Prolactin

Prolactin is a protein hormone and is also known as 'milk hormone', PRL and luteotropic hormone. It plays a role in lactation, metabolism and regulation of the immune system. The production of Prolactin is controlled by another hormone called as dopamine. Estrogen is also another prolactin regulator.

Normal Prolactin levels

Women: 2 to 29 ng/mL

Pregnant Women: 10 to 209 ng/mL

Men: 2 to 18 ng/mL

Prolactin levels are an indicator of a person's fertility.

Prolactin levels of between 30 ng/mL and 200 ng/mL are considered moderately high. Elevated prolactin levels or hyperprolactinaemia can be attributed to Hypothyroidism, pregnancy, prolactinoma (pituitary tumor), estrogen deficiency (females), testosterone deficiency (men), medications affecting dopamine action, anorexia, PCOS or menstrual irregularities. When prolactin levels are high, infertility might occur due to lack of ovulation. Men might suffer erectile dysfunction.

Reduced prolactin levels or hypoprolactinaemia are very rare. It can happen due to medication such as levodopa and dopamine. Hypopituitarism is also another cause for low prolactin levels. It can lead to delayed puberty and growth or premature aging.

Prolactinoma

A prolactinoma is a benign pituitary tumor that causes excess secretion of prolactin. It is more likely to occur in women than in men. Prolactinoma can lead to cessation of menstrual cycle, abnormal milk discharge, vision problems and infertility in women. In men, the symptoms are headaches and vision changes, impotence, infertility and reduced sexual interest. It also leads to lowered bone density for women and men.

To treat prolactinoma, blood tests are done to check the levels of other pituitary hormones. MRI of the brain is done to detect the tumor. Prolactinoma less than 10 mm are called microprolactinomas while the larger ones are called macroprolactinomas. Oral medications most often can reduce prolactin production and provide relief. Some medications such as dopamine agonists can shrink the tumor. Cabergoline and bromocriptine are commonly prescribed to reduce tumors and normalize prolactin levels. Surgery is resorted to based on the size and location of the tumor.

Sedatives

Antihistamines

Antihistamines are widely used for allergies and motion sickness. As they exhibit properties that can indirectly induce drowsiness, there is a class of antihistamines, sold as OTC sleeping pills. However, the American Academy of Sleep Medicine warns that such pills should be used only occasionally. Beware that there is a price to pay for buying OTC antihistamines. Some OTC sedatives combine antihistamines with pain relievers and some combine it with alcohol.

They can induce abnormal muscle spasms. Other side effects are blurred vision, constipation, diarrhea, nausea and vomiting, dry mouth and general dehydration. Therefore she needs to consume plenty of water if she is taking any antihistamine. In elders and children, antihistamines can cause nervousness and insomnia. Similarly, asthmatics should steer clear of antihistamines as these can aggravate their condition. They can affect the behavior of the fetus in the womb. Antihistamines also interfere with lactation. Be warned that OTC antihistamines should never be clubbed with alcohol or other sedatives.

Although it is construed that some antihistamines are non prescription sleep aids, and they are more sedating than prescription hypnotics, beware that their effectiveness may decrease over time. More importantly, OTC sedative is only meant for short-term insomnia and by and large the long term effectiveness and safety of the OTC drugs is questionable. However, for transient insomnia or insomnia based on illness or depression, antihistamines can be an effective OTC tool.

Sedative antihistamine list includes (the following list also contains suggested dosage for an adult. Always take the medications e.m.p (ex modo prescripto as directed by the physician):

• Chlorpheniramine (Chlor-Trimeton) 4 mg every 4 to 6 hrs; maximum dose: 24 mg/day
  
  
• Cyproheptadine (Periactin) , 4 mg at bedtime
  
  
• Clemastine (Tavist), 50-100 mg every 4-6 hours, not to exceed 400 mg/day and it is supplied in table form chewable
  
  
• Diphenhydramine (Benadryl), as a night sleep aid to be taken 30 minutes before bedtime, and the dosage is 50 mg for adults
  
  
• Promethazine (Phenergan) Sedation: 25-50 mg orally or 50 mg rectally
  
  
• Hydroxyzine (Atarax, Vistaril), oral sedation dosage 50-100 mg, IM 25-100 mg. Intravenous (IV), subcutaneous and intra-arterial administrations are not recommended as these can cause thrombosis and digital gangrene.
  
  

These come in various brand and trade names and they can be taken as tablets, syrups or nasal sprays. Droplet form for use in the eyes is also available. The effects of these antihistamines including drowsiness, dizziness, headache, loss of appetite, vision changes, irritability, dry mouth, stomach upset should subside, when the body begins to adjust with the medication. If these side effects continue, it is better to contact the medical practitioner. Sedative antihistamines may be taken with food and milk. Sustained release low acting tablets can be swallowed whole as chewing the sustained release long acting tablets may destroy the action and increase the side effects. Chewable tablets can be chewed thoroughly and swallowed. Suspensions should be shaken before food consumption.

Melatonin

This is a hormone produced by human body – by the pineal gland, a pea-sized structure at the center of the brain. This regulates sleep and wakefulness. Taken as a supplement, melatonin helps to reduce delayed sleep syndrome. This also improves sleep quality and lengthens the period of sleep. Day time alertness also seems to improve when this is taken. Melatonin can treat insomnia without altering the sleep pattern of the individual. It also does not impair any performance related skills.

This may help elders with insomnia as the amount of melatonin produced in the body seems to decrease as one gets older, although it is not recommended for chronic insomnia. Melatonin works on the circadian rhythm – the biological clock that regulates our sleep and wake cycles. Many become melatonin deficient due to age, work schedules and stress. Melatonin supplements are a quick way to adjust the lack of melatonin in the body and rebalance the sleep cycle. These are available OTC and when used in conjunction with herbs like chamomile and lemon balm, help lull the body to sleep acting as a true sedative.

Although Melatonin shows good effects for the treatment of insomnia, if used in excess, this sedative can produce side effects including sexual irregularities, mood swings and depression. Although by and large safe when used in moderation, it is unsafe for small children and pregnant women to use melatonin supplements. It is also not recommended for those with lymphoma, extreme allergies, depression, rheumatoid arthritis, auto immune diseases and for cancer patients. Some melatonin sedatives include:

• clonazepam (Klonopin)
  
  
• lorazepam (Ativan)
  
  
• phenobarbital (Donnatal)
  
  
• zolpidem (Ambien)
  
  

As such Melatonin can cause sleepiness and drowsiness, and if taken with sedatives that cause sleepiness, then too much of sleepiness can result. Research indicates that quick release Melatonin can be more effective than sustained-release formulations, especially when used as sedatives. Intramuscular injections of 20 mg of Melatonin are also available.

SAMe

This is also found naturally in the body. This OTC aid can not only help to sleep but also treats depression and chronic fatigue by promoting serotonin production in the body. Unless consumed in large quantities, SAMe has no known side effects.

Antidepressants used as sedatives

Although the FDA has not approved the use of antidepressants as sedatives, there are those who believe that insomnia is related to depression. As with any other medication for depression, there is a significant risk of suicidal thoughts particularly in adolescents and children. Approximate dosage of antidepressants s.o.s (si opus sit only if there is a need) :

Citalopram 20 mg
Escitalopram 5-10 mg
Fluvoxamine 100 mg
Fluoxetine 20 mg
Paroxetine 20 mg
Sertraline 50-75 mg
Venlafaxine 75 mg
Donormyl sleeping pills are available without prescription and they are approved by the FDA for non-prescription. They are used in the treatment of insomnia. 25 mg of Donormyl is the strongest non-prescription sleeping pill. Possible common side effects of antidepressant sedatives include diarrhea, dizziness, headache, insomnia, rash, vomiting, blurred vision, decreased appetite, cold symptoms, nervousness, cramps, hallucinations, hair loss and decreased coordination.

OTC sedatives side effects

Although OTC sedatives can be effective for an occasional sleepless night, the longer you take them, the less they are likely to make you sleepy. OTC sleep aids can leave you feeling groggy and unwell the next day. This is like the 'hangover' effect. Much remains unknown about the safety and effectiveness of OTC sleep aids.

Dizziness and forgetfulness, clumsiness, feeling off balance, dry mouth and throat are some common side effects. Serious risks of OTC sedatives include severe allergic reaction, facial swelling, memory lapses, hallucinations, suicidal tendencies, sleep-related complexities such as sleep-walking, sleep-driving, and sleep-eating. If any unusual sleep-related behavior is exhibited, consult the doctor immediately.

Over-the-counter sedative tips

• Consult the doctor before taking OTC sedative, although you do not need the doctor concurrence to buy an OTC drug. This is because your doctor can make sure that the sedative does not interfere with other underlying medications.
  
• Certain OTC drugs are not recommended for those with glaucoma, asthma, chronic pulmonary disorders, liver diseases and urinary retention.
  
• Remember that OTC sedatives are only a temporary solution for insomnia and they are not intended to be used for longer than about two weeks.
  
• Persistent insomnia is a symptom of an underlying medical or psychological problem. These cannot be cured with OTC sedatives. It is better to learn about safer and effective way of end sleepless nights.
  
• Never mix alcohol with sedatives and this can increase the sedative effects of the medication.
  
• Combining medications such as OTC sedatives and pain relievers and allergy medicines is very dangerous.
  
• Do not drive or attempt any other activity that may require alertness while taking a sedative.
  
• Over a period of time, you may build up intolerance to sedatives and this can in turn lead to more side effects.
  
• You may also come to rely on sedatives and will be unable to sleep without them.

Breast Density

Breast density compares the amount of fat in the breast to the amount of tissue present. It is a measure used to describe mammogram images and is not a measure of how the breast feels (breast size and firmness). Breast tissue is made up of milk gland, milk ducts and supportive tissues (dense breast tissue) and fatty tissue (non- dense breast tissue).

Higher breast density indicates that the breast and connective tissue are denser when compared to the fat present in the breast. Lower breast density indicates more fat when compared to breast and connective tissue.

BIRADS or BI-RADS means Breast Imaging Reporting and Data System - a standard established by the American College of Radiology. This helps place findings from mammogram screenings into well-defined categories:

BI-RADS type 1: fatty; breast is almost entirely fat. Glandular tissue is less than 25%.

BI-RADS type 2: scattered fibroglandular; breast has scattered areas of fibroglandular density.

BI-RADS type 3: heterogeneously dense; breast tissue is heterogeneously dense.

BI-RADS type 4: dense; breast tissue is extremely dense. The breast contains greater than 75% glandular and fibrous tissue.

Dense breasts may be common and may not always pose a health issue. However women with high breast density are more prone to breast cancer when compared to women with low breast density. It is unclear as to why dense breasts may be more cancer prone. In a few cases women with low breast density are prone to develop breast cancer due to aging or menopause. 2/3 of pre-menopausal and 1/4 of post menopausal women (40%) have dense breast tissue.

A mammogram helps in identifying the density of breast. Women with dense breasts have more dense tissue than fatty tissue. Dense breasts look white or grey. Thus for women with dense breasts it may be difficult to identify cancer using a mammogram as both the dense breast tissue and cancer look grey or white in color in the image. Whereas for women with more fatty breasts it is easy to identify cancer as fatty tissues look black cancer look grey or white in color.

The 'success' rate of Mammogram detecting incidence of cancer depends on several factors:

patient age
breast density
tumor size
location
mammographic appearance

In younger women with denser breasts, mammography is less sensitive than in older women with fatty breasts where mammography can detect at least 90% of malignancies. Smaller tumors especially those without calcifications are more difficult to detect especially in dense breasts. Diagnostic mammography is associated with higher sensitivity but lower specificity as compared to screening mammography.

Factors that affect breast density

Factors increasing breast density

• High breast density is common among younger women and varies based on the age and weight of the woman.
  
  
• Pre-menopausal women tend to have dense breasts.
  
  
• Healthy women are more likely to have dense breast when compared to obese women.
  
  
• Lactation
  
  
• Mastitis
  
  
• Medication like menopausal hormone therapy or other medications that contain hormones may affect the breast density of a woman. These medications tend to increase the breast density of the woman.
  

Factors lowering breast density

• Breast density of a woman lowers as she gets older.
  
  
• Weight gain
  
  
• Acromegaly
  
  
• Vitamin D and calcium intake in pre-menopausal women
  

Women with high breast density

• Discuss after mammogram with their health care provider. In case the woman belongs to a high risk group classified based on gene mutation study or family history, then she should get an MRI done.
  
  
• Adapt a healthy lifestyle.
  
  
• Quit smoking
  
  
• Exercise regularly
  
  
• Limit alcohol consumption
  
  
• Eat a nutritious diet.
  
  
• Should undergo Breast Self Examination regularly.
  
  
• Get a doctor to examine the breasts every year.
  
  
• A digital mammogram every year from the age of 40.
  
  
• MRI and other imaging studies as per doctor recommendation