Pregnancy and Prolactin Levels: Your Questions Answered

Pregnancy and lactation hormones?

On February 9th, the first day of my menstrual period started.
I had intimate contact on February 20th, but there was no penetration or ejaculation, just finger touching.
My period was expected on March 9th, but it didn't arrive until March 12th.
Concerned about abnormal bleeding, I took a pregnancy test after my period ended, which showed one line (negative).
On March 24th, I went to the hospital for a blood test and an abdominal ultrasound, but nothing significant was found.
On April 2nd, I returned for my results, which indicated a prolactin level of 135.
The abdominal ultrasound showed no abnormalities, and I was prescribed medication to lower my prolactin levels (two pills per week).
After taking two pills, I visited another obstetrician-gynecologist on April 10th.
The doctor stated that a prolactin level over 100 would make menstruation unlikely.
An abdominal ultrasound was performed again, and it showed no signs of pregnancy (only an ultrasound, no pregnancy test).
The doctor asked if I had any milk secretion, and I mentioned that I only experienced some discharge resembling acne when pressed.
The doctor said that was normal, conducted a visual examination, and concluded that everything was fine.
A new blood test was done, and the result was 3.06.
I was speechless.
My period started on April 11th.
Since some people say that one can still be pregnant while menstruating, I am very worried.
Q1: Is it possible that I am pregnant?
Q2: Can taking just two pills cause a significant drop in prolactin levels?
Q3: Can an abdominal ultrasound detect pregnancy at this time? If it shows no pregnancy, can I be completely certain?
Q4: Do I still need to take a pregnancy test? If so, how long until I can completely rule it out?

Yang, 10~19 year old female. Ask Date: 2018/04/15

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On February 9, the first day of menstruation was noted.
There was intimate contact on February 20, but there was no penetration or ejaculation, only finger stimulation.
Menstruation was expected on March 9, but it did not occur until March 12.
Concerned about abnormal bleeding, a pregnancy test was conducted after the bleeding ended, which resulted in one line (negative).
On March 24, a blood test and abdominal ultrasound were performed at the hospital, which did not reveal anything significant.
During a follow-up appointment on April 2, it was reported that prolactin levels were as high as 135.
The abdominal ultrasound showed no abnormalities, and medication to lower prolactin levels was prescribed (two pills per week).
After taking two pills, I visited another obstetrician-gynecologist on April 10, who stated that having prolactin levels over 100 would make menstruation unlikely.
Another abdominal ultrasound was performed, confirming no pregnancy (only an ultrasound, no pregnancy test).
The doctor inquired about any milk secretion, to which I replied that there was only a slight discharge resembling acne when pressure was applied.
The doctor indicated that this was normal, conducted a visual examination, and found nothing concerning.
A new blood test was performed, and the prolactin level dropped to 3.06, leaving me speechless.
Menstruation began on April 11.
Since some people mentioned that it is still possible to become pregnant during menstruation, I am very anxious.
Q1: Is it possible that I am pregnant?
A: No, it is not possible to be pregnant.
Q2: Will taking only two pills cause a sudden drop in prolactin levels?
A: Taking only two pills will not cause a sudden drop in prolactin levels.
Q3: Can an abdominal ultrasound detect pregnancy at this time? If it shows no pregnancy, can it be completely confirmed?
A: A negative pregnancy test (one line) and an abdominal ultrasound showing no pregnancy can completely confirm that there is no pregnancy.
Q4: Do I still need to take a pregnancy test? If I do, how long until I can completely rule it out?
A: There is no possibility of pregnancy from the described activities (no penetration, no ejaculation, only finger stimulation).

Reply Date: 2018/04/15

More Info

Understanding the complexities of pregnancy, hormonal levels, and the implications of various medical treatments can be quite overwhelming. Based on your questions regarding prolactin levels, potential pregnancy, and the effects of medication, let’s break down your concerns systematically.

Q1: Could I be pregnant despite having my period?
While it is possible to experience bleeding during pregnancy, it is generally not considered a true menstrual period. The bleeding you experienced on April 11 could be a withdrawal bleed due to hormonal changes or the medication you were taking to lower your prolactin levels. If you had a negative pregnancy test and your healthcare provider confirmed that your ultrasound did not show signs of pregnancy, it is less likely that you are pregnant. However, if there is any doubt, a follow-up pregnancy test can provide clarity.

Q2: Can taking just two pills significantly lower my prolactin levels?
Yes, taking medication designed to lower prolactin levels can lead to a rapid decrease in those levels, especially if the medication is effective. Prolactin levels can fluctuate based on various factors, including stress, sleep, and hormonal changes. It’s important to follow your healthcare provider's instructions regarding medication and to have follow-up blood tests to monitor your prolactin levels.

Q3: Can an abdominal ultrasound detect pregnancy at this stage?
An abdominal ultrasound can sometimes detect pregnancy as early as six weeks, but it is more reliable around eight weeks or later. If your ultrasound was performed before this timeframe, it may not have been able to detect a pregnancy even if one existed. If your healthcare provider indicated that there were no signs of pregnancy, it is likely accurate, but keep in mind that very early pregnancies can sometimes be missed.

Q4: Should I take a pregnancy test, and when can I be sure?
If you have had a negative pregnancy test and your healthcare provider has confirmed that there are no signs of pregnancy, you may not need to retest immediately. However, if you have any symptoms of pregnancy or if your menstrual cycle does not normalize, it would be prudent to take another test. Generally, it is recommended to wait at least a week after a missed period for the most accurate results. If you are still unsure, consulting with your healthcare provider for further testing or evaluation is advisable.

Additional Considerations
High prolactin levels can affect menstrual cycles and fertility. Prolactin is a hormone produced by the pituitary gland, and elevated levels can lead to irregular menstrual cycles or amenorrhea (absence of menstruation). It is crucial to address the underlying cause of high prolactin, which could be due to various factors, including stress, medication, or a prolactinoma (a benign tumor of the pituitary gland).

If you are experiencing unusual symptoms, such as milk production outside of breastfeeding, it is essential to discuss these with your healthcare provider. They may recommend further testing to rule out any underlying conditions.

In summary, while your concerns are valid, the combination of your menstrual history, ultrasound results, and hormonal levels suggests that you are likely not pregnant. However, continuous monitoring and communication with your healthcare provider are key to managing your health effectively. If you have further questions or concerns, do not hesitate to reach out to your healthcare provider for personalized advice and support.

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