Raised prolactin from antipsychotics often goes unreported because people do not link the symptoms to the drug or find them embarrassing to raise.
Ask directly about menstrual change, galactorrhoea, reduced libido and erectile dysfunction at baseline and at follow-up. Measure prolactin at baseline and when symptoms appear. Where hyperprolactinaemia is troublesome, dose reduction, a switch to a prolactin-sparing antipsychotic, or adjunctive aripiprazole are the usual options, chosen with the patient.
- Ask about periods, breast discharge, libido and erectile function at each review.
- Check prolactin at baseline and if symptoms appear.
- Consider long-term bone health in people with persistent hyperprolactinaemia.
- Discuss options with the patient before changing a drug that is controlling psychosis.
Why it matters
Unspoken sexual and menstrual side effects are a common, quiet reason people stop antipsychotics.
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