Correspondence

Polycystic Ovary Syndrome

N Engl J Med 1996; 334:668March 7, 1996

Article

To the Editor:

Franks (Sept. 28 issue)1 cites a prevalence of hyperprolactinemia of up to 30 percent in women with polycystic ovaries, yet he does not address the treatment of women with the polycystic ovary syndrome and hyperprolactinemia. Carefully controlled studies, in which multiple blood samples were used to eliminate the effect of stress on prolactin levels, have demonstrated that the frequency of hyperprolactinemia in women with the polycystic ovary syndrome is similar to that in the general population.2,3 These and other findings4 challenge the commonly held belief that the polycystic ovary syndrome and hyperprolactinemia are associated conditions. Therefore, the possibility that the polycystic ovary syndrome and hyperprolactinemia are two separate conditions should be emphasized, since this point may be relevant to the treatment of anovulatory women with the polycystic ovary syndrome. When pregnancy is desired and clomiphene citrate fails to induce ovulation, bromocriptine, alone or in combination with clomiphene citrate, should be tried before more complicated, time-consuming, expensive, and potentially harmful therapies, such as treatment with gonadotropins, are used. Oral contraceptive pills are usually prescribed for anovulatory women who do not desire pregnancy. However, oral contraceptive pills may increase prolactin levels.5 Therefore, in women with the polycystic ovary syndrome and preexisting hyperprolactinemia who are receiving such treatment, prolactin levels should be carefully monitored.

Ariel Zosmer, M.D.
5 Western Ave., London NW11 9HG, United Kingdom

5 References

1
Franks S. Polycystic ovary syndrome. N Engl J Med 1995;333:853-861[Erratum, N Engl J Med 1995;333:1435.]
Full Text | Web of Science | Medline

2
Murdoch AP, Dunlop W, Kendall-Taylor P. Studies of prolactin secretion in polycystic ovary syndrome. Clin Endocrinol (Oxf) 1986;24:165-175
CrossRef | Web of Science | Medline

3
Minakami H, Abe N, Oka N, Kimura K, Tamura T, Tamata T. Prolactin release in polycystic ovarian syndrome. Endocrinol Jpn 1988;35:303-310
CrossRef | Medline

4
Zacur HA, Foster GV. Hyperprolactinemia and polycystic ovarian syndrome. Semin Reprod Endocrinol 1992;10:236-245
CrossRef

5
Zacur HA. Oral contraceptive pills and prolactin. Semin Reprod Endocrinol 1989;7:585-610

Author/Editor Response

Dr. Franks replies:

To the Editor: Dr. Zosmer makes some important points about hyperprolactinemia in women with the polycystic ovary syndrome. Space did not permit me to discuss in detail the prevalence and management of hyperprolactinemia. I agree that the prevalence of hyperprolactinemia in women with the polycystic ovary syndrome may have been overestimated. In our own series of 211 subjects, 14 (7 percent) were found to have elevated serum concentrations of prolactin, and in most cases, the elevations were modest.1 Two women with very high levels of prolactin (>250 ng per milliliter) had presented with the estrogen-deficiency amenorrhea typical of hyperprolactinemia.

As far as management is concerned, I agree with the approach outlined by Dr. Zosmer for the treatment of patients who present with clinical features of the polycystic ovary syndrome and moderate hyperprolactinemia.2 Of course, women with hyperprolactinemia and estrogen-deficiency amenorrhea who happen to have polycystic ovaries will be cared for differently (i.e., with the use of dopamine agonists as the primary therapy).

Stephen Franks, M.D.
St. Mary's Hospital Medical School, London W2 1PG, United Kingdom

2 References

1
Franks S. Polycystic ovary syndrome: a changing perspective. Clin Endocrinol (Oxf) 1989;31:87-120
CrossRef | Web of Science | Medline

2
Polson DW, Mason HD, Franks S. Bromocriptine treatment of women with clomiphene-resistant polycystic ovary syndrome. Clin Endocrinol (Oxf) 1987;26:197-203
CrossRef | Web of Science | Medline

Citing Articles (1)