High Prolactin Levels: Impacts on Fertility and Health

Will it cause infertility?

Hello Doctor, last year I experienced milk secretion from my breasts (only when I applied pressure).
I went to the obstetrics and gynecology department, and my prolactin hormone level was as high as 117.
I took medication for three months, and on the night I stopped the medication, I had blood drawn.
A week later, the report showed it had dropped to 13.
However, after stopping the medication for two weeks, I still noticed a small amount of clear fluid when I applied pressure to my breasts.
Does this mean I need to continue taking the medication? I visited a neurosurgeon, but they did not order an MRI.
Is there a reason they would wait until my levels are as high as 400 or 500 before doing so? Additionally, I have been monitoring my basal body temperature, which has remained stable, neither high nor low.
Over the past six months, my menstrual flow has suddenly stopped after the second day (previously it lasted two to three days).
Could this be related to high prolactin levels or issues with the pituitary gland? Will this affect my fertility? Can a pituitary tumor be life-threatening? What should I do? I plan to get married in two years.

qaz700510, 20~29 year old female. Ask Date: 2009/02/04

Dr. Chen Changfu reply Obstetrics and Gynecology

Functional hyperplasia of pituitary gland cells with elevated prolactin levels can inhibit ovulation, leading to amenorrhea, menstrual irregularities, and infertility.
If you are aware of having hyperprolactinemia, experiencing irregular menstruation, and facing infertility issues after marriage, it is advisable to seek treatment at a reproductive endocrinology clinic.
An increase in the size of a pituitary tumor may result in neurological compression symptoms and damage.
The physician will arrange necessary medical examinations based on the symptoms and clinical assessment.

Reply Date: 2009/02/04

More Info

High prolactin levels, also known as hyperprolactinemia, can significantly impact fertility and overall health. Prolactin is a hormone produced by the pituitary gland, and its primary role is to promote breast milk production after childbirth. However, elevated levels of prolactin can lead to various reproductive issues, including menstrual irregularities, anovulation (lack of ovulation), and infertility.

In your case, the initial prolactin level of 117 ng/mL is considered significantly elevated, as normal levels typically range from 5 to 25 ng/mL for women. The subsequent drop to 13 ng/mL after three months of medication indicates a positive response to treatment, but the presence of transparent fluid from the breast upon manual stimulation suggests that prolactin levels may still be somewhat elevated or that there may be other underlying issues.

The relationship between high prolactin levels and menstrual irregularities is well-documented. Elevated prolactin can inhibit the secretion of gonadotropin-releasing hormone (GnRH), which in turn affects the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This disruption can lead to irregular menstrual cycles and difficulties in conceiving. Your observation of a shortened menstrual period, where bleeding stops abruptly after just one or two days, could indeed be related to your prolactin levels or possibly other hormonal imbalances.

Regarding your concerns about a potential pituitary tumor, known as a prolactinoma, it is essential to understand that not all cases of elevated prolactin are due to tumors. Other factors, such as stress, certain medications, and thyroid dysfunction, can also lead to increased prolactin levels. If a prolactinoma is present, it can sometimes lead to complications, but many individuals with this condition can manage it effectively with medication. The decision to perform imaging studies, such as an MRI, is typically based on the clinical presentation, the degree of prolactin elevation, and other symptoms. If your prolactin levels were significantly higher (e.g., in the range of 400-500 ng/mL), it might warrant further investigation.

As for your fertility concerns, it is crucial to address the underlying causes of your elevated prolactin levels. Continuing medication may be necessary if your prolactin levels do not stabilize or if you continue to experience symptoms. It is advisable to maintain regular follow-ups with your healthcare provider to monitor your hormone levels and adjust treatment as needed.

In the meantime, consider discussing with your doctor the possibility of additional tests to evaluate your overall hormonal profile, including thyroid function and other reproductive hormones. Lifestyle factors, such as stress management, maintaining a healthy weight, and a balanced diet, can also play a role in regulating hormone levels and improving fertility.

Lastly, while the prospect of a pituitary tumor can be concerning, it is essential to focus on the management of your current symptoms and hormonal imbalances. With appropriate medical care and monitoring, many individuals with elevated prolactin levels can achieve successful pregnancies. If you have plans to marry in the next two years, addressing these health concerns proactively will be beneficial for your reproductive health. Always consult with your healthcare provider for personalized advice and treatment options tailored to your specific situation.

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