High Prolactin Levels After Miscarriage: Key Concerns

Elevated prolactin levels?

Hello Doctor, I was informed that I was pregnant in mid-March of this year, but the fetus had no heartbeat.
I underwent a surgical abortion on April 16 (the fetus had stopped developing at 6 weeks).
Since May 16, I have been experiencing pinkish discharge, which has not been heavy enough to require a pad; it is only noticeable when I wipe after using the restroom.
However, on the morning of May 29, the discharge increased and became mixed with some pink and light red, requiring the use of a pad.
On May 27, I went to the hospital and my prolactin level was found to be as high as 144.10, which has made me quite anxious.
Prior to December 31 of last year, my menstrual cycle was regular, occurring every month with heavier flow in the first couple of days and then tapering off, lasting about five days.
I did not experience any of the symptoms mentioned online, such as headaches, dizziness, or lactation, only an issue with elevated eye pressure.
However, when I had an eye exam last year, the doctor said there were no problems.

I have a few questions:
1.
Does a miscarriage affect prolactin levels?
2.
Before I was informed of my pregnancy, I did not have my menstrual period in January and February.
Is this due to the early pregnancy, or could it indicate that my prolactin levels were already abnormal?
3.
Given that my prolactin level is so high, how should I proceed?
4.
Should I continue to consult with an obstetrician-gynecologist or seek a neurologist?
Thank you for your response, Doctor.

sunny, 30~39 year old female. Ask Date: 2020/05/29

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, the prolactin level is quite high at 144.
It is advisable to consult with an obstetrician-gynecologist or a neurosurgeon for further evaluation.
Wishing you good health.

Reply Date: 2020/05/29

More Info

High prolactin levels, also known as hyperprolactinemia, can be a significant concern, especially following a miscarriage. Prolactin is a hormone produced by the pituitary gland, and its primary role is to promote lactation in women. However, elevated levels can indicate various underlying issues, and understanding the implications is crucial for your health.

1. Impact of Miscarriage on Prolactin Levels: After a miscarriage, it is common for hormone levels, including prolactin, to fluctuate. The body undergoes significant hormonal changes during pregnancy, and following a miscarriage, it may take time for hormone levels to normalize. Elevated prolactin levels can occur as the body adjusts to the loss of pregnancy. In some cases, stress and emotional trauma associated with a miscarriage can also contribute to increased prolactin levels.

2. Menstrual Cycle and Prolactin: Your history of irregular menstrual cycles prior to pregnancy could be related to elevated prolactin levels. High prolactin can disrupt the normal regulation of the menstrual cycle, leading to missed periods or irregular cycles. It is essential to consider that while pregnancy can cause temporary changes in hormone levels, pre-existing conditions such as hyperprolactinemia may have been present before conception.

3. Addressing High Prolactin Levels: A prolactin level of 144.10 ng/mL is indeed elevated, as normal levels typically range from 4 to 23 ng/mL for women, depending on the phase of the menstrual cycle. The first step in managing high prolactin levels is to identify the underlying cause. This could include factors such as stress, medications, or a pituitary tumor (prolactinoma). It is advisable to consult with an endocrinologist or a reproductive endocrinologist who specializes in hormonal disorders. They may recommend further testing, including MRI scans, to assess the pituitary gland and rule out any tumors.

4. Choosing the Right Specialist: Given your situation, it would be beneficial to continue seeing an obstetrician-gynecologist (OB-GYN) for your reproductive health concerns, while also considering a referral to an endocrinologist. An endocrinologist can provide a more comprehensive evaluation of your hormone levels and their implications. If a pituitary issue is suspected, they may also collaborate with a neurologist if necessary.

5. Management and Monitoring: Depending on the underlying cause of your elevated prolactin levels, treatment options may vary. If a prolactinoma is diagnosed, medications such as cabergoline or bromocriptine are commonly prescribed to lower prolactin levels and shrink the tumor. If the elevated levels are due to stress or other non-tumor-related factors, managing stress and monitoring hormone levels may be sufficient.

In summary, elevated prolactin levels after a miscarriage can be a complex issue that requires careful evaluation and management. It is essential to work closely with healthcare professionals to determine the cause of the elevation and to develop an appropriate treatment plan. Regular follow-ups and monitoring will be crucial in ensuring your hormonal health and overall well-being.

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