hysterosalpingogram( HSG) both of which were normal. I enquired if she had ever done her hormones but she could not recall.
We opted to test her hormones and checked her thyroid and prolactin levels as a base line. When her results came back a startling revelation came that Cynthia had elevated prolactin levels. Personally, I was overjoyed- this is one of the easiest hormonal issues to correct and with normal prolactin levels together with oral ovulation induction majority of women with elevated prolactin levels- hyperprolactinemia, should be able to conceive.
That notwithstanding, Cynthia had a positive pregnancy test within the first month of treatment. We put her on cabergoline 0.25my twice weekly( to lower her prolactin levels) and letrozole( ovulation induction). I was quite surprised as to how fast she responded to treatment but was very pleased with the results. Cynthia was equally mesmerized considering how long she had been on follow-up. 10 years down the line Cynthia now has 3 children and is very happy enjoying the results of a simple test that forever changed her destiny.
I would also like to briefly mention Nyambura. Nyambura came in a few months ago and her chief complaint was irregular menstruation. Nyambura had been seen about 3 years ago and diagnosed with hyperprolactinemia. She had also been put on cabergoline and her menstruation immediately went back to normal. She unfortunately reports due to finances( she had lost her job), she was lost to follow-up and now presents with a similar issue. An MRI
One of my teachers in school was very interesting and told the proverbial tale of a couple, who were unable to have children. They underwent several checks and tests, which all came back normal until the fertility specialist took it upon himself to interrogate their sexual history. It came out that they had never had penetrative intercourse for more than 3 years of marriage and would hold hands and consider that as sex.
of brain did not reveal any lesion in the pituitary gland. She also thought that since the menses had become cyclical she had been healed. Nyambura’ s levels were very high 257ng / ml but did not have any symptoms such as visual disturbances, however she has been on treatment for migraines since she was a child and reports it was associated with her eyes( acutely short cited and wears specs).
I put Nyambura on Cabergoline and requested her to consult with an endocrinologist. On follow-up her prolactin levels gradually returned to normal along with her periods. I advised her that as long as she was in reproductive age she needs to be on medication to control her symptoms and prevent worsening of the disease.
The women came with different issues but both had complications arising from having high levels of the hormone prolactin( hyperprolactinemia), however both had successful treatment with the dopamine agonist cabergoline.
High prolactin( hyperprolactinemia) in females is commonly caused by pituitary tumors( prolactinomas), certain medications( antipsychotics, antidepressants), an underactive thyroid( hypothyroidism), stress and sometimes kidney or liver disease.
It should however be noted that in certain instances prolactin can be elevated without disease. High prolactin levels can be found during pregnancy and breastfeeding. Prolactin also rises naturally during sleep, excessive exercise, and one can get a temporary elevation during sexual intercourse.
Dopamine agonists are the drugs of choice and currently the most commonly used is cabergoline with gradual decline to normal levels and resumption of normal reproduction and menstruation.
High prolactin levels leads to women not ovulating and having a thin lining in the uterus inhibiting implantation. Due to not ovulating some women may have few or no periods, however some women have regular periods but do not ovulate and hence present with infertility. Cynthia and Nyambura have clearly demonstrated the effects of hyperprolactinemia and that it is relatively easy to treat.
I hope this has been insightful and we again want to wish you a very Happy New and fantastic 2026!!
Dr. Maureen Owiti is a practicing Obstetrician Gynaecologist and fertility consultant based in Nairobi. You can commune with her on this or related matters via email at: Drmaureenowiti @ gmail. com.