It’s no secret that medical research often excludes women who aren’t on birth control. This may be in part due to researchers’ fears about the effects of a medicine or intervention on a preborn baby if a woman conceived during the study. But this isn’t the only reason naturally cycling women are purposefully excluded.
Women on hormonal birth control are easier to study than women whose hormones fluctuate throughout their cycle phases. After all, such hormonal fluctuations could affect their response to medical interventions or medications. Is it any wonder, then, that many women aren’t told by their healthcare providers how the medications they take every day or regularly could affect their current or future menstrual cycles or fertility?
This may be the current norm in women’s healthcare. But is it acceptable?
She was prescribed an antidepressant and later got abnormal blood draw results
Katelin* recently reached out to Natural Womanhood to share her story after reading an article on the site that prompted her to speak to her OB/GYN about a medication she’d been taking daily for a year. While she was in college several years back, Katelin began seeing a psychiatrist for mental health issues and was prescribed an antidepressant. A year or so later, she sought out a NaPro-trained OB/GYN to get to the bottom of cycle irregularities she was experiencing. The OB/GYN ordered bloodwork that revealed Katelin had a high prolactin level.
High prolactin levels are normal and expected toward the end of pregnancy and throughout the postpartum period if a woman is breastfeeding. But they are not normal in a woman who isn’t pregnant or nursing. A high prolactin level always needs to be explored because of its connection with endometriosis and autoimmune conditions, but in many cases its due to a benign tumor on the pituitary gland in the brain [1][2]. Katelin’s OB/GYN believed this to be the most likely explanation. The doctor recommended a ‘wait and see’ approach and ordered repeat bloodwork six months later. When that second blood draw showed an even higher level, Katelin was immediately prescribed medication to decrease her prolactin.
Neither her psychiatrist nor her OB/GYN explained how Katelin’s high prolactin level and antidepressant use might be connected
Looking back, Katelin wishes several things. She wishes that her psychiatrist had considered the possibility that a hormonal imbalance (like high prolactin) was causing the mood changes that led her to seek help. The psychiatrist should also have educated her up front on the possibility that the antidepressant would cause high prolactin. The first NaPro OB/GYN could have looked into all of the above possible connections. Katelin also wishes the OB/GYN had ordered an imaging test like an MRI to confirm that she indeed had a tumor. Instead, the presence of a tumor was merely assumed and she was told, “Take this medication twice a week and it will shrink the tumor.”
Her OB/GYN didn’t tell her what would happen if she got pregnant while taking the new prolactin-lowering medicine
Katelin recalled that once the OB/GYN ascertained that she wasn’t actively trying to conceive, “no further explanation or education” was given about how the new medicine could affect her menstrual cycles, fertility, or family planning goals. Education on how medication impacts fertility is particularly important for women on prolactin-lowering medication since during the end of pregnancy and breastfeeding, prolactin levels are normally expected to rise dramatically. Katelin wondered how her situation would be handled if and when she decided to start a family, but that topic went unaddressed by her provider.
She shared,
“I took the medication, but in the meantime started doing research of my own to see what else could cause hyperprolactinemia. [On the list I found] was ‘certain depression medications,’ and I was taking one at the time, so I brought it up to my psychiatrist. ‘No, that medication won’t cause high prolactin levels,’ I was assured. So I moved on, but never really felt peace, or like either doctor had truly done a thorough work-up.”
Then she read Natural Womanhood’s article on hyperprolactinemia
Katelin continued, “About a year later, I read Natural Womanhood’s article on hyperprolactinemia. In it I again read that some depression medications can cause the condition, but also that having high prolactin levels can negatively impact your cycles and fertility. I took this as a sign to take action and find greater peace and clarity with my recent diagnosis. Plus, I had just gotten off the depression medication I had been taking, so it was an opportune time to see if that was indeed the cause of it.”
She went on:
“Knowing now that I had an accurate, scientific basis for the concerns I held, I found a [new] Napro doctor. She agreed that it was possible [that the antidepressant had raised my prolactin level], so we retested. Sure enough, everything was normal. But if I hadn’t read that NW article and taken it as a sign to advocate for myself, I would’ve continued taking a medication I didn’t even need, wondering how long I would need to be on it, and how/if I would be able to conceive.”
Most women have no idea how the medicines they take routinely could affect their cycles or fertility
Katelin opted to share her story with us, “hoping it can be used to inspire others to advocate for their health.” Sadly, she isn’t alone when it comes to being left in the dark about the effects of medical interventions on one’s fertility. Natural Womanhood previously covered a study finding that the vast majority of female cancer patients received little to no education on how their cancer treatment(s) could impact their menstrual cycle or fertility. If information about the fertility-damaging effects of such powerful medicines as those that destroy cancer cells isn’t routinely shared, what’s the likelihood that the average woman (who takes medication for 60% of her life!) will receive education about interventions believed to be far less potent?
Until healthcare providers consistently tell women how their medicines could affect their cycles or fertility, women themselves need to ask these questions
This may be the status quo, but women deserve better. It’s true that this topic may fall through the cracks because the majority of reproductive-aged American women are on hormonal birth control, meaning that they aren’t having menstrual cycles and aren’t planning to get pregnant (or breastfeed). These women are less likely to ask questions about the potential impact to their fertility from certain medications.
Nevertheless, menstrual cycles and fertility are the biological norms, not hormonally-induced sterility. Women deserve education on how the medications they take every day or regularly could affect those norms. Until it becomes commonplace for doctors to initiate these conversations, the task falls to individual women to always ask “How could this affect my cycle or fertility?” when they discuss starting a new medication. And, as Katelin’s story shows, if their doctor isn’t aware of the effects, women may have to dig to find this information for themselves.
*Name changed for privacy.
This article was updated on January 22nd, 2024, to reflect the connection between high prolactin levels and autoimmune conditions or endometriosis.
References:
[1] Mirabi P, Alamolhoda SH, Golsorkhtabaramiri M, Namdari M, Esmaeilzadeh S. Prolactin concentration in various stages of endometriosis in infertile women. JBRA Assist Reprod. 2019 Aug 22;23(3):225-229. doi: 10.5935/1518-0557.20190020. PMID: 30969738; PMCID: PMC6724390. [2] Borba VV, Zandman-Goddard G, Shoenfeld Y. Prolactin and Autoimmunity. Front Immunol. 2018 Feb 12;9:73. doi: 10.3389/fimmu.2018.00073. PMID: 29483903; PMCID: PMC5816039.Additional Reading:
Where is my period?: The causes of primary amenorrhea
Why have my periods stopped? Exploring the causes of secondary amenorrhea
