How do you get rid of galactorrhea

Pituitary ovarian failure

General

This clinical picture is based on damage to or incorrect development of the pituitary gland. The FSH and LH production and / or distribution is disturbed. It is often difficult to tell whether a disorder is due to a problem in the hypothalamus or the pituitary gland. This is why one often speaks of hypothalamic-pituitary ovarian insufficiency.

causes

In addition to inflammation (tuberculosis, syphilis, etc.), the causes of insufficiency can be primarily tumors. B. the craniopharyngioma or the adenoma. The prolactinoma is one of the most common tumors of the pituitary gland. Prolactin is a hormone that is responsible for the growth of the mammary glands and milk production. Excessive production of this substance by this very tumor also affects the function of the ovaries. Ovulation does not occur, menstrual disorders or amenorrhea occur. However, even without a prolactinoma, hyperprolactinemia, an increased prolactin level, can occur. This is perfectly normal during pregnancy and while breastfeeding, but not outside of this period. The dysfunction can e.g. B. be due to an endocrinological (= hormonal metabolism) disorder such as an underactive thyroid (hypothyroidism). Physical and emotional stress as well as certain medications can also lead to increased prolactin levels.

Sheehan syndrome is rarely seen these days. Due to severe blood loss during childbirth, there is a temporary reduced blood flow to the pituitary gland and, as a result, tissue death (necrosis). The resulting inability of the pituitary to function is also noticeable in an ovarian disorder. Due to the improved obstetrics, however, the disease rarely occurs.

Clinical picture

One of the hallmarks of pituitary ovarian failure caused by a prolactinoma is the increased prolactin level in the blood (hyperprolactinemia). Depending on the amount of prolactin, symptoms can vary in severity. These range from apparently normal cycles with an unnoticed luteal weakness to the absence of menstruation and infertility. Galactorrhea is often the reason why the gynecologist is consulted. Galactorrhea is the technical term for a spontaneous or pressure-induced milky discharge from the mammary glands without pregnancy or breastfeeding.

Due to the increased prolactin concentration, the formation of estrogen is greatly reduced, so that typical estrogen deficiency symptoms such as osteoporosis ("bone loss") and loss of libido can occur.

If tumors are the cause, headaches may occur and the field of vision may be restricted. If the tumor continues to grow, the prolactin concentration in the blood also increases, which in turn leads to a decrease in the FSH and LH values. Since prolactin also has an influence on the thyroid gland, hypothyroidism can occur due to the drop in the concentration of TSH, a thyroid hormone.

If more than 3/4 of the pituitary gland is destroyed in Sheehan's syndrome, symptoms such as amenorrhea, reduction of armpit and pubic hair, loss of pigment and libido and lack of milk production (agalactia) occur. Overall, the woman is very weak and powerless.

recognition

So that the gynecologist can get an overview, a detailed anamnesis always starts at the beginning of the diagnostic work-up. Tell your doctor about changes in your menstrual cycle, galactorrhea or other symptoms. The gynecologist will then perform an examination of the patient's external appearance, a general physical examination and a gynecological vaginal and rectal examination.

It makes sense to do a pregnancy test. Since pregnancy first manifests itself in the absence of menstrual bleeding, it could be wrongly assumed that ovarian insufficiency is behind it.

For further clarification, analyzes of the hormone concentrations in the blood are required. If hypophyseal ovarian insufficiency is suspected, it is primarily the prolactin level and the thyroid hormone TSH that are determined. If the prolactin concentration is increased, the doctor can draw conclusions about a possibly present prolactinoma or its size.

therapy

The aim of therapy is to normalize the prolactin level. The choice of treatment depends on the clinical situation and is largely based on the needs of the patient. If the patient finds galactorrhea very annoying, drugs that inhibit prolactin formation are the first remedy of choice. The resulting drop in the prolactin level also leads to the restoration of the ovulatory cycle in most patients and thus to the fulfillment of any desire to have children.

If there is a prolactinoma, it must be considered whether surgical removal is necessary based on the growth tendency, which is usually very low. Here, too, drug treatment can be tried first. If the therapy does not work or if the tumor has a negative effect on the neighboring organs, surgery is common. The exception, however, is a planned pregnancy. Prolactinomas increase in size very quickly during pregnancy, so in this case they should be removed before pregnancy.

Author (s): äin-red