What is hyperprolactinemia, and can it affect your fertility?

Hyperprolactinemia is a condition that means there are excessively high levels of the hormone prolactin in the blood. In some cases, this can lead to lost periods, infertility, and low bone density. Even though hyperprolactinemia can affect fertility, it doesn't always, and it's highly treatable. Most women who get their prolactin levels back within a normal range can conceive naturally.

Woman talking to doctor
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What is hyperprolactinemia?

Hyperprolactinemia is a condition that means there's too much prolactin in your blood. Prolactin is a very important hormone for the female reproductive system, and it's produced by the brain's pituitary gland. In women, prolactin is normally responsible for breast development and milk production during and after pregnancy. It also plays a role in regulating periods.

After you give birth, high prolactin levels in your body often stop your menstrual periods. If you haven't given birth and have high levels of prolactin, it may reduce your estrogen levels and interfere with ovulation, causing irregular or absent periods – therefore affecting fertility. It also leads to low bone density, and may cause some women who aren't pregnant or breastfeeding to produce breast milk (known as galactorrhea).

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What causes hyperprolactinemia?

There are many causes of hyperprolactinemia, though in up to 40 percent of cases, the cause is unknown. Many known causes include:

  • A noncancerous tumor in the pituitary gland that produces high levels of prolactin, known as prolactinoma. This affects 50 to 60 percent of women with hyperprolactinemia. (In very rare cases, the tumor may be cancerous.)
  • Overactive cells in the pituitary gland
  • Disorders that lead to an increase in white blood cells (histiocytosis)
  • Tuberculosis, a disease affecting the lungs
  • Underactive thyroid (hypothyroidism)
  • Various medications such as certain antipsychotics, anti-depressants, and anti-hypertensives
  • Damage to the chest area (from shingles or surgical scars, for example)
  • Cirrhosis, or severe scarring of the liver
  • Chronic kidney failure
  • Cushing syndrome, which results from high cortisol levels in the body
  • Trauma in the hypothalamus
  • Empty sella syndrome, a condition that means an area of your brain is enlarged
  • Lymphocytic hypophysitis, an inflammatory condition of the pituitary gland
  • Sarcoidosis, a disorder that causes inflamed tissue to develop in the body's organs

If you're concerned that your medications may be causing your irregular periods and ovulatory problems, talk with your ob-gyn or reproductive endocrinologist so they can help you figure out if that's the case.

What are the symptoms of hyperprolactinemia?

Some women don't have any symptoms, but a blood test can show whether your prolactin level is higher than normal. If it's borderline, you may be tested twice to be sure. Your doctor may also give you a physical exam and order an MRI.

If you do have symptoms, they could include the following:

Will having hyperprolactinemia affect my fertility?

Typically, untreated hyperprolactinemia could affect fertility due to lost or irregular periods. Prolactin may cause infertility in several different ways: First, prolactin may stop you from ovulating – if this occurs, your menstrual cycle will stop.

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In less severe cases, high prolactin levels may only disrupt ovulation once in a while. This would result in intermittent ovulation or ovulation that's later than normal. Women in this category may experience infrequent or irregular periods.

Or, women with mild cases of hyperprolactinemia may ovulate regularly but not produce enough of the hormone progesterone after ovulation. This is known as a luteal phase defect. Not producing enough progesterone after ovulation may result in a uterine lining that can't support embryo implantation and growth. Some women with this problem may see their period come sooner than expected after ovulation.

Generally, hyperprolactinemia is treatable: Prolactin levels return to normal in about 90 percent of women who take the medications bromocriptine or cabergoline. However, if you still don't ovulate despite getting back to normal prolactin levels, it's a good idea to talk to your provider about taking additional fertility drugs.

How is hyperprolactinemia treated?

If you have mild symptoms or no symptoms at all, you may not need treatment. Still, it's best to tell your provider about any symptoms you may have, or if you're having trouble getting pregnant.

The first line of treatment for hyperprolactinemia is usually bromocriptine or cabergoline, two medications known as dopamine agonists that reduce prolactin levels, shrink pituitary tumors, and help regulate ovulation and fertility.

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  • Bromocriptine has a long track record of safety and is recommended for women who are hoping to conceive. You may need to take it for a few months for it to reduce your prolactin to a normal level. But once your level is within the normal range, ovulation is often restored and you'll have your period again.
  • Cabergoline is a newer drug and hasn't been prescribed for as long as bromocriptine, but it has become the preferred drug because it's generally tolerated well by most women, requires less frequent dosing, and has a higher efficacy rate. It's usually prescribed for women who don't respond to bromocriptine, or if taking bromocriptine causes unwanted side effects like nausea, vomiting, diarrhea and/or bloating and cramping.

If your provider does recommend treatment, they'll start you on a low dose of medication and gradually increase it as needed. Your prolactin level usually starts to fall two to three weeks after you begin treatment. With bromocriptine, you take the pills orally or vaginally once or twice daily until you get pregnant. If cabergoline is prescribed, you take the pills orally once or twice a week until you get pregnant.

You can use either drug safely for several years, if needed. But once you stop taking the drug, hyperprolactinemia may return. In most cases, treatment can be discontinued once you find out you're pregnant.

While taking bromocriptine or cabergoline, you may have these side effects:

  • Low blood pressure
  • Nausea
  • Mental fogginess
  • Fatigue
  • Nasal congestion
  • Depression
  • Constipation
  • Dizziness
  • Headache
  • Fainting
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Side effects can be more severe when you first start taking the medication or whenever the dose is increased, but usually subside as your body gets used to the drug.

In the case that you have a tumor, however, medication might not be enough. A tumor can grow during pregnancy in some women, and so women with a pituitary tumor larger than 10 millimeters in diameter who want to get pregnant usually take a medication – like bromocriptine or cabergoline – in order to shrink the tumor before conceiving. In some rare cases, however, the tumor doesn't shrink enough or can cause other dangerous symptoms, such as vision problems. In this case, your doctor may recommend having surgery to remove the tumor before getting pregnant.

Things to know if you're TTC and have hyperprolactinemia

If you're trying to conceive and have hyperprolactinemia, it's important to know that while hyperprolactinemia can contribute to infertility, it's a highly treatable condition. If your provider realizes your prolactin levels are high, they might prescribe a number of treatments – including taking medications to reduce prolactin levels, surgery, radiation, or even synthetic hormone replacements. You can always speak to your provider if you're worried you have high prolactin levels that are affecting your chances of pregnancy, so they can come up with the best treatment plan for you.

A combination of medications is effective to treat high prolactin, but it's also possible to reduce your prolactin levels by making lifestyle changes. Common stressors can raise prolactin levels, like low blood sugar, strenuous exercise, and certain psychiatric and acid reflux medications. Ask your provider about these factors too, especially if you're trying to get pregnant.

Overall, you don't need to be too worried if you have hyperprolactinemia and are trying to get pregnant, since treatment options are very successful. It's likely, however, that other factors may be contributing to your infertility, which is why your provider will likely want to have a complete fertility work-up done. Getting to the root cause of infertility or trouble getting pregnant will help them determine the best treatment plan for you.

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Nikhita Mahtani
Nikhita Mahtani is a lifestyle and wellness journalist working in New York City. Originally from Mumbai, India, she has called the United States home for more than a decade. Her hobbies include cooking new recipes, trying new workout classes, debunking popular health myths, and reading and writing voraciously.