[Hyperprolactinemia in the postmenopause: versions and contraversions]

Area of Science:

• Endocrinology
• Reproductive Medicine
• Oncology

Context:

• Hyperprolactinemia and prolactinomas are frequently underestimated in postmenopausal women.
• Prolactinomas post-menopause are often macroadenomas, diagnosed late due to subtle or absent symptoms.
• Tumor growth potential persists post-menopause, with many tumors being invasive and associated with high prolactin levels.

Purpose:

• To highlight the diagnostic and therapeutic challenges of hyperprolactinemia in postmenopausal women.
• To review the current understanding of prolactinoma management in this demographic.
• To identify knowledge gaps and areas for future research.

Summary:

• Dopamine agonist treatment, like cabergoline, aims to reduce tumor size and normalize prolactin levels, but remission is not guaranteed in postmenopausal women.
• Relapse rates increase significantly after 5 years of drug discontinuation in this population.
• Key controversial issues include the prolactin-breast cancer link, effects on bone mineral density, metabolic parameters, and climacteric syndrome severity.

Impact:

• This review underscores the need for dedicated research into hyperprolactinemia management in perimenopausal and postmenopausal women.
• Developing specific diagnostic and therapeutic strategies could yield benefits in weight management, insulin sensitivity, fracture risk reduction, and psycho-emotional well-being.
• Clarifying the use of estrogen-progestin therapy in this context is crucial.