Hyperprolactinemia: Causes and How it affects Fertility

The fertility of a person can be affected by how much prolactin hormone they have in their blood. This hormone (Prolactin) is produced in the pituitary gland (a small gland in the middle of the head) of humans.

The hormone in a women’s body is responsible for making breast milk during pregnancy or breastfeeding and also has reproductive functions. while men have a lower level of Prolactin, its role is not clear.

You will learn more about the causes, symptoms, and treatment of hyperprolactinemia in this article. 

What is hyperprolactinemia?

We will explain this condition by breaking down the word for better understanding. Hyper means high, prolactin refers to the hormone itself, while aemia means a condition in the blood.

We can then say Hyperprolactinemia is a medical condition in which the level of prolactin in the blood is high.

How prolactin is regulated

• The release of prolactin is regulated by Dopamine, Which inhibits the release of prolactin
• Thyrotropin-releasing hormone (TRH) actually upregulates the release of prolactin hormone.
• Prolactin hormone itself inhibits Gonadotrophin-releasing hormone (GnRH)
• GnRH acts on the anterior pituitary gland to release follicle-stimulating hormone and luteinizing hormone which are important in gonadal functioning (reproductive gland such as ovary or testis)

Normal levels of prolactin in women are less than 25 ng/mL while in men is less than 17 ng/mL

What are the causes of hyperprolactinemia? 

Physiological causes of hyperprolactinemia

These causes are transient meaning they are temporary in nature so they may not cause some of the symptoms that will be listed here. they include:

• Exercise
• lactation
• pregnancy
• sleep
• physical stress
• sexual activity

All these can lead to an elevated level of prolactin.

Pathophysiological causes of hyperprolactinemia

This is where the problem occurs, they include :
1) Pituitary conditions like

• Having a prolactinoma, an overproduction of prolactin in the pituitary gland caused by a non-cancerous tumor on the gland. Prolactinoma leads to a decrease in some sex hormones.
• Acromegaly can also cause hyperprolactinemia
• Cushing’s disease

2) Hypothyroidism

3) Renal failure, liver failure.
4) Medication e.g. anti-dopaminergic, anti-psychotics, antihypertensive etc.
4) Polycystic ovary syndrome (PCOS)

When will a prolactin level test be recommended for a person

• Produces breast milk when not pregnant or breast-feeding
• Has symptoms (Headaches, Vision problems, Unexplained tiredness, Mood changes, Irritability, Changes in menstrual cycles) of growth on the pituitary gland called a prolactinoma
• Has another pituitary disorder
• Experiences infertility or irregular periods
• Has a medical condition that affects how much dopamine they make.

How prolactin levels affect fertility

High prolactin levels in the blood for women can stop the ovaries from making the hormone estrogen which is responsible for maintaining the reproductive system. A low level of estrogen can result in irregular periods or stop periods completely, reduce sex drive, and cause vaginal dryness. All this will make it challenging to get pregnant.

High levels of prolactin in men can stop testes from producing the hormone testosterone which may result in erectile dysfunction and low sex drive. this may cause infertility.

Symptoms of hyperprolactinemia

Symptoms in females:

• infertility
• irregular periods
• change in menstrual flow
• pause in the menstrual cycle
• loss of libido
• lactation (galactorrhea)
• pain in breasts
• vaginal dryness

Symptoms in males:

• abnormal breast growth (gynecomastia)
• lactation
• infertility
• erectile dysfunction
• loss of sexual desire
• headaches
• vision change

Conclusion

It is normal for prolactin levels to increase in pregnant women and breastfeeding mothers. while for others, It may indicate an underlying health condition.

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