Cabergoline monotherapy in polycystic ovary syndrome patients with elevated prolactin: a viable option?

Cabergoline is widely used to treat hyperprolactinemia, but its effects on polycystic ovary syndrome (PCOS) remain unclear. Since hyperprolactinemia is present in nearly 30% of PCOS cases, this study aims to assess the impact of cabergoline on androgen levels and clinical outcomes in PCOS with elevated prolactin cases, discussing these findings with the results in prolactinoma cases.

A total of 66 women aged 18-40 were included in this retrospective cohort study, with 36 in the PCOS with elevated prolactin group (median 24.0 (22.0-27.5) years) and 30 in the prolactinoma group (median 28.0 (23.7-33.0) years). Only patients who had been started on cabergoline treatment and had available follow-up data were included. Hormonal profiles and clinical findings, including hirsutism, and menstrual cycle regularity, were assessed before and after cabergoline treatment.

After cabergoline treatment, significant reductions in prolactin and total testosterone levels were observed in both groups. In the PCOS group, total testosterone decreased from 0.65-0.49 ng/mL (p < 0.001) and dehydroepiandrosterone-sulphate levels from 407.5-301.0 µg/dL (p < 0.001). In the prolactinoma group, total testosterone decreased from 0.39-0.29 ng/mL (p < 0.001). Menstrual irregularities improved markedly in both groups, with prevalence decreasing from 83.3-5.6% in PCOS group and from 80.0-10.0% in the prolactinoma group (p < 0.001). Furthermore, in PCOS group, the prevalence of hirsutism was decreased from 86.1-61.1% (p = 0.007).

Cabergoline is effective in lowering prolactin and androgen levels while improving menstrual regularity in both PCOS and prolactinoma patients, highlighting its potential as a valuable therapeutic option for patients with PCOS with elevated prolactin.