Therapy for hyperprolactinemia depends on the causes, the level of serum prolactin, and, in the case of existing prolactinomas (see surgical therapy for details), their extent.
Therapy goals
- Improvement of the symptomatology
- Regression of the prolactinoma
Therapy recommendations
Hyperprolactinemia in reproductive age in the absence of a current desire to have children.
- Prolactin inhibitors (dopamine antagonists):
- Pronounced nuisance galactorrhea (abnormal breast milk discharge) and/or mastalgia (breast pain).
- Proliferation inhibition in pituitary adenoma (benign tumors arising from the cells of the anterior lobe of the pituitary gland (adenohypophysis)).
- Ovulation inhibitors – when contraception (birth control) is desired:
- Estrogen-progestin combinations are preferable to progestin-only contraception if bleeding abnormalities (bleeding disorders)or an estrogen deficit is detectable
- Estrogen-progestin sequential preparations or estrogen-progestin contraceptives in bleeding abnormalities:
- Unless locally or systemically caused and after exclusion of nondocrine causes.
- For symptomatic regulation of abnormal bleeding.
- Estrogen or estrogen-progestin substitution – for hyperprolactinemia with an estrogen deficit (e.g., hypogonadotropic amenorrhea). This avoids or reduces the risk of osteopenia (reduction in bone density)or osteroporosis (bone loss) in chronic hyperprolactinemia.
- Cyclically administered progestin (eg, 15th-26th day of cycle, transformation dose) in:
- Prophylaxis of bleeding disorders
- Endometrial hyperplasia (benign proliferation of the endometrium); ovarian dysfunction with progesterone formation/effects without endometrial hyperplasia does not require treatment.
Hyperprolactinemia in reproductive age in current childbearing or prolactioma.
- Prolactin inhibitors (dopamine antagonists) Duration of therapy: at least 4 years (due tohigh recurrence rate up to 50% in macroadenomas)Discontinuation of therapy if:
- Normal PRL level for at least 2 years.
- No tumor or a reduction in tumor size of at least 50% on (magnetic resonance imaging) MRI.
After discontinuation of therapy, PRL control examinations should be performed every 3 months for the first year, then annually for 5 years.
During pregnancy
- Growth risk is 2-2.5% for microadnomas and up to 31% for macroprolactinomas.
- If pregnancy is detected, discontinuation of medication is recommended because of adverse effects of dopamine antagonists on fetal development, which cannot be ruled out.
In menopause
- Hyperprolactinemia rarely occurs in postmenopausal women.
- It is unclear whether postmenopausal prolactinomas should be treated; if treated primarily conservative.
