Hormonal replacement therapy in menopausal women with a history of hyperprolactinemia

Abstract

Hyperprolactinemia is involved in almost 30% of infertility problems. At the onset of menopause, prolactin levels often decrease; however, no data are available regarding the course of hyperprolactinemia after menopause with hormonal replacement therapy (HRT). A retrospective study was undertaken in our department to evaluate the potential role of estrogens in women with a history of hyperprolactinemia. Twenty-two patients, with hyperprolactinemia before menopause, were followed-up. Group I included 11 patients who withdrew bromocriptine treatment when menopause was confirmed. These patients were placed on HRT with no other medication administered. HRT was a combination of percutaneous estradiol gel and an oral progestin. Group II included 7 women treated by bromocriptine before menopause and after menopause concomitantly with HRT. Group III included 4 patients who did not receive HRT or other treatments once menopause was diagnosed. The mean serum prolactin level was unchanged in Group I (22.8+/-21.7 before and 22.8+/-16.1 ng/ml after HRT) while it increased but not significantly from 8.1+/-5.2 to 16.0+/-11.7 ng/ml in Group II. The mean duration of HRT was 42.8+/-23.8 (7-81) and 37.3+/-31.0 (6-99) months in Group I and II respectively. In Group III patients, PRL levels decreased spontaneously from 61.2+/-39.8 to 33.0+/-34.7 ng/ml. In conclusion, in this population of menopausal patients with a history of moderate hyperprolactinemia, HRT did not seem to affect plasma prolactin levels.

The effect of the menopause on prolactin levels in patients with hyperprolactinaemia

“…We could find only one other study for comparison of hyperprolactinaemic females followed over the menopause. Touraine et al . (1998) found there was little change in prolactin levels after the menopause in women who took hormone replacement therapy, but a significant reduction in prolactin levels was seen in a small group who were left untreated.…”

“…Both a fall (Reye et al ., 1977) and an increase (Urban, 1992) in prolactin levels have been reported in normoprolactinaemic subjects. Touraine et al . (1998) found little change in their patients undergoing the menopause, but in a small subgroup of patients who were left untreated postmenopausally, a significant reduction in prolactin levels were seen.…”

Hyperprolactinemia

“…In a retrospective analysis of hyperprolactinemic patients, Karunakaran et al showed that 45% normalized serum prolactin as they entered menopause [16]. Touraine et al found a minimal change in prolactin after the onset of menopause in women taking hormone replacement therapy and a reduction in those who were not treated [17]. Most studies have shown that estrogen replacement therapy has little effect on serum prolactin [18].…”

Prolactinomas: evolution after menopause

“…in their retrospective study assessed the role of estrogen in women with a history of hyperprolactinemia and found that in a group of untreated patients, PRL levels decreased spontaneously during menopause (8). At the current time there is a lack of evidence to advocate the treatment of asymptomatic postmenopausal women with prolactinomas (21,22).…”

“…There is scarce literature about the effects of menopause in patients with prolactinomas (7,8); we previously published a study about the effects of menopause in women with a history of microprolactinomas (9). The aim of this study was to retrospectively assess in the menopause the effects of the suspension of treatment on PRL levels and on the tumor size in patients with micro and macroprolactinomas diagnosed and treated with dopamine agonists (DA) during their fertile age.…”