Challenging contraceptive issues in a woman with hyperprolactinemia – a case report

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.

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