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 analysed 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 post-menopausal women continuing DA at stable doses, median prolactin (PRL) levels decreased significantly from 18.0 µg/L before Mp to 9.8 µg/L 3-6 months after Mp (n=71, p=0.05) and to 7.9 µg/L after 24 months (n=45, p<0.001). Coronal surface also decreased significantly from 16.5 to 8.2 mm² at 24 months (n=34, p<0.01). 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 post-DA withdrawal. PRL concentration measured 3-6 months after DA discontinuation was the only independent predictor of recurrence. Estrogen-progestin replacement therapy, given in 23 women, did not influence prolactinoma outcome.

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