Hormonal Imbalances

What's Inside?

Hyperprolactinemia

What is it?

Hyperprolactinemia is a condition associated with higher than normal amounts of the hormone prolactin in the body. It affects between 9-17% of all women experiencing reproductive issues.

Prolactin is secreted by the pituitary gland and is responsible primarily for growth of breasts and lactation in mothers after childbirth. Prolactin is also involved in other body functions such as ovulation and immunity, though not to the same extent. 

What causes it?

It is a hormonal imbalance that may be caused by existing known or unknown medical conditions, and/or by damage to the pituitary gland which is responsible for its secretion including tumors/ cysts.

Thyroid disorders, PCOS, and dysfunction in the livers or kidneys, may also cause elevated prolactin in the blood. Stress and commencement of strenuous exercise may also cause hormonal imbalances.

What are the signs and symptoms?

The common symptoms of hyperprolactinemia include:

  • Irregular periods (absence of periods, or increased days between periods)
  • Nipple discharge
  • Infertility
  • Lower libido
  • Bone weakness resulting from decreased bone mass

However, it is important to note that excess prolactin may also be asymptomatic i.e. have no visible symptoms.

How is the condition diagnosed?

Blood tests are prescribed to check the amount of prolactin present in the blood. Normal prolactin levels in females range between 5 and 25 ng/ml, however the exact amount varies with several factors including time of day, time from last meal, drug intake and present medication. For these reasons, hyperprolactinemia is only suspected if the hormone level is noticeably elevated: > 250 ng/ml.

What are my treatment options?

  • If your hyperprolactinemia is caused by tumors on or around the pituitary gland, medication may be prescribed to reduce the size of the tumor, or surgery to remove it completely. It is recommended to discuss future pregnancies and concerns with your physician as some medications might have unwanted side effects.
  • If your hyperprolactinemia is caused by existing medication, other drugs may be prescribed to counter the increase in prolactin caused by the first. Medication may include dopamine agonists or hormonal contraceptives.

Thyroid Gland abnormalities

What are hormonal abnormalities in relation to the thyroid gland?

The thyroid gland is located in front of your neck, at the base. It is responsible for producing hormones that play a significant role in menstrual and reproductive health, in addition to bodily functions like regulating metabolism and growth.

Hypothyroidism is a condition caused by insufficient production of thyroid hormones, while hyperthyroidism is a condition caused by overproduction of thyroid hormones. 

What causes it?

Inflammation of the thyroid gland, toxic nodules or growths on the thyroid gland called adenomas, and sometimes disorder of the pituitary gland, may all interfere with normal production of thyroid hormones in the body. Autoimmune disorders such as Hashimoto’s disease is a condition where the body attacks its own thyroid, resulting in lesser secretion of the thyroid hormones.

Some factors that may increase the risk of developing thyroidism include genetics (family history) and lifestyle factors such as great amounts of stress and excessive smoking.

What are the signs and symptoms?

Hypothyroidism is caused by an underactive thyroid gland. Due to insufficient thyroid hormones you may experience:

  • Metabolism slows down, causing weight gain (or difficulty losing weight)
  • Feeling cold even when those around you are not (intolerance to cold)
  • Dry hair
  • Long term constipation
  • Heavy and sometimes painful periods, or lesser time between successive periods

 

Hyperthyroidism is caused by an overactive thyroid gland and may result in:

  • Weight loss, or difficulty gaining weight
  • Feeling hot even when those around you are not (intolerance to heat)
  • Hair loss/ thinning of hair
  • Diarrhoea or irritable bowel syndrome
  • Lighter periods, or absence of periods (amenorrhea), or greater time between successive periods

In both cases you may also observe swelling of the area around the neck.

How is the condition diagnosed?

  • Your doctor will most likely perform a physical examination of the area around your neck for swellings or enlargement of the thyroid and to check whether you experience any difficulty swallowing, weight gain/loss, and reflexes;
  • Following the physical examination, clinical blood tests may be recommended to test levels of thyroid hormone. This generally includes tests for TSH (Thyroid Stimulating Hormone), T3, T4, and TPO antibodies. Prolactin levels are also generally checked as the two conditions are often found to be interrelated.

What are my treatment options?

  • Thyroid replacement hormones are often prescribed for underactive thyroid gland (hypothyroidism)
  • In the case of overactive thyroid, antithyroid drugs may be prescribed to reduce the level of thyroid hormone produced. Surgical removal of parts of the thyroid or radioactive iodine may be recommended to reduce the gland’s ability to produce hormones.
  • Lifestyle changes are also frequently recommended in the form of better stress management, improved diet to reduce inflammation, and iodine or other nutritional supplements.

Primary ovarian insufficiency

What is it?

Primary ovarian insufficiency (POI) is sometimes inaccurately referred to as ‘premature menopause’ or ‘premature ovarian failure’.This nomenclature is now unpopular since a lot of persons struggling with POI do still get their periods. It is a condition in which the ovaries do not function as expected in women below 40 years of age, i.e. the release of eggs is impaired or the production of essential hormones (like progesterone, estrogen, and testosterone) is absent or intermittent. As expected, POI affects a woman’s fertility, making it difficult to get pregnant.

What causes it?

All causes of POI are not presently known, however the few known causes include genetic factors (abnormal genes and chromosomes), factors pertaining to toxins (such as radiation and chemotherapy), and autoimmune factors where the body’s immune system begins mistakenly attacking hormone producing glands.

What are the signs and symptoms?

  • Irregular periods (absent, light, or otherwise irregular)
  • Difficulty getting pregnant
  • Vaginal dryness or hot flashes

How is the condition diagnosed?

After taking stock of your symptoms, you may be prompted to get your hormone levels checked.

  • High FSH levels: Follicle Stimulating Hormone (FSH) is required to stimulate the ovaries. If you have elevated levels of FSH, it could be the sign that your body is unsuccessfully trying to stimulate the ovaries by producing higher than normal levels of this hormone.
  • If the above blood test shows reason for concern, your physician may recommend testing for specific autoimmune or genetic factors that cause POI.

What are my treatment options?

  • It is important that you treat POI even if you have no intention of getting pregnant because low levels of estrogen could also affect your bone density (resulting in osteoporosis in some cases) and increase risk of heart disease.


    1. Artificially introducing the appropriate levels of estrogen and progesterone in the body through estradiol and progesterone alternatives. This may be consumed as a pill, a vaginal ring, or as a skin patch also called hormone replacement therapy. Estrogen Replacement therapy in particular is useful to prevent osteoporosis and heart disease and ideally should be used until 50-51 years of age. If you aren’t already having perimenopausal symptoms, this therapy can keep them at bay.
    2. If you wanted to conceive whether it was becoming a first time mom or having more children, this can be a bitter pill to swallow. Emotional support and therapy to deal with the psychological aspects of being unable to get pregnant is advisable.