This is a review of hyperprolactinemia or hyperprolactinaemia (high blood prolactin) in endometriosis-related infertility. The fact of their connection is known; but, the definite cause of the relationship between high prolactin (PRL) levels and infertility is not known. This article is a review of the current literature on the subject.
PRL is known to have at least 85 functions. Estrogen and stress stimulate PRL secretion by the anterior pituitary gland. Breastfeeding and breast stimulation are the strongest promoters of PRL secretion. Regulation of PRL levels is controlled by the release of dopamine in the blood vessels of the pituitary. Elevated PRL levels can cause a block in ovulation. Thyrotropin releasing hormone (TRH) injection is a strong stimulus for the secretion of PRL.
Some infertile patients who have endometriosis have hyperprolactinemia. Some doctors suggest PRL suppression to treat infertility. Results of PRL suppression studies are variable.
PRL levels may be used as a marker for endometriosis since increased PRL is due to production from endometrial tissue outside the uterus, only. The symptoms of endometriosis are pain and infertility, primarily. 20% to 50% of patients with infertility have endometriosis. The incidence of infertility does seem to be related to the severity of the endometriosis.
Danazol is a FDA approved synthetic testosterone to treat endometriosis that doesn’t change PRL levels. Danazol’s side effects are voice changes, edema, excess hair growth and acne.
CONCLUSION: The studies of the relationship between PRL levels, infertility and endometriosis show conflicting results. More studies are required. Dopamine agonists are suggested.
NOTE: Dopamine agonists are known to reduce prolactin levels. These include Vitex, phenylalanine and tyrosine. Boswellia serrata reduces prolactin because of 5-lipoexygenase inhibition. Read about the ability of dopamine agonists to shrink a prolactin-secreting pituitary tumor.
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