Prolactin Testing in Abnormal Uterine Bleeding Workup
Yes, obtain serum prolactin levels as part of the initial laboratory evaluation for abnormal uterine bleeding in reproductive-aged women. This is a standard component of the workup to exclude hyperprolactinemia as an underlying cause of ovulatory dysfunction.
Laboratory Testing Algorithm
Prolactin measurement is explicitly recommended in multiple guidelines as part of the initial assessment:
- Measure thyroid-stimulating hormone (TSH) and prolactin levels to rule out thyroid dysfunction and hyperprolactinemia in all patients with abnormal uterine bleeding 1, 2, 3, 4.
- These endocrine tests help identify treatable causes of anovulation, which is a common mechanism for abnormal uterine bleeding 1.
Clinical Rationale
The inclusion of prolactin testing addresses a specific category in the diagnostic framework:
- Hyperprolactinemia is one of the recognized causes of anovulation that must be considered during evaluation 1.
- The PALM-COEIN classification system guides the workup, with ovulatory dysfunction being a key non-structural cause that requires endocrine evaluation 1, 4.
- Identifying hyperprolactinemia can fundamentally change management, as treating the underlying prolactin disorder may resolve the bleeding without need for hormonal contraception or surgical intervention 1.
Complete Initial Laboratory Panel
When ordering prolactin, obtain these concurrent tests:
- Pregnancy test (β-hCG) in all reproductive-age women to rule out pregnancy-related bleeding 2, 3, 4.
- TSH to exclude thyroid disease as a cause of anovulation 1, 2, 3, 4.
- Complete blood count with platelets to assess for anemia and coagulopathy 2.
Common Pitfall to Avoid
Do not skip endocrine testing even when structural causes seem likely on imaging, as multiple etiologies can coexist and hyperprolactinemia requires specific treatment that differs from standard abnormal uterine bleeding management 1, 4.