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.

Polycystic Ovarian Syndrome

In PCOS, under-developed follicles accumulate in the ovaries. Since they fail to mature, they accumulate as cysts in the ovaries. The low levels of follicle stimulating hormone (FSH) and elevated levels of androgens may be the reasons for this condition. When there is no ovulation, the progesterone hormone is not created and the lining of the uterus is not shed in a timely fashion. This increases the chances of endometrial hyperplasia and even cancer.

Another feature associated with PCOS is hyper androgenism or increased responsiveness to testosterone. This usually shows up in oily skin and acne. Excess hair may be noticed on the face and other parts of the body. Women suffering from PCOS have a weight problem, especially around the waist. Insulin resistance is also noticed in some women. This increases the risk of developing diabetes in later years.

Polycystic Ovarian Syndrome Symptom

• Absence of menses or abnormal or scanty menstrual periods
  
• Weight gain
  
• Infertility
  
• Aggravated acne
  
• Increased hair growth in a male pattern
  

High levels of insulin can result in symptoms such as high androgen levels, infertility and lack of ovulation. These symptoms are usually noticed when women are in their 20s or 30s. Diagnosis of PCOS is after a physical examination and laboratory tests. Thyroid and prolactin levels in the blood are tested. Serum levels of male hormones (DHEA and testosterone) are tested for higher than normal levels. Tumors in the ovary or adrenal glands can be diagnosed with vaginal and abdominal ultrasounds. Insulin resistance is vital in the diagnosis of PCOS. Insulin is instrumental in regulating the ovarian function. An ovarian biopsy may also be done.

Treatment for Polycystic Ovarian Syndrome

Treatment for women with Polycystic Ovarian Syndrome depends on what stage of a woman's life this condition has manifested and her fertility desires. Birth control pills are prescribed to regularize the menstrual cycle and reduce the risk of uterine cancer. Other medications used in the treatment of PCOS are flutamide and spironolactone.

Clomiphene induces the pituitary gland to secrete more FSH and this stimulates release and maturity of ova. Insulin resistance is reduced with drugs such as Metformin (Glucophage) and Troglitazone. 'Ovarian drilling' is a process of using laser to place small holes in the ovaries so as to normalize the hormonal environment and allow normal ovulation.

Amenorrhea

Amenorrhea is a condition where a woman of reproductive age does not get her regular menstrual periods. Amenorrhea can be primary or secondary Amenorrhea.

Primary Amenorrhea: This condition occurs when the first menstrual period of a girl is delayed or does begin by 16 years. This could be due to delay in pubertal development. Birth defects in the reproductive system can often lead to primary Amenorrhea as also tumor in the hypothalamus or pituitary gland. Abnormal chromosome or genetic defects can be a cause. Hypothyroidism, hyperthyroidism, Cushing's disease and congenital heart disease can be a cause for primary Amenorrhea. Often the cause is not known. Symptoms include acne and excess body hair, headaches and vision problems.

Secondary Amenorrhea: This kind of Amenorrhea occurs in women during their reproductive period. Secondary Amenorrhea is a situation where the menstrual period is absent for about 3 months. This is most often due to pregnancy and breastfeeding. Symptoms of secondary Amenorrhea are mood fluctuations, goiter, vaginal dryness, depression and nausea.

If any systemic condition is the cause for Amenorrhea, appropriate treatment often leads to the start of menstruation. Often anorexia or over exercising can lead to Amenorrhea. Endocrine disorders, hormonal imbalance, PCOS and use of birth control pills often lead to Amenorrhea. Other causes for Amenorrhea include malfunctioning ovaries and stress. Women who complain of Amenorrhea are given a physical examination by the gynecologist. Blood tests for prolactin and T3, T4 and FSH are done. Other blood tests include test for serum progesterone. Pelvic ultrasound is done to check for any abnormalities.