How to manage prolactin levels in young women with schizophrenia?

Question

Hello doctor,

My 24-year-old daughter, who has schizophrenia, is struggling with medication side effects that are impacting her feminine health. She has been stable on Risperidone for two years, but her prolactin levels are elevated at 89 ng/mL, and she has not had a period in eight months. She has gained 45 pounds and developed galactorrhea, which she finds very embarrassing. Her psychiatrist is concerned that switching medications could trigger a psychotic episode. A recent bone density scan revealed osteopenia, which is especially worrying at her age. She is also experiencing sexual side effects and has expressed feeling like less of a woman. While the antipsychotic medication seems necessary for her mental stability, the physical side effects are taking a serious toll. She hopes to have children one day, but we are concerned about genetic risks and the potential impact of medication on pregnancy. What options are available for managing prolactin elevation in young women with schizophrenia? Can fertility be preserved?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I am sorry to hear about your daughter's struggles. Managing prolactin elevation in young women with schizophrenia can be challenging, but there are options to consider:

Medication adjustments: While switching antipsychotics can be risky, some medications like Aripiprazole have a lower risk of increasing prolactin levels. Discuss this with her psychiatrist to weigh the benefits and risks.
Prolactin-lowering agents: Medications like Cabergoline or Bromocriptine can help lower prolactin levels. These should be used under the guidance of her healthcare provider.
Bone health: Addressing osteopenia with calcium and vitamin D supplements, along with weight-bearing exercises, can help improve bone density.
Fertility preservation: If your daughter wishes to have children in the future, consulting a fertility specialist can provide options for preserving fertility, such as egg freezing.
Psychological support: Providing emotional support and counseling can help her cope with the physical and emotional side effects of her medication.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.