By Kate Boundy
When it comes to conditions that can cause infertility, prolactinoma is largely unheard of in the public domain, or spoken about as a common fertility problem. It can also be misreported as a form of cancer, which it is not
This is the reason we are using October as the month to highlight these lesser known fertility conditions and diseases.
What is a prolactinoma and how is it treated?
Antonia Brooke, clinical lead in diabetes and Endocrinology, at the Royal Devon and Exeter Foundation Trust states: “Prolactinomas are small benign (non-cancerous) swelling of the pituitary gland (which sits between the eyes) which can affect fertility. They can be the size of a pin head and difficult to see on a scan, or occasionally very big. However, we can tell the likely size of the swelling by measuring the prolactin in the blood and we confirm this by doing a scan if elevated.
“The prolactin usually stops the message from the pituitary to the ovaries (gonadotrophins) so that you don’t ovulate or menstruate normally. It is also the hormone that usually helps with breastfeeding, so sometimes people have milk from their breast at the beginning before treatment.
“The good news is that it is usually treatable with medication and as the prolactin in the system comes down, ovulation returns and the menstrual cycles become more regular and this increases the chances of getting pregnant naturally. Measuring a prolactin is a routine part of screening for people who are having problems with fertility.
“Sometimes there are other reasons why the prolactin is raised – some tablets increase prolactin such as antidepressants or the stress of a blood test, so having a mildly raised prolactin doesn’t mean that there is always a problem with the pituitary, but the doctors can help work this out.”
According to the patient.info website prolactinomas are rare but they are the most common type of pituitary gland tumour. It is estimated that about four in 10,000 people have a prolactinoma.
The exact cause of prolactinomas is unknown, although some common causes of raised prolactin according to the Pituitary Foundation website are certain medications – some antidepressants or tranquilisers, certain anti sickness medications, pregnancy, breastfeeding, stress as well as some homeopathic and herbal medications.
Symptoms of raised prolactin as stated above, can include a loss of periods or lack of ovulation for women or low testosterone or sperm count for men. Breast milk production can also occur in both men and women, along with visual disturbances, as if there is a large enough growth it can sometimes press on the optic nerve. Medication will usually resolve this and bring prolactin back to an optimum level to hopefully achieve a successful pregnancy and alleviate any other symptoms that may have occurred.
Where can you turn for help and advice?
The Pituitary Foundation, which launched in 1994, is a national support and information organisation for pituitary patients, their families, friends and carers. We are the UK’s leading charity providing support to people affected by disorders of the pituitary gland such as Acromegaly, Cushing’s, Prolactinoma, Diabetes Insipidus and Hypopituitarism.
Head of patient services, Pat McBride, said: “Operating throughout the UK and Eire, we are a membership organisation and have in the region of 2,300 subscribed members. We are a relatively small charity, with ten members of staff, and we have a team of over 100 volunteers across the country, supporting our work.
“The charity’s objectives is to promote the relief and treatment of anyone suffering from pituitary disorders and related conditions and diseases, and their families, friends and carers, and to provide information and support, as well as promote and support research and to disseminate for the public benefit the results of any such research.”
Several celebrities are known to suffer with prolactinoma, including actor, Stephen Campbell-Moore, who is the charity’s celebrity ambassador, the late socialite, Tara Palmer Tomkinson was a known sufferer and comedian and television presenter, Sue Perkins spoke about her diagnosis in an interview in 2015.
Speaking to Good Housekeeping magazine, she said she was ‘lucky’ that it is benign and ‘not in itself a worrying thing’.
“She said: “Sometimes it’s big and makes me mad, and sometimes it’s small and is in the background.
“Sometimes it screws up my hormones. I have various tests to make sure the side effects aren’t too onerous.”
Professor William Ledger, Professor of Obstetrics and Gynaecology and Consultant in Reproductive Medicine, University of New South Wales and Royal Hospital for Women, Sydney, said: “Restoration of ovulation in women with hyperprolactinemia does not always occur even with increased doses of dopamine agonists. It is important to rule out other causes of anovulation and it may be necessary to add other medications such as tablets of letrozole or clomiphene citrate, or injections of FSH hormone (such as Gonal-F, Puregon) to ensure that ovulation is achieved.
“It is also important to assess the couple holistically, looking at the male partner’s semen analysis, sperm DNA fragmentation, the couples sexual history and knowledge of the fertile window in the cycle. The female partner should also have an ultrasound assessment of tubal patency and the health of the uterus.
“Early referral to a specialist in reproductive medicine is highly recommended if conception does not occur quickly once regular periods and ovulation are restored with use of cabergoline or bromocriptine.”
To find out more about the Pituitary Foundation, click here to visit the website The charity offers a series of help and information services, including a dedicated endocrine specialist nurse helpline, general support and information, email and text helpline. There is also a series of booklets and factsheets that can be downloaded from the website.
Do you suffer with prolactinoma? What has your experience of it been like? We’d love to hear your story, email email@example.com