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Having prolactinoma and missed period. Had miscarriage. Taken cabergiline. Increased prolactin level. Treatment?

i am having prolactinoma and hence i am having tablet cabergiline and hence i had my periods back.Last October i had miscarriage and doctor asked me to stop cabergoline and to have Bromocriptine 2.5 mg daily once.Last Dec i got my periods back. Later i dint had my periods and when io checked my prolactine it was 52 and last 2 months i didnt had my periods also ..Doctor asked me to take 5 mg daile once ,i took the tablet and when i checked my prolactin after 1 month it was increased to 60..what should i do doctor
Asked On : Tue, 10 Apr 2012
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General & Family Physician 's  Response
Hi Deepthy,
I understnd that you have prolactinoma, with irregular periods, ovulatory dysfunction, and thus infertility. Usually Cabergoline is more potent as compared to Bromocryptine in terms of prolactin level, ovulatory dysfunction, and menstruation, and has less side effects, but it is the drug of second choice, who wants to become pregnant also. There are chances of miscarriage alos, as it happened in your case.
You may take the following advise-
1. Whether you are taking cabergoline and bromocryptine, it is advisable to stop medication as soon as you know that you are pregnant. You should also make sure that you detect your pregnancy as early as possible, by using BBT readings ( basal body temperature), or blood test for B HCG.
2.the slight increase in prolactin level, as written in your question may not be significant, though it suggest that this dose is not sufficient. I do not think that you have any side effects with bromocryptine, so your doctor may increase the dose of it up to 15 mg in divided doses every 3rd day gradually. if in case you develop any side effects with higher doses, you have the option to use the tablet vaginally.
iEven if your prolactin level does n't come back to normal, and you do not see your menstruation and ovulation, then your Doctor may try again, Cabergoline under strict supervision, and stop the medicine as soon as you become pregnanct. bromocryptine should also be stopped as soon as you become pregnant.
What is your age? if you are still young, you may first try to lower your level of prolactin with either of your medicine continuously for 6months to 1 year, while using contraceptives. Check your prolactin level after 6 months. it will regularize your period also,ovulation will happen, then you can take maintenance dose for bromosryptine which would be low dose, and then you plan for pregnancy. It would be like planned normal pregnancy.
I hope that you have checked your thyroid hormone levels, and they are within normal range.
have you done MRI? how big is your prolactinoma?
If at all medicine do not work, your Doctor has the option for surgery to remove prolactinoma.
Best of Luck
Answered: Tue, 10 Apr 2012
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