Prolactinomas are tumors that secrete prolactin, a hormone that normally regulates lactation in women. These tumors are usually detected earlier in women, compared to men, because they cause more manifestations in women. These include infertility, reproductive dysfunction, and increased lactation and breast milk production.
Treatment for Prolactinomas
Unlike other pituitary diseases there are particularly good pharmacological treatments for prolactin secreting tumors. These are dopamine-agonist medications that include bromocriptine and cabergoline to name a few. These medications lower the prolactin levels down to within the normal range as well as reduce the size of the mass. As a result, surgical intervention is usually necessary to treat these tumors.
Pregnancy and Prolactin
High levels of circulating prolactin interfere with the function of the ovaries, which can result in fertility issues. For this reason medications are used to lower the prolactin levels in order to assist a woman in becoming pregnant. Once a woman is pregnant these prolactin lowering medications are usually stopped, since they are not really needed during pregnancy. The literature does say that they are actually pretty safe during pregnancy. However, since prolactin levels normally raise during pregnancy these prolactin lowering medications are often stopped.
Breast-feeding and Prolactinomas
One of the main roles of prolactin is to stimulate breast milk production, thus circulating prolactin levels in a woman are quite high when she is breast feeding. In most cases, women with prolactinomas will continue to remain off of their medications while they breastfeed. And once a woman has decided to stop breast feeding the prolactin lowering medications will be started again. However, if the tumor has grown during the pregnancy the recommendation may be to start the medications again and to not nurse.
Menopause and Prolactin
Women with prolactinomas are treated with prolactin lowering medications because high prolactin levels disrupt the normal cycles and causes amenorrhea, or a loss of periods. Once a woman goes through menopause and is no longer having regular periods these prolactin lowering medications can sometimes be stopped. Also during menopause circulating estrogen levels drop, this can sometimes result in a dropping of prolactin levels. This often results in the prolactinomas burning out and no longer requiring treatment.