Hyperprolactinemia in cases of infertility and amenorrhea

Of 17 patients with longstanding (3--15 years, mean 7.7 years) amenorrhea and hyperprolactinemia, 8 developed their amenorrhea after the use of oral contraceptives (Group I) and 9 became amenorrhoic spontaneously (Group II). There were no differences between the groups with respect to the basal serum levels of FSH, LH, low polar estrogens (estradiol-17 beta + estrone) and prolactin. Tomography revealed pituitary adenoma in four patients. One of these developed symptoms of her tumor during pregnancy; the symptoms disappeared after delivery. The other patients with tumors are checked twice a year and have not yet received any treatment. The patients with no detectable tumors were treated with bromocriptine starting with 1.25 X 3 daily. The peripheral serum levels of prolactin, FSH, LH, low polar estrogens and progesterone were determined once a week and if the prolactin levels remained high, the bromocriptine dose was increased. All these patients started to menstruate as soon as prolactin returned to normal levels (below 25 micrograms/l). All patients who wished to became pregnant, i.e. 6 patients. Three were delivered by cesarean section, one had a normal delivery and two are still pregnant. There was no difference between Group I and Group II in the dose required or in the duration of treatment before menstruation started. Three cases of galactorrhea were found.