Hyperprolactinemia

What is hyperprolactinemia?

Hyperprolactinemia means there is too much of the hormone prolactin in the blood. Prolactin is made by the pituitary gland and is mainly responsible for milk production after childbirth. Outside pregnancy and breastfeeding, high prolactin suppresses the hormones (GnRH, FSH and LH) that drive ovulation, leading to irregular or absent periods and difficulty conceiving. It can also affect men, lowering testosterone and sperm production.

Symptoms and signs

In women

• Irregular, infrequent or absent periods
• Milky discharge from the nipples when not breastfeeding (galactorrhoea)
• Difficulty conceiving
• Vaginal dryness and low sex drive

In men

• Low sex drive and erection problems
• Breast enlargement
• Low sperm count

Headaches or changes in vision may occur if a large pituitary tumour presses on nearby structures. Mildly raised prolactin may cause no symptoms.

Causes and risk factors

• Prolactinoma, a non-cancerous tumour of the pituitary gland
• Medicines, including some antipsychotics, antidepressants, metoclopramide, domperidone and some blood pressure drugs
• Hypothyroidism
• Pregnancy and breastfeeding (normal causes)
• Chronic kidney or liver disease
• Stress, recent exercise or nipple stimulation, which can raise levels temporarily
• Macroprolactin, a large, mostly inactive form of prolactin that can make levels look high without causing problems

How it is diagnosed

• Prolactin blood test, ideally taken in the morning in a relaxed state, and repeated if mildly raised
• Macroprolactin testing when symptoms do not match the result
• Pregnancy test and thyroid function (TSH)
• Kidney and liver function tests
• Review of all current medicines
• MRI of the pituitary gland if prolactin is persistently high without another explanation
• Visual field testing for larger tumours

Treatment options

Treating the cause

If a medicine is responsible, your doctor may change it or suggest an alternative, but you should never stop a prescribed medicine without advice. Hypothyroidism is treated with levothyroxine, which often brings prolactin down.

Dopamine agonists

Cabergoline, taken once or twice a week, is usually the first-choice treatment. Bromocriptine is an alternative. These medicines lower prolactin, shrink most prolactinomas and restore regular ovulation in the majority of women. Once pregnancy is confirmed, the medicine is usually stopped on medical advice, though women with large tumours need closer monitoring.

Surgery

Pituitary surgery is needed only rarely, for example when tumours do not respond to medicines or cause pressure symptoms.

Fertility treatment if needed

If ovulation returns but pregnancy does not follow, other causes are checked, and ovulation induction, IUI or IVF may be offered.

Chances of pregnancy

Most women with hyperprolactinemia start ovulating again once prolactin levels are controlled, and many conceive without further treatment. Overall chances depend on age, any other fertility factors and the partner's semen quality. Outcomes vary and cannot be guaranteed.

When to see a fertility specialist

See a specialist if you have irregular or absent periods, nipple discharge when not breastfeeding, or a raised prolactin result while trying to conceive. Seek prompt medical attention for persistent headaches or vision changes. Iswarya Fertility offers hormone testing and fertility care across its 91+ centres.