Menopause Has a Beneficial Influence on the Evolution of Prolactinomas. A Study of 99 Patients.

CONTEXT: Menopause is thought to have beneficial effects in women with prolactinoma, potentially offering a higher chance for successful dopamine agonist (DA) withdrawal. However, strong evidence supporting this remains limited.

OBJECTIVE

To assess the impact of menopause on prolactinoma evolution and recurrence after DA withdrawal.

DESIGN

Retrospective study.

SETTING

Two tertiary academic hospitals.

PATIENTS: We retrospectively analyzed data from 99 women undergoing menopause (Mp, defined as 12 months of amenorrhea, low estradiol, and FSH > 25 U/L) while still on DA treatment for a prolactinoma (mean age at diagnosis: 37.9 ± 8.1 years). The tumors were microadenomas in 67 cases and macroadenomas in 32 (12 invasive).

RESULTS

In postmenopausal women continuing DA at stable doses, median prolactin levels decreased significantly from 18.0 µg/L before Mp to 9.8 µg/L 3 to 6 months after Mp (n = 71, P = .05) and to 7.9 µg/L after 24 months (n = 45, P < .001). Coronal surface also decreased significantly from 16.5 to 8.2 mm² at 24 months (n = 34, P < .01). DA treatment was successfully discontinued in 56 women, all meeting stringent criteria for discontinuation, with 41 (73%) remaining in remission over a median follow-up of 29 months. Recurrence occurred in 15 women (27%), mostly within the first year after DA withdrawal. Prolactin concentration measured 3 to 6 months after DA discontinuation was the only independent predictor of recurrence. Estrogen-progestin replacement therapy, given in 23 women, did not influence prolactinoma outcome.

CONCLUSION

We confirm that menopause has a beneficial effect on the evolution of prolactinomas. When fulfilling stringent criteria for DA withdrawal, two-thirds of postmenopausal women can expect sustained remission, and recurrences are generally mild and asymptomatic.