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Menopause01:28

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Menopause, a natural biological process marking the end of a woman's fertility, typically occurs between the fifth and sixth decade of life. This phase is characterized by the exhaustion of the ovarian follicle pool, leading to less responsive ovaries despite the high levels of Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). The consequential decrease in estrogen production results in symptoms like hot flashes, heavy sweating, headaches, hair loss, muscle pains, vaginal...
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Prolactinomas and menopause: any changes in management?

Yona Greenman1,2

  • 1Institute of Endocrinology, Metabolism, Diabetes and Hypertension, Tel Aviv-Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel. yonagr@tlvmc.gov.il.

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Summary

Postmenopausal women with prolactinomas (benign pituitary tumors) may achieve prolactin normalization without treatment. Current guidelines for asymptomatic microprolactinomas remain appropriate, while macroprolactinomas require standard management.

Keywords:
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Area of Science:

  • Endocrinology
  • Reproductive Medicine
  • Oncology

Background:

  • Prolactinomas are pituitary tumors that secrete prolactin, often causing hypogonadism and infertility.
  • Current guidelines suggest medical treatment for prolactinomas is not indicated in asymptomatic postmenopausal women.
  • Management aims to normalize hormone levels, restore fertility, and control tumor size.

Purpose of the Study:

  • To review prolactinoma behavior during menopause.
  • To assess dopamine agonist withdrawal success in postmenopausal women.
  • To evaluate prolactin-mediated morbidity and its impact on management.

Main Methods:

  • Comprehensive literature search of PubMed and Medline databases.
  • Included studies published up to July 2019.

Main Results:

  • Postmenopausal women with prolactinomas show higher rates of prolactin normalization.
  • Large prolactinomas diagnosed in menopause respond well to dopamine agonists.
  • Evidence linking hyperprolactinemia to increased cancer or cardiovascular/metabolic morbidity is inconsistent.
  • No data supports improved outcomes for asymptomatic microprolactinoma patients with hyperprolactinemia correction.

Conclusions:

  • Current recommendations to withhold treatment for asymptomatic postmenopausal microprolactinomas are supported.
  • Macroprolactinoma management should follow established clinical practices.