Normogonadotropic hyperprolactinemic ovarian insufficiency

Ovarian insufficiency means that the ovaries aren’t working as they should, leading to problems with egg maturation. With normogonadotropic hyperprolactinemic ovarian insufficiency, gonadotropin hormones (LH and FSH) are in the normal range, but prolactin levels are too high (hyperprolactinemia). Prolactin is a hormone produced by the pituitary gland which increases during pregnancy and makes it possible to breastfeed. Hyperprolactinemia prevents the body from releasing gonadotropin hormones and estrogen.

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Impact on fertility

High prolactin levels interfere with the menstrual cycle and ovulation. You may have irregular cycles or no periods at all – this is known as amenorrhea. Without ovulation, it’s not possible to get pregnant because there is no egg available to be fertilized by sperm. 

Potential causes

Hyperprolactinemia is commonly due to:

• Benign tumors on the pituitary gland (prolactinomas)
• Underactive thyroid (hypothyroidism) – about half of all women with hyperprolactinemia have a thyroid disorder
• Kidney condition
• Medicines for depression, psychosis, and high blood pressure
• Certain herbs, such as fenugreek, fennel seeds, and red clover
• Chest wall irritation (from scarring after surgery, shingles, or a bra that’s too tight)
• Excessive stress or exercise
• Lack of sleep

Symptoms of normogonadotropic hyperprolactinemic ovarian insufficiency

These are potential symptoms of hyperprolactinemia in women:

• Irregular or missed periods (amenorrhea)
• Milky discharge from the nipples when not pregnant or breastfeeding
• Vaginal dryness and painful sex
• Infertility
• Weak, brittle bones 
• Vision problems
• Headache

Diagnosis of normogonadotropic hyperprolactinemic ovarian insufficiency

Doctors diagnose hyperprolactinemia based on a person’s symptoms, medical history, and a blood test that measures prolactin. Prolactin levels are sensitive to stress, sleep deprivation, exercise, and medication, so you may have a second test to confirm the high level and diagnose hyperprolactinemia.

If your blood tests show highly elevated prolactin and your doctor suspects you could have a prolactinoma, you may also receive an MRI scan of the brain. If you’re having problems with your vision, you will be referred to an eye doctor (ophthalmologist) for further testing and treatment.

Treatment to improve fertility

The good news is that hyperprolactinemia is just a temporary cause of infertility, and you can fix the hormonal imbalance through medication.

The first line of treatment is usually dopamine agonists. These reduce prolactin levels and get the ovaries working normally again so that you can ovulate regularly and get pregnant.

If medication is responsible for your high prolactin levels, you should change your medication or dose together with your doctor.

In case you have a prolactinoma, you can take medication that will shrink it. Rarely, surgery or radiation may be necessary. If testing reveals that you have hypothyroidism, that is also treated with medication.

Once your prolactin levels are back at a healthy level, you should be able to conceive.

This article has been verified by a medical professional

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