Prolactinoma: When Will Menstruation Return After Treatment?

Hyperprolactinemia

Hello Doctor: In May and June of this year, I had a blood test at a large hospital, and my prolactin level was over 200.
An MRI revealed a prolactinoma in the pituitary gland measuring less than 1 cm.
The doctor recommended starting cabergoline (Dostinex) to lower my prolactin levels.
I have been taking it for a month now, and during my last follow-up in July, my prolactin level decreased to 18.
I have been on the medication for another two weeks, but my menstruation has not yet returned.
I would like to know when I can generally expect my period to resume after starting the medication?

Guo Xiao Jie, 20~29 year old female. Ask Date: 2017/07/18

Dr. Lin Manying reply Obstetrics and Gynecology

Dear Ms.
Kuo, regarding the issue you raised, it is recommended that the prolactin levels be reduced to below the normal range, which is an average of 8 ng/ml for adult women, in order for menstruation to resume.
The Hualien Hospital of the Ministry of Health and Welfare cares about your health.

Reply Date: 2017/07/18

More Info

Prolactinoma is a benign tumor of the pituitary gland that produces excess prolactin, a hormone responsible for lactation and various reproductive functions. The treatment for prolactinoma typically involves the use of dopamine agonists, such as cabergoline (Dostinex), which help to lower prolactin levels and reduce the size of the tumor. Your situation, where you have been on cabergoline for about six weeks with a significant reduction in prolactin levels, is a positive sign, but the return of menstruation can vary from person to person.

In general, the timeline for the return of menstruation after starting treatment for prolactinoma can be influenced by several factors, including the duration of elevated prolactin levels prior to treatment, the individual’s overall health, and the specific characteristics of the prolactinoma. Many women may experience a return of their menstrual cycle within a few months of starting treatment, particularly if their prolactin levels have normalized. However, it is not uncommon for some women to take longer, sometimes several months, to see the return of regular menstrual cycles.

The normalization of prolactin levels is a crucial factor in the resumption of menstruation. In your case, with prolactin levels dropping from over 200 to 18, this indicates that the treatment is effective. However, it is important to note that even with normalized prolactin levels, it may take time for the hypothalamus and pituitary gland to resume normal function and for the menstrual cycle to regularize.

If menstruation does not return within a few months of treatment, it is advisable to follow up with your healthcare provider. They may consider additional evaluations to rule out other potential causes of amenorrhea, such as thyroid dysfunction or other hormonal imbalances. In some cases, further adjustments to the treatment regimen may be necessary.

In summary, while many women may see their menstrual cycles return within a few months of starting cabergoline, individual experiences can vary widely. It is essential to maintain open communication with your healthcare provider, who can monitor your progress and make any necessary adjustments to your treatment plan. If you have any concerns or if your menstrual cycle does not resume in a reasonable timeframe, do not hesitate to reach out for further evaluation and guidance.

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