Hyper­pro­lacti­naemic ovarian insuf­fi­ciency

In hyperprolactinaemia, the level of the hormone prolactin in the blood is raised. Normally, prolactin stimulates milk production in mothers who have just given birth. Through a negative feedback mechanism, high prolactin levels stop the hypothalamus from producing GnRH (gonadotrophin-releasing hormone). This in turn blocks the release of the pituitary gonadotrophins (FSH, LH), so the ovaries do not work properly. The higher the prolactin level rises, the greater the ovarian dysfunction.
This is useful in the weeks after childbirth (a woman does not easily become pregnant while she is breastfeeding), but on the other hand it causes irregular cycles and infertility.

• Organic hyperprolactinaemia, caused by macroprolactinomas of the pituitary gland.

With prolactin levels above 50 ng/ml, a prolactinoma is very likely to be the cause. Today the diagnosis is made with magnetic resonance imaging (MRI). Depending on their size, prolactinomas are classed as microprolactinomas or macroprolactinomas.

Treatment. Most prolactinomas are treated with medicines that suppress the release of prolactin (and shrink the prolactinoma). If there are neurological problems (e.g. a narrowing of the visual field) or the medicines do not work, surgery is recommended.

• Functional hyperprolactinaemia.

So-called functional hyperprolactinaemia is more common. Prolactin levels are below 50 ng/ml. Many factors and various other influences cause fluctuations in the release of prolactin. The most common causes of functional hyperprolactinaemia are:

• Hyperprolactinaemia accompanying hypothyroidism or hyperandrogenaemia (increased production of male hormones)
• Taking medicines (neuroleptics, antidepressants, antacids, blood pressure medicines, tranquillisers, etc.)
• Stress during sleep
• Stimulation of the nipples after sexual intercourse

Treatment. First, the underlying cause is treated.

If the irregular cycles and the cycles without ovulation continue after the cause has been treated, treatment with medication is advisable.

Hope for pregnancy

Keeping prolactin at normal levels results in normal ovulatory cycles and so increases the chances of the pregnancy you are hoping for.