Pathological hyperpolactinemia as one of the causes of infertility

Have you ever wondered why a woman can't get pregnant while breastfeeding? Or why does menstruation stop during pregnancy and re-fertilization is impossible? The answer to these questions is quite simple: the hormone prolactin. During pregnancy and lactation, the production of this particular hormone by the pituitary gland is significantly increased, which tends to turn on a kind of “blocking” of a woman’s reproductive ability. This condition is called physiological hyperprolactinemia. But what if there is a malfunction in the body, and prolactin begins to be intensively produced at the wrong time for this? It is then that the disease occurs - pathological hyperprolactinemia.

Why does pathological hyperprolactinemia occur and how does it manifest?

In the structure of all violations of the menstrual function of women with the subsequent development of infertility, pathological hyperprolactinemia is as much as 25%. Excessive production of the hormone prolactin by the pituitary gland turns off the menstrual and, accordingly, the reproductive function of a woman, causing the development of amenorrhea of ​​the pituitary genesis. The cause of excessive secretion of prolactin is a failure that occurs in the hypothalamus-pituitary system. The cessation of menstruation is only one of the symptoms of hyperprolactinemia, since the hormone prolactin affects various organs of the female body.

Pathological hyperprolactinemia:

• etiological factors in the development of pathological hyperprolactinemia;
• mechanism of reproductive disorders in pathological hyperprolactinemia;
• what symptoms can manifest pathological hyperprolactinemia.

Etiological factors in the development of pathological hyperprolactinemia

Disorders in the work of the hypothalamic-pituitary system can occur for completely different reasons. In the etiology of pathological hyperprolactinemia, today it is customary to distinguish three main groups of causes: anatomical, functional and iatrogenic.

Anatomical causes of hyperprolactinemia:

• neoplasms of the pituitary gland;
• hormone-producing tumors of the body, such as prolactinoma;
• traumatic damage to the pituitary gland;
• The effect of radiation on brain structures.

Functional causes of hyperprolactinemia:

• constant severe stress;
• brain infections;
• endocrine diseases such as hypothyroidism, acromegaly, etc.

Iatrogenic causes of hyperprolactinemia:

• taking estrogen-containing drugs;
• taking drugs that affect the metabolism and secretion of dopamine;
• taking drugs that deplete dopamine stores in the central nervous system;
• Using certain drugs such as amphetamines and hallucinogens.

Mechanism of reproductive disorders in pathological hyperprolactinemia

The pathogenesis of the development of pathological hyperprolactinemia is quite complex and depends directly on the etiological factor that provoked the failure of the hypothalamic-pituitary system. However, the mechanism of female reproductive dysfunction caused by hyperprolactinemia includes two main stages:

• at the level of the hypothalamus, under the influence of an excess amount of prolactin, the synthesis and production of gonadotropin-releasing hormone is inhibited, and, accordingly, the production of luteinizing and follicle-stimulating hormones decreases;
• At the level of the ovaries, prolactin inhibits gonadotropin-dependent steroid production, reduces the sensitivity of the ovaries to exogenous gonadotropins and reduces the secretion of progesterone by the corpus luteum.

What are the symptoms of pathological hyperprolactinemia

Menstrual irregularities, which can manifest themselves in various forms, come to the fore in the clinical picture of pathological hyperprolactinemia. Oligomenorrhea - an increase in the intervals between menstruation, or amenorrhea - the complete absence of menstruation, occurs in more than 60% of women with hyperprolactinemia. However, about 30% of patients do not complain of changes in the menstrual cycle, they may have regular menstruation, and disturbances occur only in the form of a lack of ovulation or insufficiency of the luteal phase.

The second important symptom of hyperprolactinemia is galactorrhea - the secretion of milk from the breast, while the severity of the symptom can be completely different: from a few drops to the separation of milk from the nipples in a whole jet. About half of patients with pathological hyperprolactinemia report symptoms such as dizziness, headaches, and periodic rises in blood pressure. An asymptomatic course of the disease is also possible, which is quite rare.

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