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Suggest Treatment For PCOD And Hyperprolactinemia

Posted on Wed, 12 Oct 2016

Question: I experienced symptoms of Galactorrhea in XXXXXXX so I consulted a gynecologist who asked me to get the ultrasounds and blood tests done.The blood tests showed elevated levels of serum prolaction 58, and the ultrasounds showed tiny cysts around the walls of the overaries (bilateral PCOD), as prescribed I had cabergoline for 4 weeks (.25 twice a week) and improved my routine.post that the prolactin came below to normal level, and I discontinued cabergoline. but today after two months I again experienced a slight discharge. Could you please advise on this. Also I wish to start with the oral contraceptives but need guidance on it.

Answered by Dr. Sameer Kumar (20 minutes later)

Brief Answer:
PCOD+ hyperprolactinemia.

Detailed Answer:
Hello,
Thanks for the query to HCM,
Hyperprolactinemia can be acutely controlled with cabergoline which was rightly advised as an initial treatment but as the nipple discharge has reoccurred, the likely cause can be increased breast stimulation during foreplay or sex and also in cases of pituitary microprolactinomas.
Breast stimulation to be avoided for atleast 4 weeks post treatment with cabergoline if microprolactinomas are ruled out with an MRI SCAN. Microprolactinomas usually cause severe headaches.
Also PCOD as has been diagnosed, indicate that you have irregular menses as well, which can be regulated with low dose oc pills with cyproterone acetate especially for at least 3-6 months along with weight reduction and myoinositol supplement support regularly.
Presently repeat serum prolactin levels, get an MRI brain for ruling out microprolactinoma and avoid breast stimulation . Oc pills can be started from next cycle day 3, but prolactin levels should be controlled first.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sameer Kumar (21 minutes later)

Thank you Doctor for your timely response. :)

I missed my menses in May for the first time, that was the first and last time so far.
Apart from that I have not experienced severe headaches as such.

I have uploaded my ultrasound reports along with some blood test reports.
Kindly refer them.

Thanks & Regards

Answered by Dr. Sameer Kumar (5 minutes later)

Brief Answer:
Answered

Detailed Answer:
Hello,
I have seen the report and post medication prolactin are normal in july 29th report. USG shows early PCOD with increased ovarian volume and multiple subcenterimetric follicles .
Are you sexually active? If yes , then still MRI BRAIN and repeat prolactin levels are must now. When was your last menses?
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sameer Kumar (11 minutes later)

I replied to your questions above not sure if it got submitted.

I was sexually active in august, but no sexual activity at all in september.

My last menses was around 4-5th september.

Thanks & Regards.

Answered by Dr. Sameer Kumar (8 minutes later)

Brief Answer:
Answered

Detailed Answer:
Okay.
please get the investigations done and then if required cabergoline may have to be started again and oc pills can be started from next cycle onwards.
You have 10 days before your next menses may start.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar