Impact of menopause on outcomes in prolactinomas after dopamine agonist treatment withdrawal

Objective Discontinuation of dopamine agonist (DA) treatment in women with prolactinoma after menopause is a potential approach; studies systematically assessing long‐term outcomes are lacking. Our aim was to investigate the natural history of prolactinoma in this group. Design/Patients Retrospective cohort study of women with prolactinoma diagnosed before menopause and who after menopause were not on DA. Results Thirty women were included. Twenty‐eight received DA (median duration 18 years, median age at DA withdrawal 52 years). At last assessment (median follow‐up 3 years) and compared with values 6‐12 months after stopping DA, PRL increased in 15%, decreased but not normalized in 33% and was normal in 52%; PRL levels or visible adenoma on imaging before DA withdrawal, treatment duration and presence of macro‐/microadenoma at diagnosis were not predictors of normoprolactinaemia at last review, whereas PRL values 6‐12 months after stopping DA were. Adenoma regrowth was detected in 2/27 patients (7%), who showed gradual increase of PRL. Comparison with 28 women who had DA withdrawal before their menopause revealed lower risk of hyperprolactinaemia recurrence in the postmenopausal group (HR:0.316, 95% CI:0.101‐0.985, p<0.05). Two women with microprolactinoma diagnosed in peri‐menopausal period had not been offered DA; PRL decreased (but not normalized) during observation of 1 and 8 years. Conclusions PRL normalised over time in nearly half of the women and serum PRL 6‐12 months after DA withdrawal is useful predictor. Nonetheless, 7% of the patients demonstrated adenoma regrowth which, given the life expectancy post‐menopause, necessitate regular monitoring of the cases with persistent hyperprolactinaemia.