Hyperprolactinemia – Causes, Symptoms & Treatment

By (gynecologist), BSc, MSc (embryologist), BSc, MSc (embryologist) and (invitra staff).
Last Update: 01/17/2020

Hyperprolactinemia is a hormonal disorder that can occur in both men and women.

However, it is more common to find hyperprolactinemia as a cause of female sterility, as the excess of the hormone prolactin causes alterations in the menstrual cycle and anovulation.

The causes of this disorder are very diverse, ranging from normal pregnancy and lactation to the appearance of benign tumors in the pituitary gland.

Prolactin hormone

Prolactin (PRL) is a hormone secreted by the pituitary gland, a gland at the base of the brain. Its main function is to stimulate the production of colostrum and breast milk in the mammary glands after childbirth.

Prolactin is also involved in the synthesis of progesterone during the luteal phase of the menstrual cycle.

Although the level of the hormone prolactin usually increases during pregnancy and lactation, it is normal for an adult woman to have values between 0 and 20 ng/ml.

Hyperprolactiemia is a pathology characterized by an increase in the hormone prolactin in the blood, with a concentration higher than 30 ng/ml.

Abnormal blood prolactin levels can alter the menstrual cycle, produce anovulation and, consequently, infertility.

In particular, excess prolactin inhibits the secretion of GnRH (gonadotropin-releasing hormone), which in turn affects the production of FSH and LH hormones, responsible for follicular development and ovulation.

It is also common for women with polycystic ovary syndrome (PCOS) to have hyperprolactinemia due to increased estrogen production.

Causes

As we have already mentioned, pregnancy is the main cause of hyperprolactinemia in women. During gestation, the prolactin level may increase to 300 ng/ml.

The same is true during breastfeeding, in which the baby stimulates the nipple when sucking milk causing continuous blockage in dopamine secretion. As a consequence, the decrease in dopamine causes more prolactin to be secreted, as both hormones are regulated by a negative feedback system.

However, these are normal physiological situations in a woman's life in which the increase in blood prolactin is transient, just as it occurs during deep sleep, physical exercise, or orgasm. Once lactation is over, prolactin will return to normal levels and the menstrual cycle will re-establish itself.

Also, hyperprolactinemia can have some pathological causes, such as the following:

  • Hypothyroidism
  • Pituitary adenomas (prolactinomas)
  • Chronic renal failure
  • Polycystic ovary syndrome (PCOS)
  • Hyperandrogenism
  • Anorexia nervosa
  • Stress and anxiety
  • Multiple Sclerosis
  • Cancer and pituitary tumors

There is also a type of iatrogenic hyperprolactinemia, caused by external factors such as neuroleptic drugs, antidepressants, anxiolytics, tranquilizers, opioids (morphine derivatives), and so on. All these drugs decrease the action and synthesis of dopamine.

Finally, oral contraceptive pills with estrogens may also produce a moderate increase in circulating prolactin in the blood.

Symptoms

The following are the most important signs and symptoms of hyperprolactinemia:

  • Galactorrhea: secretion of milk by the mammary glands. It occurs in 30% of cases.
  • Primary or secondary amenorrhea: disappearance of menstruation.
  • Headaches and visual field alterations. These symptoms are caused by tumors.
  • Hirsutism, if the woman has PCOS and/or hyperandrogenism.
  • Osteroporosis, especially in cases of hypogonadism.
  • Decreased libido and dry vagina.
  • Infertility, mainly due to chronic anovulation.

It is not necessary for a woman to have all of these symptoms at once to make a diagnosis of hyperprolactinemia. Sometimes only the most common ones take place.

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Diagnosis

The first diagnostic test that should be done in any patient with suspected hyperprolactinemia is the determination of prolactin levels in the blood.

To do this, a blood test must be done between the third and fifth day of the menstrual cycle, when the ovaries are at rest and hormones at basal levels.

As indicated above, blood prolactin levels greater than 30 ng/ml indicate hyperprolactinemia disorder. If a prolactin result between 20 and 40 ng/ml is obtained, repeat the analysis to confirm the diagnosis.

In addition, it is important to make an anamnesis and review the patient's medical history to determine the cause of this hormonal disturbance. Pregnancy has to be ruled out in the first place, as well as it must be taken into account whether the patient takes oral contraceptives, anxiolytic drugs, antidepressants, etc.

Finally, it is also important to rule out the presence of any pituitary tumor using computed tomography (CT) or magnetic resonance imaging (MRI), especially if hyperprolactinemia is not associated with hypothyroidism.

A blood prolactin value greater than 200 ng/ml in a non-pregnant woman may indicate a pituitary tumor.

If the cause of the high prolactin is not found after all tests have been performed, the patient will be told that she suffers from idiopathic hyperprolactinemia.

Treatment

Before starting treatment to lower the level of prolactin in the blood, it is necessary to know the exact cause of this hormonal disorder.

In the case of drugs that are causing hyperprolactinemia, it will be enough to stop taking these substances to restore normal prolactin levels.

If high prolactin is the result of hypogonadism, the endocrine may indicate thyroid hormone replacement therapy.

In other situations, such as pituitary adenomas or prolactinomas, the treatment of hyperprolactinemia is based on the administration of dopamine agonist drugs, such as cabergoline or bromocriptine. These substances act like dopamine, inhibiting the production of prolactin in the pituitary gland.

Generally, this type of treatment is the most widely used in order to restore prolactin levels soon and restore fertility, especially in young patients who want to get pregnant. However, a woman can spend months or even years on these medications.

If drug treatments do not work, or if large prolactinomas are found, surgery or radiation therapy may be needed to remove the tumor. The latter is less used because it takes a very long treatment for prolactin levels to return to normal.

FAQs from users

Can I get pregnant with high prolactin?

By Dra. Amanda Olinda Sinchitullo Rosales (gynecologist).

Once the cause of hyperprolactinemia has been determined, prolactin (PRL) is normalised. With proper management, most women can become pregnant.

Bromocriptine and cabergoline are drugs used for treatment and are not teratogenic.

In the case of macroadenomas near the optic chiasma and which do not present a significant reduction in tumor volume with dopamine agonists, the best pre-pregnancy therapeutic option is transsphenoidal surgery.
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Do men also suffer from hyperprolactinemia?

By Zaira Salvador BSc, MSc (embryologist).

Yes, although it's less common. In this case, a man is considered to have hyperprolactinemia when his blood prolactin hormone level is above 20 ng/ml.

The main clinical manifestations of hyperprolactinemia in men are erectile dysfunction, decreased libido, gynecomastia and infertility.

Does Hyperprolactinemia make you gain weight?

By Zaira Salvador BSc, MSc (embryologist).

That might happen. This is because prolactin hormone irregularities may influence other metabolic pathways related to weight gain.

Can hyperprolactinemia be cured?

By Zaira Salvador BSc, MSc (embryologist).

This depends on the exact cause that is causing the prolactin hormone surge.

When excess prolactin is due to physiological causes such as pregnancy or breastfeeding, normal levels of this hormone will be restored as soon as the mother stops breastfeeding and recovers her regular menstrual cycles.

If there is a pathological cause, the woman may have to live for long periods of time with hyperprolactinemia. However, dopamine antagonist drugs can help to achieve normal prolactin levels in these cases.

Suggested for you

Apart from prolactin, there are other hormones involved in the female reproductive system that can cause infertility. For more information related to this topic, you can read more here: Female Hormone Check - How Are Hormone Levels Monitored?

If you want to know more about breastfeeding and its effect on the menstrual cycle during it, we recommend you read the next post: Breastfeeding Your Baby.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Freeman ME, Kanyicska B, Lerant A, Nagy G. Prolactin: structure, function, and regulation of secretion. Physiol. Rev. 2000;80:1523-1631.

Grattan DR. Behavioural significance of prolactin signalling in the central nervous system during pregnancy and lactation. Reproduction. 2002;123:497-506.

Melgar V, Espinosa E, Sosa E, Rangel MJ, Cuenca D, Ramírez C, Mercado M. Current diagnosis and treatment of hyperprolactinemia. Rev Med Inst Mex Seguro Soc. 2016 Jan-Feb;54(1):111-21.

Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA; Endocrine Society. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96(2):273-288.

FAQs from users: 'Can I get pregnant with high prolactin?', 'Do men also suffer from hyperprolactinemia?', 'Does Hyperprolactinemia make you gain weight?' and 'Can hyperprolactinemia be cured?'.

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Authors and contributors

Dra. Amanda Olinda  Sinchitullo Rosales
Dra. Amanda Olinda Sinchitullo Rosales
Gynecologist
Dr Amanda Sinchitullo Rosales graduated in Medicine and is specialized in Obstretrics and Gynecology developed in the Hospital Complex of A Coruña. She holds also a Master's degree in Human Reproduction from the Complutense University of Madrid and currently works in the clinic FIVMadrid Valladolid. More information about Dra. Amanda Olinda Sinchitullo Rosales
Licence number: 471511813
 Cristina Mestre Ferrer
Cristina Mestre Ferrer
BSc, MSc
Embryologist
Bachelor's Degree in Biological Sciences, Genetics & Human Reproduction from the University of Valencia (UV). Master's Degree in Biotechnology of Human Assisted Reproduction from the UV and the Valencian Infertility Institute (IVI). Embryologist at IVI Barcelona. More information about Cristina Mestre Ferrer
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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