Understanding Elevated Prolactin Levels: Causes, Symptoms, and Treatment Options

Hormones are powerful chemical messengers that influence nearly every aspect of your health from reproduction to metabolism and mood. One hormone that often flies under the radar is prolactin, which plays a key role in lactation and fertility. When this hormone is present in excessive amounts, the condition is known as hyperprolactinemia.

While elevated prolactin levels are normal during pregnancy and breastfeeding, abnormally high levels at other times can lead to menstrual problems, infertility, breast discharge, and even sexual dysfunction. In this article, we explain what hyperprolactinemia is, its causes, signs, and how it can be diagnosed and treated.

What Is Prolactin?

Prolactin is a hormone produced by the pituitary gland, a small gland located at the base of the brain. Its main function is to stimulate breast development and milk production in women, especially during and after pregnancy.

In people who are not pregnant or breastfeeding, prolactin levels are typically low. When levels become elevated without a natural cause, it can interfere with the body’s hormonal balance particularly the hormones estrogen, progesterone, and testosterone.

What Is Hyperprolactinemia?

Hyperprolactinemia is a condition characterized by higher-than-normal levels of prolactin in the blood. It is more common in women, but it can also affect men and, rarely, children.

The condition can be:

Physiological – due to natural causes like pregnancy or stress
Pathological – due to disease or abnormal gland function
Pharmacological – caused by medications that affect dopamine, which normally inhibits prolactin secretion

What Are the Symptoms of Hyperprolactinemia?

Symptoms depend on gender, age, and how high the prolactin levels are. In some cases, people may not experience noticeable symptoms, especially if the elevation is mild.

In Women:

Irregular or absent menstrual periods (amenorrhea)
Infertility or difficulty conceiving
Milky nipple discharge (galactorrhea) in non-pregnant women
Painful intercourse due to vaginal dryness (from low estrogen)
Low libido or sexual dysfunction
Headaches or vision problems (if a tumor is involved)

In Men:

Erectile dysfunction
Low libido
Infertility due to low testosterone
Enlarged breasts (gynecomastia)
Loss of body hair or muscle mass

What Causes Hyperprolactinemia?

There are many potential causes of elevated prolactin levels. These can be grouped into physiological, pathological, and drug-induced categories:

1. Physiological Causes

Pregnancy and breastfeeding
Stress (emotional or physical)
Intense exercise
Sleep deprivation

2. Pathological Causes

Prolactinoma – a benign tumor of the pituitary gland that secretes prolactin (most common cause)
Hypothyroidism – low thyroid hormone increases prolactin production
Chronic kidney disease – reduces prolactin clearance
Polycystic Ovary Syndrome (PCOS) – sometimes linked to elevated prolactin
Chest wall injury or surgery – can stimulate prolactin release

3. Medications

Several drugs can increase prolactin by blocking dopamine, which normally suppresses prolactin:

Antipsychotics (e.g., risperidone, haloperidol)
Antidepressants (especially SSRIs and tricyclics)
High blood pressure medications (e.g., verapamil)
Anti-nausea drugs (e.g., metoclopramide)

How Is Hyperprolactinemia Diagnosed?

Diagnosis begins with a blood test to measure serum prolactin levels. A level higher than 25 ng/mL in women or 20 ng/mL in men is typically considered elevated.

To determine the cause, your doctor may also order:

Thyroid function tests (to rule out hypothyroidism)
Pregnancy test (for women)
Kidney function tests
MRI scan of the brain to detect a pituitary tumor (prolactinoma)
Medication review to identify possible drug-induced causes

At Erdem Hospital, we offer comprehensive hormone testing and pituitary imaging to ensure accurate diagnosis and tailored treatment plans.

How Is Hyperprolactinemia Treated?

Treatment depends on the underlying cause and whether the condition is causing symptoms. The main goals are to normalize prolactin levels, restore fertility and hormone balance, and shrink any tumors if present.

1. Dopamine Agonist Medications

These drugs stimulate dopamine receptors to reduce prolactin production:

Cabergoline (preferred for fewer side effects)
Bromocriptine (older option, still effective)

They are effective in most cases of prolactinoma, often reducing tumor size and restoring normal hormone levels.

2. Treating Underlying Conditions

Thyroid hormone replacement for hypothyroidism
Discontinuing or replacing medications that raise prolactin (if possible)
Dialysis or transplant for kidney-related causes

3. Surgery or Radiation

In rare cases where tumors do not respond to medication or cause significant symptoms (e.g., vision problems), pituitary surgery may be necessary. Radiation therapy is rarely used today due to its long-term risks.

Can Hyperprolactinemia Affect Fertility?

Yes. High prolactin suppresses the hormones GnRH, LH, and FSH, which are necessary for ovulation and sperm production. This can lead to infertility in both women and men.

The good news is that with proper treatment, fertility is often fully restored, and many patients go on to have successful pregnancies.

Balancing the Hormone Behind the Scenes

Hyperprolactinemia may not be as widely known as other hormone disorders, but its effects are far-reaching, impacting reproduction, sexual health, and emotional well-being. Fortunately, once diagnosed, it is often easily treated with medication or hormone management.

If you’re experiencing irregular periods, unexpected lactation, sexual dysfunction, or fertility challenges, a simple blood test might provide the answers you’re looking for.

At Erdem Hospital, our endocrinology and reproductive health teams have over 37 years of experience in diagnosing and treating hormone-related conditions with compassion, precision, and personalized care.