Hyperprolactinaemia and HRT dose

[GussyG]

Hi All, does anyone have any experience with Hyperprolactinaemia whilst being on HRT? I’ve been on bio identical HRT for two years for perimenopause and since my prolactin has been high over the last few months it’s completely messed up my menstrual cycles.

I’ve gone from being consistent at around 26 days to a complete muddle of anywhere between 10-18 days. It seems like I bleed, ovulate (based on discharge observations), then suddenly bleed again.

As such, it’s incredibly difficult to judge when I’m in my luteal phase and to start taking Utrogestan. It also means I’m not getting enough progesterone compared to oestrogen (which is continuous)

I’m tempted to take Utrogestan continuously so at least I keep some sort of balance until I see an Endo in….6 months?

Is it worth contacting the Pituitary Org for advice? I feel like this way is beyond the scope of a GP (who recently commented I was too young to start HRT 🙄. I’m 49!).

Thanks 🙏

[Regenallotment Ambassador]

how are your thyroid hormones?

I ask because when I was at my most hypo it was the two bleeds a month that the locum GP spotted. Stopped HRT and started Levo and it resolved.

Check with GP and get a gynae referral, could be fibroids could be other things, don’t settle for your new normal 🤗

[JumpJiving]

I contacted the Pituitary Foundation recently as my prolactin level suddenly and unexpectedly went above range. They were very helpful (and prolactin is way outside the knowledge of my GP), so I'd suggest contacting them.

[RedApple]

Are you on any thyroid hormone replacement? Hyperprolactinaemia is frequently caused by hypOthyroidism. All hormones need to be in balance.

[GussyG in reply to RedApple]

Hi all, thanks so much for commenting  JumpJiving  Regenallotment I should have stated that I’ve just started Levo (50mcg) , literally two days ago (private dr)! So far it’s making me feel worse, but of course it’s super early days. I’m wondering how I continue with my HRT while my body adjusts. I’m currently on day 10 of my cycle and can feel another period about to start….so that’s more missed Utrogestan. This is my 5th very odd/short cycle with hardly any progesterone. If I have only oestrogen in my system does that adversely affect thyroid function? But then if it’s a pituitary problem and I’ve understood correctly I might need the oestrogen replacement gahhhh! I won’t know that for months until I see an Endo.

Do you think I should wait for levo to do its job which should in turn should hopefully reduce the prolactin and therefore regulate my cycle? I’m not sure how long that could take, but I’m guessing it’s not overnight.

I’ll give the Pituitary Org a call. From what I’ve read on here they sound very helpful 👍

[RedApple in reply to GussyG]

'I’ve just started Levo (50mcg) '

Can you post your latest full thyroid test details i.e. TSH, FT4, FT3, TPOab and TGab to give a more complete picture of your thyroid hormone status before starting on levo?

'Do you think I should wait for levo to do its job which should in turn should hopefully reduce the prolactin and therefore regulate my cycle? '

It will take time for thyroid levels to rise, and to get the hormones in balance, so yes, might be best to wait it out for the time being. My prolactin was massively high before starting on thyroid meds, but gradually normalised over time, as my dose of levo stabilised.

[GussyG in reply to RedApple]

Sure, latest bloods (Medichecks):

TSH 5.11 (0.27 - 4.2)

T4 14.8 (12 - 22)

T3 4.5 (3.1 - 6.8)

TPO 19.8 (0 - 34)

TgAb 16.8 (0 - 115)

[Regenallotment Ambassador in reply to GussyG]

Ah ok so are you stopping urtogestan everytime you start bleeding? TiggerMe will know but if it was me I’d continue for the 15 days regardless.

[GussyG in reply to Regenallotment]

Yes I had been, but maybe I shouldn’t have been? I was working it back from 26 days to start halfway and then stop once my period started. But now it’s so short and random I can’t do that. What a muddle. Half wondering now if I taper off it altogether to see what the Levo does or maybe that’s too much change at once

[Regenallotment Ambassador in reply to GussyG]

Yes one idea might be to stop HRT for a few cycles (stop estrogen too to protect your uterus lining). Then restart when your Levo is more settled.

Some people take urtogestan every day throughout the cycle and almost stop periods altogether. The only take a half dose then though.

My GP wanted me to start urtogestan with 14 days on 14 days off. So I take it on day 15 counted from day 1 of a period and take every day till day 29.

I’m guessing here, but going on and off it might be causing you to have withdrawal bleeds.

[gabkad]

For what it's worth, I started HRT at age 45. Continuous both estrogens and progesterone.

I never took a day off of either. I had my period regularly every 35 days until age 52. I started on the HRT because of perimenopausal symptoms like hot flashes and inability to get decent sleep. As a bonus side effect it regulated my mood so I wouldn't experience PMS anymore.

I had high prolactin levels prior to being put on levothyroxine decades ago. Since then, my prolactin has been checked a few times and it's always been fine. Halfway through range and not over range. Probably aside from the exhaustion, the other sign I had of being hypo at age 18 was no longer getting regular periods. They'd happen every three or four months.

[GussyG in reply to gabkad]

That’s interesting thanks for commenting. I also started at 46 for similar reasons, sleep poor, brain fog the odd hot flush but my main symptom was hair loss. Looking back it was probably the start of my thyroid struggling in combination with perimenopause. I’ve never felt like the HRT has stabilised my own spikes/dips. I’ve also found being on sequential (rather than continuous) a challenge. Like my body didn’t like coming off the progesterone part and would struggle to readjust to just the oestrogen in the follicular phase. This led me to think about oestrogen dominance (I have v heavy painful periods) and read how often in peri progesterone is the first thing to fall. Looking back I wish I’d not listened to the HRT specialist (from a reputable practice on Instagram) who told me my thyroid was fine when it was clearly struggling (TSH was 4). But I guess they follow the same principles as most GPs as they are GPs themselves, just with an interest in menopause. If only I’d known then what I do now!

[gabkad in reply to GussyG]

I have two friends who have both started HRT this year. They are using them every day, no days off.

I think doctors are confusing the rhythm of the birth control pill with HRT. But even with the birth control pill, there are women who take it continuously for a year at a time. Withdraw once, then continue for another year.

Progesterone, if you take it every day, will reduce the thickness of the lining of the uterus and reduce the amount of bleeding during menstruation.

Check your iron (ferritin). Anemia results in more blood loss and not the other way around. Sound contradictory but if the muscle of the uterus doesn't get enough oxygen and energy, it doesn't contract as it should to expell the endometrial tissue and this results in prolonged excessive bleeding.