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Evaluation of suspected hyperprolactinemia in premenopausal woman taking an antipsychotic

Hyperprolactinemia is a common cause of amenorrhea/oligomenorrhea in women taking an antipsychotic. Evaluation of other causes of secondary amenorrhea and the management of other causes of hyperprolactinemia are discussed separately.

PRL: prolactin; MRI: magnetic resonance imaging; GnRH: gonadotropin-releasing hormone; LH: luteinizing hormone; FSH: follicle-stimulating hormone.

* Hyperprolactinemia suppresses hypothalamic GnRH secretion and therefore LH and FSH secretion, leading to amenorrhea and estrogen deficiency.

¶ Lowering dose or changing antipsychotic may increase the risk of worsening psychosis. Aripiprazole has both dopamine agonist and antagonist properties and can dampen the antipsychotic-associated hyperprolactinemia.

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