Hyperprolactinemia occurs when blood prolactin levels exceed 25 ng/mL in someone who is neither pregnant nor breastfeeding. This hormone, produced by the pituitary gland, is key for breast development and lactation. Outside of pregnancy, elevated levels disrupt GnRH signaling, halt ovulation, disturb menstruation, and lower estrogen, complicating conception.
In women and men, excess prolactin may present with:
- Absent or irregular menstruation (amenorrhea, oligomenorrhea)
- Milk production without breastfeeding (galactorrhea)
- Anovulation and infertility
- Frontal or retro‐ocular headaches and visual disturbances
- Decreased libido
- Hirsutism if associated with PCOS
- Recurrent pregnancy losses
What causes hyperprolactinemia?
- Physiological: pregnancy, lactation, stress, intense exercise, sleep deprivation.
- Systemic: hypothyroidism, chronic renal failure, cirrhosis, lupus, multiple sclerosis.
- Medications: antipsychotics, metoclopramide, estrogens, calcium channel blockers.
- Pituitary adenomas: prolactinomas (micro <10 mm or macro >10 mm).
Diagnosis
- Measure fasting prolactin after 30 minutes of rest; repeat if elevated.
- Exclude pregnancy and medications that raise prolactin.
- Evaluate TSH to rule out hypothyroidism.
- If persistent, perform pituitary MRI or CT scan.
Do not self‐medicate: always consult a reproductive medicine specialist.
Treatment and pathway to pregnancy
- Discontinue or switch causative medications under medical supervision.
- Treat hypothyroidism with thyroid hormone.
- Dopamine agonists (bromocriptine or cabergoline): start low and adjust until prolactin <20 ng/mL; ovulation and menstruation usually resume in 2–3 months.
- If no response after 6 months or macroadenoma >10 mm: transsphenoidal surgery or radiotherapy.
- If anovulation persists, complement with in vitro fertilization (IVF) to retrieve and fertilize eggs directly.
Frequently Asked Questions
1. Can mild prolactin elevation normalize on its own?
Moderate elevations (20–40 ng/mL) may correct with less stress and better sleep, but require lab follow‐up and specialist evaluation. If it lasts more than 3 months or symptoms occur, treatment is needed.
2. When do I see results with dopamine agonists?
Ovarian function and menstruation improve in 2–3 months. Treatment starts with bromocriptine 1.25 mg/day or cabergoline 0.25 mg/week and is adjusted based on response.
3. Do these treatments affect my health?
Dopaminergic agonists can cause nausea, dizziness, or headache, but these are usually temporary. Thyroid hormone therapy improves energy and overall well‐being.
4. Does high prolactin increase miscarriage risk?
Yes. Elevated prolactin can impair implantation and luteal function. Treating it reduces early losses and improves chances of pregnancy.
We understand how important this journey is: seeking emotional support, managing stress, and working with a reproductive medicine team makes a difference. Consult a professional to evaluate your case and guide you toward the pregnancy you desire.