Amenorrhea & Hyperprolactinemia
Amenorrhea & Hyperprolactinemia is very complicated situation which could be noted in many women suffering from absence of menstrual cycles.
Amenorrhea is the absence of periods (menstrual bleeding) for more than 6 months. Absence of periods during 2-6 months called oligomenorrhea. Amenorrhea could be primary or secondary.
Primary amenorrhea is the absence of menstrual bleeding and secondary sexual characteristics (for example, breast development and pubic hair) in a girl by age 14 years or the absence of menstrual bleeding with normal development of secondary sexual characteristics in a girl by age 16-17 years.
Secondary amenorrhea is the absence of periods in girls and women who had been menstruating but later stop menstruating for 6 or more months in the absence of pregnancy, menopause, hormonal treatment and/or hormonal contraception.
One of most common causes of amenorrhea is hyperprolactinemia (increased levels of hormone “prolactin”). In healthy women the hormone prolactin is responsible for milk production in a woman’s breasts during pregnancy and breastfeeding.
Sometimes hyperprolactinemia could develop in women without pregnancy. Possible causes of hyperprolactinemia include:
- prolactin-secreting tumor (prolactinoma),
- large pituitary tumor,
- prolonged chronic stress,
- numerous medications (phenothiazines, dopamine antagonists, antihypertensives, antiulcer drugs, estrogen oral contraceptives, opiates, cocaine),
- alcohol (especially some beers which stimulate breast milk production),
- excessive regular breast stimulation (so called “Chinese Deer exercise).
Hyperprolactinemia symptoms can vary from person to person and could include the following:
- Amenorrhea (absence of the menstrual cycles and periods);
- Galactorrhea (lactation in non-pregnant and non-breastfeeding women);
- Menstrual disorders (rare cycles, irregular cycles);
- Infertility (because of absence of periods and absence of ovulation);
- Decreased libido (decreased sexual needs);
- Vision problems (mainly because of large pituitary tumors);
- Headache/Migrane (mainly because of large pituitary tumors);
- Osteoporosis (lack of calcium in bones).
AMENORRHEA and HYPERPROLACTINEMIA
The combination of amenorrhea (mainly secondary amenorrhea) and hyperprolactinemia is the complex health condition which need immediate medical attention for specific diagnosis and in-time adequate treatment which could include:
Treatment with specific drug called ergo-bromocriptine. The dose of the drug is adjusted depending upon “how high” the levels of prolactin are. Regular intake of the drug will result in the drop in prolactin levels, regular menstrual periods and normal ovulation. These women may either ovulate on their own or may need ovulation inducing drugs.
Bromocriptine treatment should not be interrupted without consulting an endocrinologist.
Treatment with bromocriptine in combination with some ovulation stimulation hormonal drugs could be needed in cases with infertility.
Doses of all hormonal interventions should be calculated specifically for each woman.
Surgery should be considered in cases of tumors.
The effectiveness and results of tumor (prolactinoma) surgery depend a great deal on tumor size and prolactin levels as well as the skill and experience of the doctor-neurosurgeon.
After operation it may still be necessary to prescribe above mentioned hormonal treatemnt if the tumor has been incompletely removed.
It is strongly recommended for women with very high prolactin levels to seek the advice of a neurologist.
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