Challenging contraceptive issues in a woman with
hyperprolactinemia – a case report
M. Navani, C. Robinson, and A. Asliwal
Palatine Centre, Central Manchester pct, Manchester, United
Kingdom, Southwark Pct, Southwark, United Kingdom and Palatine Centre, Central Manchester Pct, Manchester,
Background Macroprolactinemia is an under recognised cause of
hyperprolactinemia occurring in 25% of cases. Macroprolactin is a complex of
anti-prolactin immunoglobulins and monomer prolactin with little biological
activity in vivo. The need to differentiate this from true hyperprolactinemia is
emerging and screening tests for its detection are currently available in UK.
Clinicians should be aware of the potential misleading nature of macroprolactin
as it may not be associated with hypoestrogenism that is seen in
hyperprolactinemia, which has implications on making contraceptive choices.
Summary of Case report Mrs JB, age 45 with past history of 3 caesarean sections
was referred to the family planning clinic for Implanon insertion in 2003. She
was using Depo Provera® for contraception since her last child was born in
In 1996, Mrs JB was diagnosed with idiopathic hyperprolactinemia following
investigations for subfertlity. At the time screening tests for
macroprolactinemia were not widely available.
After her last childbirth in 2000,
she had discontinued bromocryptine. Repeat investigations in 2003 showed that
hyperprolactinemia in this case was due to macroprolactin and Mrs JB made an
informed choice of using condoms for contraception after being counselled about
her other options of contraception.
Women presenting with idiopathic
hyperprolactinemia should be investigated for presence of macroprolactin,
particularly in the presence of discrepant clinical findings, as in the case of
Mrs JB who had regular ovulatory menstrual cycles with subfertility.
Challenging issues in this case are Relevance of macroprolactinemia,
Investigations, Depo-provera® and it’s effects on prolactin levels and FSH
levels. Hyperprolactinemia, macroprolactinemia and risk of osteoporosis.
Contraceptive options in the perimenopausal age group with macroprolactinemia
and a history of three previous caesarean sections.