Prolactin – role, norms. Symptoms of increased prolactin

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Prolactin is a hormone produced in the pituitary gland, and the name of prolactin is associated with its first known role, which is lactation. Prolactin, however, has a wide range of activities in the human body, starting from the effect on the reproductive system, through the influence on our mood and behavior, to the regulation of the immune system.

Prolactin – role in the body

Prolactin – also called luteotropic hormone (LTH) – is a hormone that was originally named for its function of stimulating the production of milk (lactation) in mammals, which occurs in response to the breastfeeding of the pups after birth. Since then, prolactin has been shown to perform over 300 functions in the body. They can be divided into several areas:

1. reproductive,
2. metabolic,
3. fluid regulation (osmoregulation),
4. regulation of the immune system (immune),
5. regulation of behavioral functions.

In humans, prolactin is produced both in the front of the pituitary gland (the anterior pituitary gland) and elsewhere, including the uterus, breast, prostate and skin, and by immune cells and fat cells.

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See also: Prolactin in men – what is its function?

Prolactin – regulation

One of the main factors regulating the production of prolactin from the pituitary gland is another hormone, dopamine. Dopamine is produced by the hypothalamus, which is located directly above the pituitary gland. Dopamine inhibits the production of prolactin, which means that the more dopamine is secreted, the less prolactin is released. Prolactin, in turn, increases the secretion of dopamine, which creates the so-called feedback loop.

Estrogens are another important regulator of prolactin secretion. Estrogens have been shown to increase the production and secretion of prolactin from the pituitary gland. This is especially important during pregnancy, when high estrogen levels also cause prolactin levels to rise.

The concentration of prolactin also increases during breastfeeding. Interestingly, however, the concentration of prolactin also fluctuates during the day, more precisely, it increases in the second half of the night, reaches the highest value in the early morning, and then gradually decreases during the day.

The high concentration of prolactin in the blood indirectly inhibits the secretion of gonadotropins (luteinizing and follicle-stimulating hormones), which are responsible for stimulating Graff’s follicle maturation and ovulation. This means that prolactin stops menstruation by inhibiting the secretion of these hormones. Everyday situations also affect the level of prolactin, e.g. after eating food, during sex, stress.

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Prolaktyna – normy

The level of prolactin can be checked with a blood test, and it is usually a day for the result. The norms for the hormone for women differ depending on what phase of the cycle the test is performed in:

1. follicular phase – below 23 µg / l,
2. lutein phase – below 40 µg / l,
3. third trimester of pregnancy – up to 400 µg / l,

In men, the norm of prolactin is below 20 µg / l.

What do the individual prolactin norms indicate?

1. 5-25 ng / ml – correct norm,
2. over 25 ng / ml – irregular menstruation and anovulatory cycles,
3. over 50 ng / ml – there is a complete stop of menstruation,
4. above 100 ng / ml – there is a risk of a pituitary tumor.

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Read more about menstrual disorders.

Prolactin – increased levels of prolactin

Hyperprolactinemia is a condition with elevated levels of prolactin in the blood. The most common causes of hyperprolactinaemia include pregnancy, drugs that reduce the effects of dopamine in the body, hypothyroidism, and benign pituitary tumors (known as prolactinomas). Symptoms that accompany elevated prolactin levels can include:

1. disorders of the menstrual cycle (menstruation occurs more than every 25 days or less frequently than every 33 days. Over time, menstruation becomes more and more tight, until it can finally disappear altogether. Cycles can also be anovulatory, which can lead to problems with getting pregnant),
2. decreased libido, sex due to vaginal dryness is painful, Moisturizing intimate gel – compare prices
3. headaches, visual disturbances (when the pituitary tumor presses on the optic junction),
4. symptoms related to estrogen deficiency in women or testosterone deficiency in men.

The vast majority of hyperprolactinemia patients can be successfully treated with drugs that mimic the effects of dopamine. In a situation where menstrual disorders and accompanying discomfort last for a long time, a gynecologist-endocrinologist should be consulted. In particular, he or she will recommend that you check your blood prolactin levels. You should go for a prolactin test on an empty stomach, preferably from 8 to 12 o’clock. The day before the test, do not have sex, exercise or eat a hearty supper.

Too much prolactin causes your doctor to test your thyroid hormones. If the results show no hypothyroidism, the patient takes the prolactin concentration again. This procedure helps to initially determine whether the cause of the hormonal disorders is pituitary adenoma. If the examination confirms its presence, an MRI or CT scan is recommended to determine the location and size of the tumor.

Some natural substances help to lower the level of prolactin. In the form of tablets, you can use a dietary supplement with chasteberry for the hormonal balance of women.

If you have hormone problems, do a series of tests: Hormonal profile for women

Prolactin – decreased levels of prolactin

Hypoprolactinaemia is a condition in which the blood levels of prolactin are reduced. Hypoprolactinaemia is very rare and may occur in people with pituitary insufficiency.

Too low levels of prolactin can lead to insufficient milk production after delivery. Most people with low prolactin levels don’t have any particular health problemsalthough preliminary data suggest they may have a lower immune response to some infections.

How to Treat High Prolactin Levels?

There is no single effective way to reduce blood prolactin levels that are too high. The matter becomes even more complicated in the case of adenoma. It is not known why the tumor grows from glandular tissue and why it is capable of producing hormones, including prolactin. Simultaneously with the enlargement of the tumor, the amount of secreted prolactin increases. What if medications are responsible for high levels of prolactin? The doctor recommends discontinuing them or changing to another.

In diseases of the thyroid gland, kidneys or liver – basic diseases are treated, thanks to which the level of prolactin is reduced.

Most of the tumors mentioned earlier are benign tumors. Their early detection means that it is enough to take medications (eg Bromocriptine, Norprolac or Dostinex) to be absorbed after several months of therapy. If there is a situation where the tumor still exists after drug treatment, surgery must be performed. Under the upper lip, the doctor makes a small incision (in the center of the mouth), then goes into the pituitary gland and removes the tumor. Sometimes additional radiotherapy is recommended after surgery.

Many patients think that they have peace of mind for the rest of their lives after the procedure. The truth is slightly different, people after surgery have to consult an endocrinologist for the rest of their lives and monitor the level of prolactin in the body.

Hyperprolactinemia most commonly affects women between the ages of 25 and 34, and among men it occurs 4 times less frequently. The prevalence in the general population is approximately 0,4% and it is estimated to affect 10 to 90 out of 100 people. In addition, hyperprolactinaemia occurs in 000 to 15% of women with menstrual disorders.

When the levels of prolactin in the blood are too high, i.e. hyperprolactinemia, it is treated with D2 agonists, which increase the production of dopamine in the body, which in turn inhibits the production of prolactin and reduces the size of pituitary gland tumors. D2 agonists include:

1. cabergoline – used at doses from 0,25 to 2 mg per week and has fewer side effects compared to bromocriptine;
2. bromocriptine – used at a dose of 2,5 to 20 mg per day and its effects can be noticed after the first days of use, although the full effect is achieved after a few months of use. It reduces the tumor and restores the proper functioning of the gonads;
3. quinagolide – used at a dose of 75 to 300 micrograms a day. 

The above drugs are highly effective and are used in all types of hyperprolactinemia. The use of drugs can significantly reduce or even completely disappear the tumor. Once the prolactin level has equalized, the drugs should be taken in a reduced dose for another 2 to 3 years.

It should be borne in mind that the treatment of excessively high prolactin levels should begin with the discontinuation of all medications that may cause negative effects, of course, after consulting a doctor. On their own, however, a sick person may try natural supplementation and change their lifestyle to a healthier one, which is understood by maintaining a proper diet, limiting stress factors and adequate time to rest, it is also worth going out into the fresh air more often.

Prolactin levels and stress

The physiological stress response is complex; involves the release of norepinephrine from various parts of the CNS (Central Nervous System), the release of adrenaline from the adrenal medulla, and activation of the hypothalamic-pituitary-adrenal axis. The stress response also involves the release of prolactin, which is clinically important as there is substantial evidence that prolactin plays a significant role in the development of stress-induced pathology, including stress-induced epithelial barrier dysfunction, stress-induced tracheal epithelial barrier dysfunction, cardiac dysfunction in perinatal cardiomyopathy and psychological stress in the development of cardiovascular pathology.

Psychological studies have shown that hyperprolactinemia is more common in people with mental illnesses than in mentally healthy people. It is hypothesized that the increase in dopamine in psychosis may be, in part, a regulatory response to a reduction in the stress-induced increase in prolactin. There is evidence that passive coping situations increase prolactin, however, active coping situations do not affect prolactin.

In addition, exposure of a child to an absentee, alcoholic, or aggressive father may predispose women to develop hyperprolactinaemia later in life. Similarly, research conducted under hypnosis found that prolactin secretion increased with anger from humiliating experiences, while cortisol was associated with surprise and intimidation. This finding supports a complex neuroendocrine response to emotional stress.

In the field of psychiatry, there is growing interest in the potential role of prolactin as a biological marker of suicidal activity, particularly as to whether elevated postmortem prolactin levels may be associated with pre-mortem exercise. In addition, more research is needed to confirm or refute the role of prolactin in the development of psychosis.

Regarding hyperprolactinemia in emerging psychosis, women have been found to have higher levels of prolactin, even after correcting biological changes, which may suggest a gender-specific prolactin-induced stress response, which should be further elucidated.

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