Prolactin Female
Prolactin is the anterior pituitary hormone that drives lactation but exerts broader effects on the reproductive axis and dopaminergic tone. Persistently elevated prolactin (hyperprolactinemia) in women is one of the most common reversible causes of amenorrhea, anovulatory infertility, and galactorrhea. It deserves a screening draw in any woman with unexplained cycle disruption or persistent fatigue paired with low libido.
Why this biomarker matters
High prolactin suppresses gonadotropin-releasing hormone (GnRH) from the hypothalamus, which in turn lowers LH and FSH and stalls ovulation. The result is the clinical triad of irregular or absent menses, infertility, and sometimes milky nipple discharge in non-postpartum women. Hyperprolactinemia has many causes: a prolactin-secreting pituitary adenoma (prolactinoma), medication side effects (antipsychotics, some antidepressants, opioids, certain antiemetics), hypothyroidism, chronic kidney disease, and physiological causes including pregnancy and breastfeeding. The workup is structured. Confirm any elevated value with a repeat morning fasting draw, since prolactin is highly stress- and exercise-responsive and a single high value is often spurious. Always screen for macroprolactin, an antibody-bound form that is biologically inactive but assays as elevated. If prolactin is genuinely above roughly 100 ng/mL, pituitary imaging is indicated. Most prolactinomas respond to dopamine agonists (cabergoline, bromocriptine) with normalization of prolactin and resumption of normal cycling within months.
Test these together
These biomarkers contextualize and unlock a clearer picture than any single value can.
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