potency weakens, interest in the opposite sex disappears.
Advice! If you notice any of these manifestations of hyperprolactinemia, consult a doctor, because high prolactin can also be with tumors.
Consequences of high prolactin in men:
- change in the shape and size of the mammary glands (gynecomastia);
- overweight;
- prolonged 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 causes of hyperprolactinemia, you need to undergo a medical examination.
There are several types of laboratory and instrumental research, allowing you to find the cause of a hormonal surge:
- MRI of the brain, in particular the pituitary gland (this manipulation allows you to identify the presence of malignant and benign neoplasms);
- X-ray of the skeleton (to assess changes in the state of the bone tissue);
- thyroid function check (ultrasound plus additional tests);
- Ultrasound is vital important organs(to identify their pathology);
- glucose tolerance test (especially if overweight - blood sugar concentration);
- visit to an ophthalmologist.
Important! The normal prolactin level is from 120 to 600 mU / l.
To get the results, you need to donate blood from a vein in the morning, on an empty stomach (you can only drink water). Do not smoke 1 hour before the study. Before donating blood, the patient needs to be in a relaxed state: at least a day, try to avoid depression, sexual intercourse and thermal effects (bath, solarium).
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 which day of the cycle the analysis is taken. The phases are:
- 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 mcfu/mL.
During pregnancy, a woman's prolactin is elevated (the hormone changes its level depending on the period):
- 1 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, the 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:
- Medical.
- Surgical.
- Usage folk remedies(the use of soothing decoctions a couple of hours before bedtime or the use of dietary supplements).
Medical treatment
Drugs that reduce the production of prolactin are used. There are two groups of drugs:
- Ergoline (ergot alkaloids): Bromkriptine, Lactodel, Parlodel, Serocriptine, Bromergon, Abegrin, Dostinex. Therapy is generally well tolerated by patients. side effects weakly expressed (some people complain of low blood pressure and headaches after taking the pills).
Dostinex is the most effective drug from the entire range of medicines. Active substance- cabergoline. Produced in the form of tablets of 0.5 mg, in a package of 8 pieces. Dostinex blocks the production of prolactin, makes it possible for the follicle to mature in time and restore the menstrual cycle. As a result, ovulation occurs and pregnancy becomes possible.
Dostinex - a drug that allows you to reduce the production of prolactin and restore the menstrual cycle
- Non-ergoline (quinagolide preparations): Sebergin (for mastopathy), Norprolac, etc.
Important! All these funds are prescribed individually by the attending physician. And you, in turn, are obliged to adhere to all recommendations.
Surgical intervention
Surgery is indicated if hyperprolactinemia is caused by tumor growth, and treatment medicines did not give good results. Removal of neoplasms is carried out by neurosurgeons, the path is transnasal, without craniotomy. Required for oncology radiation therapy, but complications are possible in 90-100% of cases.
Diet for high prolactin
In addition to the methods of treatment considered, the patient is prescribed a strict diet. Then the next question arises: “What can I eat with elevated prolactin?”.
With obvious symptoms of elevated prolactin, it is necessary to eat foods rich in folic acid. This approach helps to better absorb proteins, improves hematopoiesis, and increases estrogen levels. Folic acid is found in the 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.
Bowel disease reduces digestibility important substance, and medicines even change its structure. Determined that folic acid cannot be absorbed into the bloodstream without vitamin B12. Therefore, the diet of women with high prolactin should include not only vegetables and herbs, but also lean varieties meat.
At the same time, it is necessary to exclude gluten-containing products: white flour bread, biscuits, cakes, as well as smoked sausages and sausages.
In order not to treat increased prolactin in women or men, it is necessary to carry out prevention, namely:
- Properly distribute loads labor regime(fully rest), because a clear regimen and sleep will improve general state organism.
- Eliminate strong coffee and alcohol from your diet.
- Eliminate possible reasons increase in prolactin (to cure existing diseases).
- Get an annual check-up.
Important! When a doctor concludes that “prolactin is elevated”, do not despair, because hyperprolactinemia is not a sentence, but a condition that can be eliminated with a competent timely approach.
Treatment with modern and effective drugs allows in 90% of cases to achieve positive results: normalization of the menstrual cycle and even elimination of infertility. Take 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 in the pituitary gland, a gland located in the very center of the brain, which is the most important or "control" endocrine gland in the body. Lactotroph cells are located in the anterior pituitary gland, and their activity is controlled by a substance - 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 production of hormones that control the menstrual cycle (LH and FSH), resulting in menstruation becoming irregular or completely stopped. 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 a decrease in libido.
Increase in prolactin in children is extremely rare, and if this is a true increase in prolactin caused by a pituitary tumor, then growth retardation and sexual development may become manifestations.
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 the onset of pregnancy.
It should also be noted that prolactin in our body is different. 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 a large molecule of prolactin, consisting of several "small", is an inactive hormone. It has no effect, and in most cases, if there are no manifestations, no treatment is required. Most laboratories currently use kits that distinguish macroprolactin from monomeric, and then this is indicated as a separate item in the result of the analysis.
How is the 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 in the range of 1000 mU/l is insignificant. From 1000 to 2000 it really starts to alarm, and more than 5000 is the level that occurs with pituitary tumors. Often you can find prolactin, expressed in ng / ml, then its greatest normal value- around 30.
Thus, if a moderately elevated prolactin was detected during the examination, 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 that were 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 carried out 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, trauma or intimate relationships);
- physical stress (for example, active training on the eve of the analysis) or psychological stress (for young children, blood sampling from a vein often becomes such stress);
- food - after eating, the level of this hormone rises;
- the level of prolactin in women is highly dependent on the phase of the menstrual cycle, all of the above norms refer to the first phase, or rather, to the period from 2 to 7 days of the menstrual cycle; there are no norms for other phases of the cycle, except for the first, for prolactin, therefore, its study in the middle or at the end of the cycle is not always correct in its essence. In men, the level of this hormone is stable and practically does not change.
A moderate and sometimes significant increase in prolactin may be the result of other diseases. These include :
- hypothyroidism (deficiency of thyroid hormones);
- polycystic ovary syndrome in women;
- chronic serious illnesses kidneys and liver;
- celiac disease (possibly).
Prolactin may increase with the following medicines:
- dopamine receptor antagonists (neuroleptics, metoclopramide, domperidone, etc.), methyldopa, antidepressants (tricyclic, from the group of MAO inhibitors and serotonin reuptake), opiates;
- verapamil, bezafibrat;
- 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 a rare cause increase in prolactin is pituitary tumor- prolactinoma. Small adenomas up to 1 cm in diameter are most common - about 90% of cases. Large ones are much rarer. In addition, any brain tumor that displaces the pituitary funnel - structurally it connects the pituitary and hypothalamus - will lead to a significant increase in prolactin, since it is through the pituitary funnel that the substance dopamine, a natural inhibitor of prolactin production, enters.
The main indications for determining the level of prolactin content are menstrual disorders, infertility, both in women and men, lactorrhea (in women). There are many reasons for determining this hormone, but if they do not belong to the above “main”, then it is better to consult an endocrinologist about the need and feasibility of prolactin testing.
Treatment of hyperprolactinemia should be carried out only in conjunction with an endocrinologist. Very often, a patient with elevated prolactin is observed 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 an increase in prolactin was accidentally detected in you, then first you need to make sure that the analysis was correctly passed, then find out if it repeats.
- In any case, with an increase in prolactin, it is better to consult 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 diagnosed prolactinoma unattended - even if after long-term treatment she was not found, further observation is required and verification of the fact that the disease has not returned.
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