Hyperprolactinemia in reproductive-aged women: what should a physician remember


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Abstract

In recent years, interest has been expressed by different physician specialties in diseases and syndromes associated with impaired prolactin (PRL) secretion. According to the Russian clinical practice guidelines, the hyperprolactinemic syndrome is a symptom complex that occurs in the presence of hyperprolactinemia, the most characteristic manifestation of which is dysfunction of the reproductive tract. The prevalence of pathological hyperprolactinemia in reproductive-aged women is 5%. At their visit to an obstetrician/gynecologist, one third of women complain about various menstrual cycle abnormalities, which may be associated, among other things, with higher prolactin levels. According to statistics, hyperprolactinemia occurs in 9% of reproductive-aged women with amenorrhea and in 17% of those with polycystic ovary syndrome. Hyperprolactinemia may be of physiological origin. Hyperprolactinemia can be a combined clinical manifestation of a number of different pathological conditions of the reproductive tract in young women. In reproductive-aged women, about 70% of menstrual irregularities can be concurrent with hyperprolactinemia due to stress and distress, surgical treatment for gynecological and non-gynecological diseases, oral hormonal contraception, and use of psychotropic drugs from a group of neuroleptics and antidepressants. This paper considers the common reasons for higher prolactin, the basics and errors of diagnosis, and the basic principles of treatment and follow-up in reproductive-aged patients with hyperprolactinemia. There is much evidence that it is necessary to work within the framework of personalized medicine, and this is not only the efficiency of a chosen treatment regimen, but also primarily safety, especially if the same holds true for reproductive-aged women who can potentially get pregnant. Conclusion: Cabergoline is recommended as a f irst-line drug, being most effective, to normalize prolactin levels and to reduce tumor size. The 2021 study has shown that cabergoline is not only an effective, but also the safest drug to relieve hyperprolactinemia.

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About the authors

Elena N. Andreeva

National Medical Research Center of Endocrinology Ministry of Health of the Russian Federation; A.I. Evdokimov Moscow State University of Medicine and Dentistry Ministry of Health of the Russian Federation

Email: endogin@mail.ru
Dr. Med. Sci., Professor, Deputy Director of the Center - Director of the Institute of Reproductive Medicine, Head of the Department of Endocrine Gynecology, Professor of the Department of Endocrinology; Professor of the Department of Reproductive Medicine and Surgery 117036, Russia, Moscow, Dmitry Ulyanov str. 11

Ekaterina V. Sheremetyeva

National Medical Research Center of Endocrinology Ministry of Health of the Russian Federation

Email: sl98lk@yandexru
PhD, Leading Researcher of the Department of Endocrine Gynecology 117036, Russia, Moscow, Dmitry Ulyanov str. 11

Оlga R. Grigoryan

National Medical Research Center of Endocrinology Ministry of Health of the Russian Federation

Email: icebergl995@mailru
Dr. Med. Sci., Chief 117036, Russia, Moscow, Dmitry Ulyanov str. 11

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