Symptoms Suggest Evaluating for PCOS and Prolactinoma

Question

I am currently living in the Middle East as my husband is studying here – so I could use some help from an English speaking doctor.
I am trying to get pregnant but keep having pink spotting a week before my period is due(often at 24 hour intervals) and then my period comes. Plus my last one was 11 heavy, clotty days – rather than my usual light four to five days. I can’t say for sure but to me that sounds like an early miscarriage. I also have PCOS and have just gone off the pill in the last nine months. I have been wondering if it is possible that I have a progesterone deficiency. I have read that there are creams I can buy but I also don’t want to just believe everything I read on the internet either.

Before spending a fortune on doctors is there any reason that I shouldn’t give it a try (two weeks out of each cycle) – Could it be harmful?

PS. Here are a few other odd notes that could be related:

I have lactated at the oddest times, both early in my past pregnancies and when not pregnant.

Besides spotting with both my boys (now ages ten and eight) for months, I had false labor from six months on and then had them both early (four and a half and three and a half weeks early).

My morning body temp doesn’t fluctuate more than a few degrees if I chart my monthly cycle.

I have bad issues with vaginal dryness especially after my periods.

I have issues with maintaining a normal body temp. (always cold or hot when no one else is)

Have irregular periods. (often three to four months apart)

At times I have a lot of clotting when I have my period.

As I said before I have PCOS, and have been told my testosterone is unusually high. So, obviously things are not balanced.

Thank you so much for your time!

Violet

Answer

Last Updated: September 12, 2022
Dear Violet,

It is wonderful that you have such good information about your health so that you can ask such good questions. From your symptoms and your health history, one could make a case for PCOS as the underlying cause. However, the breast discharge combined with some of your other symptoms can be an indication of a prolactinoma. Of course, you may have both.

PCOS (polycystic ovarian syndrome) is a disorder that affects many things more than the ovaries. Classically the woman develops male pattern hair growth, acne, infertility, obesity. Additionally the ovaries have multiple cysts or sometimes very large painful cysts and she develops impaired glucose tolerance and hypertension. Levels of progesterone are usually low in the luteal phase (post-ovulatory) and most women have irregular cycles because they don’t always ovulate. Infertility and miscarriage can be common because of the low progesterone levels.

Interestingly, diabetes medicines such as metformin and weight loss are part of the treatment for PCOS. Unfortunately, many young women are put on birth control pills for irregular cycles without discovery of the underlying cause of the irregularity. Artificial hormones in the pill are associated with elevated blood pressure and impaired glucose tolerance, some of the very things that PCOS causes. About 8-10% of adult women in the US have this syndrome and research is only beginning to scratch the surface as to the underlying biochemical mechanism at work.

A prolactinoma is a non-cancerous adenoma (benign tumor) in the pituitary gland. The pituitary gland is a small gland in the brain that influences nearly every part of your body. Its hormones, such as prolactin, help regulate important functions such as growth, blood pressure and reproduction. Elevated prolactin levels interfere with the function of the ovaries in women and the testicles in men. High blood prolactin concentration interferes with the function of the ovaries in a premenopausal woman which then decreases the secretion of estradiol, the main type of estrogen. Symptoms include irregular or absent menstrual periods, infertility, menopausal symptoms (hot flashes and vaginal dryness), and, after several years, osteoporosis. High prolactin levels can also cause milk discharge from the breasts outside of normal lactation.

Elevated prolactin levels can also be caused by medications, chest trauma, and hypothyroidism. Evaluation would include blood tests, an MRI of the brain, medication review and treatment is usually specific medication but sometimes can include surgery or radiation treatment.

As you can see from the descriptions, you have many symptoms and give a history that coincides with both PCOS and elevated prolactin levels. Based on the information that you gave me, it would be very important for you to have a thorough exam with a physician who can help organize the blood tests and possibly an MRI.

I hope that this information helps.

Sincerely, Gretchen V. Marsh, D.O

Answered By:

Gretchen Marsh, D.O.
Dr. Marsh graduated from Western University of Health Sciences in 1987 in Pomona, CA and is board certified in Family Medicine by the American Osteopathic Board of Family Physicians. She has been certified as a NaProTechnology® Medical Consultant (NaPro) and Creighton model Fertility Care System (CrMS) teacher since 2001. She and her husband, Jon, have 5 sons and live in the Reno region, where she sees patients in person, in addition to her telehealth services offered via MyCatholicDoctor.com

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