Menstrual disorders in women are a common problem with which some women cannot find a place for themselves, while others, headlong, run to the doctor. And they do it right, because this is a signal that failures have occurred in the hormonal background. Violation of the content of what hormone provokes a violation of the menstrual cycle? What are the causes of hormonal imbalance and how to identify them?
The reason for the violation of the cycle is an increased level of prolactin in the blood
The concept of hyperprolactinemia means amenorrhea, which resulted from excessive secretion of prolactin. At the same time, the synthesis of gonadotropic hormones in the pituitary gland is significantly reduced. This type of amenorrhea is also called hypogonadotropic. An elevated level of prolactin in the blood develops with anatomical and functional disorders of the hypothalamic-pituitary system. Let's consider the reasons for the increase in the content of prolactin in the blood in more detail.
Anatomical causes:
- Injury to the pituitary stalk due to surgery or trauma, exposure to radiation.
- Pituitary tumor (granuloma, glioma), hormonally active tumors (prolactinomas, mixed pituitary adenomas).
Functional reasons:
- Endocrine pathologies (acromegaly, Cushing's syndrome, hypothyroidism, Nelson's syndrome)
- Neuroinfections.
- Stress.
Under the influence of prolactin in the hypothalamus, the synthesis of hormones such as LH and FSH decreases. In the ovaries, prolactin inactivates the synthesis of steroid hormones, and also reduces the sensitivity of the ovaries to exogenous gonads and the secretion of the hormone progesterone by the corpus luteum.
Clinical manifestations of elevated prolactin in women
Symptoms of elevated prolactin in the blood in women are diverse. The main one is violation of the menstrual cycle. Most often it is secondary amenorrhea. At the same time, a woman can associate the absence of menstruation, if not with pregnancy, then with stress, climate change, trauma, surgery, or taking certain drugs.
With hyperprolactinemia, the phenomenon of galactorrhea is possible, which correlates between a jet discharge and a few drops on pressure. But galactorrhea does not depend on the level of prolactin in the blood.
Patients feel headaches, sometimes they acquire the character of migraine, dizziness. Some women may experience a transient increase in blood pressure. But the main complaint of many women is the violation of the menstrual cycle and the inability to get pregnant. Therefore, symptoms such as irritability, depression and emotional lability are very common.
Methods for detecting hyperprolactinemia in women:
- Anamnesis. From the anamnesis, it is necessary to clarify the time of menstrual irregularity. This information will make it clear what is the duration of hyperprolactinemia. If the patient complains of some narrowing of the visual fields, this is a likely sign of a pituitary macroadenoma.
- Physical examination. If the patient has dry and pasty skin, complains of hair loss, increased fatigue, as well as impaired cognitive functions – probably, hyperprolactinemia arose against the background of hypothyroidism.
During a gynecological examination, it is important to pay attention to the condition of the walls of the vulva and the mucous membrane of the vagina. In hyperprolactinemia, the vulva will have a "hypoestrogenic" view.
- Laboratory research. If hyperprolactinemia is functional, the level of prolactin is not more than 3000 mIU / l. If the concentration of prolactin reaches 6000-8000 mIU / l, then with 80% probability we can assume a pituitary microadenoma. In the blood, the level of the hormones LH and FSH decreases in proportion to the increase in the level of prolactin. Mandatory in hyperprolactinemia is the study of thyroid hormones to exclude hypothyroidism.
- Instrumental research. It includes the study of the fundus and visual fields, because the bitemporal narrowing of the visual fields and changes in the vessels of the fundus may indicate a pituitary microadenoma. To differentiate the diagnosis from PCOS, it is advisable to conduct transvaginal echography. With hyperprolactinemia, multifollicular ovaries will be observed. They are of normal size and volume. Multiple follicles are 4-8 mm in diameter. Also, CT and MRI are referred to instrumental diagnostic methods.
Treatment of hyperprolactinemia - prevention of infertility and oncological processes
Hypothyroidism must be ruled out before starting treatment for hyperprolatinemia. If a woman has hirsutism, she should be ruled out for PCOS.
In the treatment of hyperprolactinemia, dopamine agonists (cabergoline, bromocriptine) are used. As a rule, ovulation occurs at 4-8 weeks of treatment. A woman's fertility returns to 75-90%. In the future, such a woman needs to regularly visit a gynecologist and determine the level of progesterone in the blood.
Timely detection and treatment of elevated prolactin levels in women is very important, especially for women of reproductive age, since hyperprolactinemia is one of the main causes of infertility. For women who do not plan to have children, an increased concentration of this hormone in the blood can cause cancer.
Share:
Add a comment