High prolactin and missed periods: when to get a pituitary MRI

Added: 2026-04-30

[00:00:00]I diagnose brain tumors quite regularly.

[00:00:02]Yes, as a fertility doctor. Allow me to explain.

[00:00:05]So your pituitary gland is this tiny structure at the base of your brain and it's basically the command center for many of our hormones. It can control signals like follicle stimulating hormone or luteinizing hormone. These are signals from our brain to our ovaries that tell them to ovulate each month. One of the hormones the pituitary also makes is called prolactin and prolactin's main job is to help with milk production. This is the hormone that ramps up when we're breastfeeding.

[00:00:28]But here's what's interesting. You can develop a benign tumor, so not cancer, a benign tumor on your pituitary gland, but it pumps out excess prolactin and this can cause some really bizarre symptoms. I'm talking nipple discharge, literally it's like your body thinks that you're ready to breastfeed. One of the bigger issues that can impact fertility is that high levels of prolactin can shut off the FSH and LH signals and so your ovaries may go quiet and ovulation stops. So whenever anyone has irregular or absent cycles, I always check a prolactin level and I check it with macroprolactin precipitation to rule out a falsely elevated level before we go any further. If after removing the macroprolactin, I still have an elevated level, then I'm going to order a pituitary MRI and a microadenoma is a mass that you find in the pituitary that is under 1 cm. Often these don't really cause a lot of symptoms aside from the symptoms associated with the high prolactin levels and we can manage it with medication, a medication called cabergoline that you usually take twice a week that can help to actually shrink the tumor and suppress the prolactin levels.

[00:01:24]But if it grows larger, I'm talking more than 1 cm, it starts compressing nearby structures causing peripheral loss of vision, that's when I would send to my neurosurgery colleagues and they may recommend removal of that tumor through the nose. Yes, you heard me right. I'm going to let her explain this one.

[00:01:39]You heard that right. We can actually perform brain surgery through the nose.

[00:01:41]Pituitary tumors are actually great candidates for a minimally invasive surgery through the nose called endoscopic endonasal surgery. We actually treat tumors that are hormone producing, tumors that are growing or tumors that are large and pressing on the eye nerves using a tiny camera that goes up through the nose to specialized instruments to remove the tumor, separate it from normal pituitary gland without touching the brain at all.

[00:02:01]Patients come out of surgery with no visible scars, looking exactly the same only without the tumor. Patients typically go home two to three days after surgery and can go about their normal life, often being entirely cured after a surgery like this. Because it can cause sudden vision loss, all pituitary tumors should be evaluated by a neurosurgeon who specializes in this condition and in this technique who works with endocrinologists and gynecologists to deliver specific care to you.