Do patients with Polycystic Ovary Syndrome (PCOS) have elevated prolactin levels?

From the Research

Patients with Polycystic Ovary Syndrome (PCOS) typically do not have elevated prolactin levels as a characteristic feature of the syndrome itself. While some PCOS patients may occasionally present with mildly elevated prolactin, this is not characteristic of PCOS and should prompt investigation for other causes. The most recent and highest quality study, 1, suggests that hyper and hypoprolactinemia seem to be related to the occurrence of metabolic alterations in PCOS patients, but the prevalence of hypoprolactinemia is not considered high.

Key Points to Consider

• If elevated prolactin (hyperprolactinemia) is found in a patient with suspected PCOS, additional evaluation is warranted to rule out conditions such as pituitary adenomas, medication effects, hypothyroidism, or other disorders.
• The core hormonal disturbances in PCOS include elevated androgens (like testosterone), insulin resistance, and often luteinizing hormone (LH) elevation relative to follicle-stimulating hormone (FSH), but not prolactin elevation.
• Hyperprolactinemia can cause symptoms that overlap with PCOS (such as irregular periods and infertility), but requires different treatment approaches.
• When evaluating patients with PCOS-like symptoms, checking prolactin levels is recommended to ensure an accurate diagnosis and appropriate management plan, as suggested by 2 and 3.
• A study from 4 found that PCOS was the most common etiology of hyperprolactinemia in pediatric patients, but this finding may not be generalizable to all PCOS patients.

Recommendations for Clinical Practice

• Evaluate patients with PCOS-like symptoms for prolactin levels to rule out hyperprolactinemia.
• Investigate the causes of hyperprolactinemia in PCOS patients, including pituitary adenomas, medication effects, and other disorders.
• Consider the potential impact of hyperprolactinemia on metabolic alterations in PCOS patients, as suggested by 1.
• Develop a management plan that addresses the underlying causes of hyperprolactinemia and PCOS, as recommended by 5 and 3.