From the Guidelines
Combined oral contraceptives (COCs) generally do not cause clinically significant elevations in prolactin levels. While some studies have shown small increases in serum prolactin in some women taking COCs, these elevations are typically mild, transient, and remain within the normal physiological range. The estrogen component in COCs may occasionally lead to slight increases in prolactin secretion by stimulating lactotroph cells in the pituitary gland. However, these changes are not usually sufficient to cause hyperprolactinemia or associated symptoms like galactorrhea, menstrual irregularities, or infertility.
Key Points to Consider
- If a patient on COCs develops significantly elevated prolactin levels, other causes should be investigated, such as pituitary adenomas, medications (antipsychotics, metoclopramide), hypothyroidism, or chronic stress 1.
- For women with pre-existing hyperprolactinemia or prolactinomas, progestin-only contraceptives may be preferable to COCs, though this should be discussed with a healthcare provider.
- Regular monitoring of prolactin levels may be warranted in women with risk factors who are using COCs.
Clinical Decision Making
In clinical practice, the decision to prescribe COCs should be based on individual patient factors, including medical history, risk factors for venous thromboembolism, and other health considerations 1. It is essential to weigh the benefits and risks of COC use and consider alternative contraceptive options when necessary.
Monitoring and Follow-up
Women using COCs should be monitored for any changes in their medical condition, including the development of hyperprolactinemia or other adverse effects. Regular follow-up appointments with a healthcare provider can help identify any potential issues early on and ensure the safe and effective use of COCs.
From the Research
Combined Oral Contraceptives and Prolactin Levels
- The relationship between combined oral contraceptives and prolactin levels has been investigated in several studies 2, 3, 4, 5.
- A study published in 2023 found that combined oral contraceptives did not have a significant effect on prolactin levels in women with hyperprolactinemia, but worsened insulin sensitivity and increased triglycerides, hsCRP, fibrinogen, and UACR 2.
- Another study published in 2015 found that oral contraceptive pills containing ethinyl estradiol and levonorgestrel slightly increased pre-polyethylene glycol serum prolactin levels and macroprolactin levels in women with macroprolactinemia 3.
- A longitudinal study published in 1986 found that oral contraceptives containing less than 50 micrograms of oestrogen had a small but significant stimulatory effect on prolactin secretion in normal women, with mean prolactin concentration increasing from 8.9 ng/ml to 10.9 ng/ml at 12 months 4.
- A study published in 1981 found that women who used oral contraceptives for more than 1 year were 2.64 times more likely to develop hyperprolactinemia, and 6.25 times more likely if they started using oral contraceptives before the age of 25 5.
Key Findings
- Combined oral contraceptives may have a stimulatory effect on prolactin secretion in some women 3, 4, 5.
- The effect of combined oral contraceptives on prolactin levels may vary depending on the individual and the specific formulation of the contraceptive 2, 3, 4.
- Combined oral contraceptives may have other effects on the body, such as worsening insulin sensitivity and increasing triglycerides, hsCRP, fibrinogen, and UACR 2.