The commonest cause of secondary amenorrhoea resulting from pituitary problems is hyperprolactinaemia (elevated prolactin levels - normal range up to 500IU/l)). Prolactin is the hormone that promotes milk production (lactation) following childbirth. Hyperprolactinaemia is the state of higher than normal blood levels of this hormone.
Hyperproactinaemia is commonly associated with inappropriate milk production - galactorrhoea.
The main causes of hyperprolactinaemia are:-
- stress (including seeing the doctor or having a blood test).
- breast examination can cause prolactin levels to rise.
- polycystic ovary syndrome (Q7. 2).
- hypothyroidism (under active thyroid gland) can be associated with sustained moderate elevation of prolactin (>700IU/l).
- some medicines, including antidepressants, cimetidene and methyldopa, may cause prolactin levels to rise.
- a tumour of the pituitary gland (prolactinoma) suggesting the need for radiological examination of this area. Tiny pituitary tumours (microadenomas) tend to be associated with moderate elevation of prolactin. Larger tumours (larger than 1cm - macroadenomas) may be associated with prolactin levels greater than 5000 IU/l. At one time plain x-ray images were obtained but more modern sophisticated techniques (computerised tomography [CT]) or magnetic resonance imaging [MRI] are usually employed these days (Q4.10). Galactorrhoea (inappropriate milk production) occurs in about a third of women with hyperprolactinaemia, although there is no correlation between prolactin levels and the amount of milk produced.
- diseases of the chest can be associated with hyperprolactinaemia on rare occasions.
Please click on the required question.
- 1 What is amenorrhoea?
- 2 What is oligomenorrhoea?
- 3 What are true and false amenorrhoea?
- 4 What is the difference between primary and secondary amenorrhoea?
- 5 Our daughter has not started her periods yet. When should we seek medical advice?
- 6 My periods have stopped. When should I seek medical advise?
- 7 My periods have stopped. How can the cause be determined?
- 8 Can generalised ill health result cause periods to stop?
- 9 I am a keen sportswoman. Could this stop my periods?
- 10 What is hyperprolactinaemia?
- 11 Which investigations are particularly helpful in finding the cause for the cessation of my periods?
- 12 What is karyotyping?
- 13 What is Turner Syndrome?
- 14 What is the testicular feminisation syndrome?
- 15 What is the resistant ovary syndrome?
- 16 What are autoantibodies?
- 17 What is premature ovarian failure (premature menopause)
- 18 What uterine abnormalities may cause amenorrhoea?
- 19 What is Asherman's syndrome?
- 20 What are the late effects of prolonged amenorrhoea?
- 21 How can my amenorrhoea be treated?
- 22 What are the risks and benefits of hormone replacement when used for premature menopause?
- 23 My periods are coming infrequently (oligomenorrhoea). What is likely to be the causes?
- 24 How are infrequent periods investigated?
- 25 How can oligomenorrhoea be treated?
- 26 If my periods are absent or infrequent, do I need contraception?
- 27 Where can I obtain more information?
- 28 Support Groups.
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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
