Increased prolactin level – what does this mean for the desire to have children?

What is prolactin and how does it work?

Prolactin is produced in the pituitary gland, the pituitary gland. The hormone is a messenger that controls other cells and organs. Together with the hormones cortisol and insulin, it is primarily responsible for the growth of the mammary glands during pregnancy and milk production (lactation) during breastfeeding and is therefore also called the “milk production hormone”.

Influence of prolactin on fearability

In addition, prolactin interferes with the release of gonadotropin-releasing hormone (GnRH). This in turn controls and regulates the release of follicle stimulating hormone (FSH) and luteinizing hormone (LH). The hormones FSH and LH are responsible for egg maturation and ovulation. The menstrual cycle is consequently inhibited or disrupted and ovulation does not occur.

The constant stimulation of the breast by the suckling baby naturally increases the prolactin level during breastfeeding. Because of this, many women are unable to conceive while breastfeeding . In women who want to have children, however, an increased prolactin value, a so-called hyperprolactinemia, is one of the possible causes of infertility .

What causes an increased prolactin level?

An increased prolactin value can have both organic and hormonal causes.

• Breast injuries : Prolactin production in the pituitary gland is stimulated by touching or sucking on the nipple. This naturally regulates milk production during breastfeeding. In the case of injuries, scars or inflammation in the chest area, hormone production can be disturbed and the concentration of prolactin in the blood increases.
• Dysfunction of the pituitary gland : Dysfunction of the pituitary gland can lead to an abnormal overproduction of prolactin, which negatively affects ovulation and can thus be the cause of an infertility. Such a disorder can be caused, for example, by drugs, especially psychotropic drugs or certain contraceptive pills, but also painkillers, anesthetics or antihypertensive drugs. But tumors can also be the cause of the dysfunction.
• Pituitary Gland Tumors : There are several types of tumors that can be responsible for an overproduction of prolactin. Some through their placement block the production of dopamine in the pituitary gland, which normally regulates the release and production of prolactin. There are also the so-called prolactinomas, which produce prolactin independently and are therefore responsible for any excess. However, tumors occur much less frequently than the other possible causes and are mostly benign.
• Underactive thyroid : When the thyroid gland is underactive, known as hypothyroidism, the hypothalamus produces more hormones to stimulate the organ. At the same time, the released hormones lead to an increased release of prolactin.

Other factors that can be responsible for an overproduction of prolactin are, for example, stress or pain. Prolactin levels can also be elevated after sex or after meals. In addition, hyperprolactinemia often occurs as an accompanying symptom of PCO syndrome . If no cause can be found, it is called idiopathic hyperprolactinemia.

Prolactin normal values

Non-pregnant women have a prolactin level of 3.8 – 23.2 µg/l. The following prolactin levels are normal during pregnancy:

• 1st trimester: up to 75 µg/l
• 2nd trimester: up to 150 µg/l
• 3rd trimester: up to 300 µg/l

If the values ​​are above these normal values, you have an increased prolactin value.

What are the symptoms of elevated prolactin levels?

There are a number of different symptoms that can indicate an elevated prolactin level.

• Irregular Cycles : The sign that most often prompts you to seek medical attention is an irregular cycle or no cycle and consequent infertility. However, since menstrual cycle disorders can have many causes, a precise examination is essential. A so-called cycle monitoring is often carried out by the gynecologist for this purpose .
• Lactating : A symptom that clearly indicates an increased concentration of prolactin in the blood is the secretion of milk from the breasts outside the lactation period. This symptom can also occur in women who have never given birth or been pregnant.
• Androgenization : In many cases, the conversion and release of sex hormones is impaired by an increased prolactin level. The production of male hormones in the adrenal glands is favored by the high release of prolactin, while the release of female hormones is inhibited by the lack of ovulation. The result is often a lot of hair on the face and chest.

Furthermore, an increased prolactin level can manifest itself through reduced sexual desire, lumps or feelings of tension in the breasts and a pronounced premenstrual syndrome .

How is hyperprolactinemia diagnosed?

Hyperprolactinemia is a serious hormonal disorder that can usually be treated very well and effectively with medication. Such treatment is necessary, especially if you wish to have children, in order to enable normal egg cell maturation.

For the diagnosis, the gynecologist takes blood from the patient in order to be able to conclude the cause of the hormone disorder from the blood plasma or blood serum. Blood sampling should take place in the morning. This has different causes.

• Prolactin levels vary at different times of the day. While the concentration of the hormone is significantly increased at night, it falls to the normal value in the morning after getting up.
• Since prolactin levels may be elevated after eating, the patient should come to the examination on an empty stomach.

In addition, it is important to note that the examination of the breast does not take place before the blood is taken, as this can also have a negative effect on the values. The stress of drawing blood itself is also another factor that can stimulate prolactin release. If the values ​​are slightly higher, a repeat measurement is therefore advisable.

How is hyperprolactinemia treated?

Once the cause has been identified, treatment is scheduled immediately. In the case of functional causes, drugs are usually prescribed that reduce prolactin production and are also prescribed, for example, to help with weaning. Dosing is usually done gradually to avoid any side effects. The drugs usually take effect within a few days.

If functional causes can be ruled out, magnetic resonance imaging is performed to localize a possible tumor. If necessary, the field of vision is then checked, since some tumors, depending on their size, can press on the optic nerve. However, this is rarely the case. As a rule, tumors are also treated with medication. Dopamine-stimulating substances are usually used here.