How is high prolactin treated?

Bottom lineHigh prolactin is treated by addressing the cause first: treating an underactive thyroid often fixes it, a medication cause goes back to the prescriber rather than being stopped unilaterally, and a mildly high result with no symptoms may just need a repeat test and a macroprolactin check. When drug treatment is needed, dopamine agonists - cabergoline first-line, bromocriptine preferred in pregnancy - normalize prolactin in about 80 to 90% of cases and shrink prolactinomas, which is why surgery is now rarely needed. Periods and ovulation usually return within weeks to a few months.

The first step is treating the cause rather than the number. When medication is needed, dopamine agonists - usually cabergoline or bromocriptine - normalize prolactin in roughly 80 to 90% of cases.

Treat the cause first

• An underactive thyroid? Treating the thyroid often brings prolactin down without anything else.
• A medication cause? Take it to the prescriber, never stop it yourself. Options include switching to a drug less likely to raise prolactin, adjusting the dose, or leaving it alone if you have no symptoms. Stopping a psychiatric medication to fix a lab value is far riskier than the raised prolactin.
• A mildly high result with no symptoms? Often the answer is a repeat test and, if it stays high, a check for macroprolactin - an inactive form that reads high but does nothing and needs no treatment.

Dopamine agonists

Prolactin is held down by dopamine, and these drugs mimic it. Cabergoline is generally first choice for effectiveness and tolerability; bromocriptine has the longer safety record in pregnancy and is usually preferred there.

They do two things at once: bring prolactin down, and shrink a prolactinoma if there is one. That is why surgery is now the exception rather than the rule for these tumors.

Common side effects are nausea, dizziness, and headache, which usually improve by starting low and taking the dose at bedtime.

What to expect

Periods and ovulation usually return within weeks to a few months of prolactin normalizing, and fertility generally returns with them. Levels are monitored with repeat blood tests, and many women eventually stop treatment successfully after a stretch of stable, normal results.

If you have a prolactinoma and want to conceive, plan that with an endocrinologist before trying - treatment is usually paused once pregnancy is confirmed.

Full context in prolactin in women.

Femora helps you track when your periods return once treatment starts working.