Irregular Periods: Causes of Elevated Prolactin Levels and Symptoms

Menstrual issues

Hello doctor, my menstrual cycle has been irregular for the past few months, but I did have my last period on August 2, which lasted about a week.
In September, I experienced premenstrual symptoms, including a few pimples on my chin, and I noticed some pinkish discharge in my underwear, but my period has not arrived.
I previously visited a gynecologist who mentioned that my prolactin level was slightly elevated at 27, but I shouldn't worry too much.
However, I am concerned about the possibility of my prolactin levels rising further.
What are the reasons for elevated prolactin levels? Could the pinkish discharge indicate the onset of my period? Should I wait a few more days or see a doctor? Thank you!

Cindy, 20~29 year old female. Ask Date: 2018/09/04

Dr. Huang Jianzhong reply Obstetrics and Gynecology

I have been experiencing irregular menstruation for several months, with my last period starting on August 2 and lasting about a week.
In September, I noticed premenstrual symptoms, including a few pimples on my chin and some pinkish discharge in my underwear, but my period has not arrived.
I previously visited a gynecologist who mentioned that my prolactin level was 27, which is slightly above normal, but I shouldn't worry too much.
However, I am concerned about the possibility of my prolactin levels rising.
What could cause an increase in prolactin levels?
Answer: A prolactin level of 27 is not considered elevated.
The pinkish discharge could indicate the onset of menstruation.
Should I wait a few more days or see a doctor?
Answer: The pinkish discharge may be a sign of menstruation.
It would be better to wait a few more days.

Reply Date: 2018/09/04

More Info

Elevated prolactin levels can be a source of concern for many individuals, especially when experiencing irregular menstrual cycles. Prolactin is a hormone produced by the pituitary gland, and its primary function is to promote breast milk production after childbirth. However, elevated prolactin levels, a condition known as hyperprolactinemia, can occur due to various reasons and can lead to menstrual irregularities, such as missed periods or changes in menstrual flow.

Causes of Elevated Prolactin Levels
1. Physiological Causes: Prolactin levels can naturally increase during pregnancy and breastfeeding. Even stress, sleep, and exercise can cause temporary spikes in prolactin levels.

2. Medications: Certain medications, particularly antipsychotics, antidepressants, and blood pressure medications, can increase prolactin levels. If you are taking any medications, it’s worth discussing with your healthcare provider.

3. Pituitary Disorders: Prolactinomas, benign tumors of the pituitary gland, can lead to significantly elevated prolactin levels. These tumors can cause symptoms such as headaches or vision changes, but some individuals may be asymptomatic.

4. Hypothyroidism: An underactive thyroid can lead to increased prolactin levels. Thyroid hormones play a crucial role in regulating prolactin secretion, and hypothyroidism can disrupt this balance.

5. Other Health Conditions: Conditions such as chronic renal failure, liver cirrhosis, and chest wall trauma or irritation can also lead to elevated prolactin levels.

Symptoms of Elevated Prolactin Levels
Elevated prolactin can lead to a variety of symptoms, including:
- Irregular or absent menstrual periods (amenorrhea)
- Galactorrhea (unexpected milk production)
- Infertility
- Decreased libido
- Symptoms of estrogen deficiency, such as vaginal dryness

Your Situation
In your case, you mentioned that your prolactin level was slightly elevated at 27, which may not be significantly concerning, especially if your doctor advised you not to worry. However, it’s essential to monitor your symptoms closely. The presence of premenstrual symptoms, such as breast tenderness or acne, along with the pinkish discharge, could indicate that your body is preparing for menstruation, but it does not guarantee that your period will arrive.

The pink discharge you are experiencing could be related to hormonal fluctuations, ovulation, or even the onset of your menstrual cycle. It’s not uncommon for some women to experience spotting or light discharge before their period begins. However, if this discharge continues without a full menstrual flow, or if you have additional concerns, it would be prudent to consult your healthcare provider.

Next Steps
1. Monitoring: Keep track of your menstrual cycle, any changes in discharge, and any other symptoms you may experience. This information can be helpful for your doctor.

2. Follow-Up: If your period does not arrive soon, or if you experience any new or worsening symptoms (such as severe headaches, vision changes, or galactorrhea), it would be wise to return to your healthcare provider for further evaluation. They may recommend additional tests, such as thyroid function tests or imaging studies of the pituitary gland, to rule out any underlying conditions.

3. Lifestyle Considerations: Stress management, regular exercise, and a balanced diet can help regulate hormonal levels and may improve menstrual regularity.

In conclusion, while elevated prolactin levels can be concerning, they are often manageable with appropriate medical guidance. It’s essential to maintain open communication with your healthcare provider and to seek further evaluation if your symptoms persist or worsen.

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