Impact on fertility
High prolactin levels interfere with the menstrual cycle and ovulation. You may have irregular cycles or no periods at all – this is known as amenorrhea. Without ovulation, it’s not possible to get pregnant because there is no egg available to be fertilized by sperm.
Potential causes
Hyperprolactinemia is commonly due to:
- Benign tumors on the pituitary gland (prolactinomas)
- Underactive thyroid (hypothyroidism) – about half of all women with hyperprolactinemia have a thyroid disorder
- Kidney condition
- Medicines for depression, psychosis, and high blood pressure
- Certain herbs, such as fenugreek, fennel seeds, and red clover
- Chest wall irritation (from scarring after surgery, shingles, or a bra that’s too tight)
- Excessive stress or exercise
- Lack of sleep
Symptoms of normogonadotropic hyperprolactinemic ovarian insufficiency
These are potential symptoms of hyperprolactinemia in women:
- Irregular or missed periods (amenorrhea)
- Milky discharge from the nipples when not pregnant or breastfeeding
- Vaginal dryness and painful sex
- Infertility
- Weak, brittle bones
- Vision problems
- Headache
Diagnosis of normogonadotropic hyperprolactinemic ovarian insufficiency
Doctors diagnose hyperprolactinemia based on a person’s symptoms, medical history, and a blood test that measures prolactin. Prolactin levels are sensitive to stress, sleep deprivation, exercise, and medication, so you may have a second test to confirm the high level and diagnose hyperprolactinemia.
If your blood tests show highly elevated prolactin and your doctor suspects you could have a prolactinoma, you may also receive an MRI scan of the brain. If you’re having problems with your vision, you will be referred to an eye doctor (ophthalmologist) for further testing and treatment.
Treatment to improve fertility
The good news is that hyperprolactinemia is just a temporary cause of infertility, and you can fix the hormonal imbalance through medication.
The first line of treatment is usually dopamine agonists. These reduce prolactin levels and get the ovaries working normally again so that you can ovulate regularly and get pregnant.
If medication is responsible for your high prolactin levels, you should change your medication or dose together with your doctor.
In case you have a prolactinoma, you can take medication that will shrink it. Rarely, surgery or radiation may be necessary. If testing reveals that you have hypothyroidism, that is also treated with medication.
Once your prolactin levels are back at a healthy level, you should be able to conceive.
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- What is Hyperprolactinemia and How Can It Affect Getting Pregnant? What to expect. Accessed 07 July 2022.
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- Domingue ME et al.: Outcome of prolactinoma after pregnancy and lactation: a study on 73 patients. Clin Endocrinol (Oxf). 2014;80(5):642-8.
- Patient education: High prolactin levels and prolactinomas (Beyond the Basics). UpToDate. Accessed 02 September 2022.
- Hyperprolactinemia. Yale Medicine. Accessed 29 December 2022.
