How Long Should You Wait to Retest Prolactin Levels After Medication Change?

How long should I wait to follow up after elevated prolactin levels?

Hello, doctor.
At the beginning of this month, I discovered that there was a small amount of milk when I compressed my breast.
I went to the obstetrics and gynecology department and had my prolactin level tested, which was 347.
Additionally, since June, I have been intermittently taking stomach medication due to stomach pain and underwent an endoscopy.
During this time, I mentioned it to a gastroenterologist, who said that the stomach medication he prescribed could cause lactation and advised me not to worry.
I have since switched to a different stomach medication (but I forgot to ask if this new medication could also cause lactation).
If the new medication does not cause lactation, how long should I wait before testing my prolactin levels again? I have stopped taking the original medication for about four days now, and I still notice milk when I compress my breast while showering.
I am a bit concerned about the possibility of a pituitary tumor.
How long should I wait before getting checked again, or do you have any other recommendations? Thank you.

Xiao Yu, 40~49 year old female. Ask Date: 2020/07/19

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, please observe for about two more weeks and it is recommended to have another blood test.
If the levels are still high, further examination will be necessary.
Wishing you good health.

Reply Date: 2020/07/19

More Info

When it comes to retesting prolactin levels after a medication change, the timing can vary based on several factors, including the specific medication involved, the half-life of the drug, and the individual patient's response. In your case, since you have recently switched from a medication that may have elevated your prolactin levels, it is generally advisable to wait at least 1-2 weeks before retesting. This allows enough time for the previous medication to be cleared from your system and for your prolactin levels to stabilize.

Prolactin is a hormone produced by the pituitary gland, and its levels can be influenced by various factors, including stress, sleep, and certain medications. Some medications, particularly those that affect dopamine pathways (like certain antipsychotics and gastrointestinal medications), can lead to increased prolactin levels. Since you mentioned that your previous medication was associated with this side effect, it is crucial to ensure that the new medication does not have similar effects.

If you are still experiencing milk discharge from your breasts after four days of stopping the previous medication, it is understandable to be concerned. While it is possible for some residual effects to linger, persistent discharge could warrant further investigation. It is essential to monitor any additional symptoms you may experience, such as headaches, vision changes, or menstrual irregularities, as these could indicate a more serious condition, such as a prolactinoma (a benign pituitary tumor that secretes prolactin).

In terms of next steps, I recommend the following:
1. Wait 1-2 Weeks for Retesting: After switching to the new medication, wait at least one to two weeks before retesting your prolactin levels. This timeframe allows for the previous medication to clear from your system and gives a more accurate reflection of your current hormonal status.

2. Consult Your Doctor: If you continue to experience milk discharge or have any other concerning symptoms, it is essential to follow up with your healthcare provider. They may recommend imaging studies, such as an MRI of the pituitary gland, to rule out any structural abnormalities.

3. Discuss New Medication: When you see your doctor, inquire specifically about the new medication you are taking for your stomach issues. Ask if it has any potential side effects related to prolactin levels. Understanding the pharmacological profile of your current medications can help you manage your health better.

4. Monitor Symptoms: Keep track of any changes in your symptoms, including the frequency and amount of discharge, as well as any other physical changes. This information will be helpful for your healthcare provider in assessing your condition.

5. Lifestyle Considerations: Stress, sleep disturbances, and certain dietary factors can also influence prolactin levels. Ensure you are managing stress effectively and maintaining a healthy lifestyle, which can contribute to hormonal balance.

In summary, while it is reasonable to wait 1-2 weeks after changing medications to retest prolactin levels, it is equally important to remain vigilant about your symptoms and maintain open communication with your healthcare provider. If you have any concerns or if symptoms persist, do not hesitate to seek medical advice sooner. Your health and peace of mind are paramount, and addressing these issues proactively is the best approach.

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