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

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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.

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