High Prolactin Levels (Hyperprolactinemia): Causes, Symptoms, Diagnosis, and Treatment

Introduction

Have you ever experienced irregular periods, unusual breast discharge, reduced interest in sex, or fertility problems? These might be the symptoms of high prolactin levels in your body, which is called hyperprolactinemia¹. Many people are not aware of this condition until they start developing these symptoms. Although this seems frightening, high prolactin levels can easily be managed with proper diagnosis and treatment. Understanding the causes and symptoms can help you seek medical advice at the right time. This article discusses key information about hyperprolactinaemia, including its causes, symptoms, diagnosis, and management. 

What Is Prolactin?

Prolactin is a hormone produced by the pituitary gland, a small gland at the base of the brain. This hormone plays an important role in the normal functioning of the body in both males and females. However, its main function is to support breast development during pregnancy and help with milk production after childbirth. It is also involved in reproductive health and menstrual cycle regulation¹.

Normal Prolactin Levels

The following table shows normal prolactin levels in males and in females: 

Normal prolactin levels may differ between laboratories as different methods may be used to perform the test. Prolactin levels in males and females are also different. In females, the values may be high during pregnancy, which is quite natural. However, high prolactin levels in non-pregnant females may be considered hyperprolactinemia, which needs medical attention. 

Not all people with high prolactin levels may have symptoms¹. Therefore, it is important to have your results interpreted by a qualified doctor to understand your condition and get proper care and treatment if needed². 

Causes of High Prolactin

High prolactin levels can occur due to normal body changes, certain medical conditions, or the use of some medications. The causes of high prolactin levels include: 

1. Physiological Causes

These are conditions where prolactin levels increase naturally: 

• Pregnancy: Enlargement of the pituitary gland during this period causes increased prolactin release. 
• Breastfeeding: Nipple stimulation and suckling by the baby can increase prolactin production, as this hormone is important for breast milk production. 
• Sleep: Sleep can also temporarily increase prolactin levels³. 
• Stress: Physical or emotional stress can increase prolactin levels temporarily. 
• Exercise: Intense physical activity may cause an increase in prolactin for a short period⁴. 

2. Pathological Causes

Medical conditions that can increase prolactin levels include: 

• Liver Disease: Impaired liver function may lead to higher prolactin levels¹.
• Hypothyroidism: Higher thyroid stimulating hormone (TSH) levels and reduced production of thyroid hormones can stimulate the production of prolactin⁴.
• Prolactinoma: This non-cancerous tumour can increase prolactin secretion from the pituitary gland (most common pathological cause)⁴.
• Chronic Kidney Disease: Reduced kidney function in kidney patients causes an increase in prolactin levels due to poor clearance of the hormone⁵. 
• Polycystic Ovarian Syndrome (PCOS): Hormonal disturbances due to PCOS may sometimes lead to a mild increase in prolactin levels^1,4.

3. Medication-Induced Causes

Some medicines may cause high prolactin levels as a side effect, as follows: 

• Antidepressants: Some antidepressants, such as clomipramine, fluoxetine, and amitriptyline, may increase prolactin levels. 
• Blood pressure medicines: Certain antihypertensive medicines, including labetalol, verapamil, and methyldopa, may increase prolactin as a side effect. 
• Antiemetics: Some medicines used to treat nausea and vomiting, such as domperidone, metoclopramide, and prochlorperazine, may increase prolactin levels. 
• Psychiatric Medications: Certain medicines used for psychiatric conditions, including risperidone, fluphenazine, and haloperidol, may increase prolactin levels⁴.

Symptoms of High Prolactin

High prolactin levels symptoms can vary between males and females. 

1. Symptoms in Males

The symptoms that indicate high prolactin levels in males include: 

• Reduced sexual drive 
• Nipple discharge 
• Erectile dysfunction (difficulty getting or keeping an erection) 
• Reduced facial and body hair growth¹

2. Symptoms in Females

The symptoms that indicate high prolactin levels in females include: 

• Irregular or missed menstrual periods 
• Difficulty achieving a pregnancy 
• Unusual nipple discharge, such as milk discharge from the breasts without pregnancy or breastfeeding¹

3. Symptoms Common in Both

High prolactin symptoms common in both men and women include: 

• Weak bones 
• Breast discharge 
• Headache 
• Vision problems (partial loss of vision) in individuals with prolactinoma 

Note: Everyone with high prolactin levels may not experience the same symptoms. These signs may also be linked to other medical conditions, so medical advice and proper testing are important for an accurate diagnosis. 

Diagnosis of High Prolactin

Doctors usually diagnose high prolactin levels through a combination of medical history, physical examination, and laboratory tests. 

1. Medical History

You may be asked about your symptoms, menstrual history, pregnancy, stress, existing medical conditions, and the use of medications that can increase prolactin levels. 

2. Physical Examination

A physical examination will be conducted to look for symptoms such as breast discharge and vision problems, and changes or abnormalities in hair growth. 

3. Laboratory Tests

Your doctor might suggest several blood tests to determine the presence (or suspected cause) of hyperprolactinemia. The most common and preliminary test suggested is the prolactin blood test. 

• Prolactin Blood Test: This test measures the prolactin levels in your blood. The test is recommended to be performed while fasting. A higher-than-normal value in this test may indicate that you have hyperprolactinemia. In some cases, such as when taking certain medicines, prolactin levels may temporarily rise. In such situations, your doctor may advise repeating the test, usually after 8 hours of fasting and preferably early in the morning.
• Thyroid Function Tests: These blood tests help check whether your thyroid gland is working properly. Low thyroid hormone levels (hypothyroidism) can increase the production of prolactin due to hormonal imbalance^1,4,6. 
• Pregnancy Test: This test helps determine whether you are pregnant, as high prolactin levels are common during pregnancy¹.
• Kidney and Liver Function Tests: These tests help detect underlying kidney or liver disease that may contribute to high prolactin levels⁴.

4. Imaging Tests

• Magnetic Resonance Imaging (MRI): An MRI scan may be recommended to get detailed images of the pituitary gland and surrounding structures in the brain. It helps detect pituitary tumours such as prolactinoma, identify their size, and assess whether they are affecting nearby structures like the optic nerves⁴.

Note: During the diagnosis of hyperprolactinemia, your doctor might sometimes check for macroprolactin, a harmless inactive form of prolactin. It can falsely increase prolactin levels in blood tests even though it usually does not cause symptoms. Therefore, interpreting your results by a qualified doctor is important to avoid a wrong diagnosis. 

High Prolactin Treatment

The treatment of a high prolactin level depends on its causes and severity of the symptoms. In some cases, treatment may not be needed if prolactin levels are only mildly elevated and there are no symptoms. Some common treatment methods include: 

1. Medications

Your doctor might prescribe dopamine agonist medicines, such as cabergoline and bromocriptine, to lower prolactin levels and shrink pituitary tumours if present. These medicines help restore normal hormone levels and improve symptoms⁴.

2. Treating the Underlying Cause

If high prolactin is caused by a medical condition, treating that condition may help bring prolactin levels back to normal. This includes treating conditions like hypothyroidism with thyroid hormone medicines or managing kidney or liver disease to help improve hormone balance⁷. 

3. Surgery

Your doctor might recommend surgery if you have a large pituitary tumour that is causing vision problems or if there is poor response to or side effects of medication. The procedure is usually done to remove the tumour from the pituitary gland^4,7.

4. Radiation Therapy

Rarely, your doctor might recommend radiation therapy if medicines and surgery are not effective or suitable for you^4,7.

5. Changing or Stopping Certain Medicines

Your doctor might adjust the dose or give you an alternate medicine if high prolactin is caused by any medicine. However, you should not stop any prescribed medicines without your doctor’s advice. 

6. Lifestyle Management 

Your doctor might also suggest some lifestyle changes along with the treatment to help support overall hormonal balance and reduce temporary increases in prolactin levels. They may advise you to manage stress, get adequate sleep and avoid excessive physical exertion^1,4.

Note: The given information is for general awareness only and is not a substitute for medical advice or treatment. High prolactin treatment can vary depending on the cause and individual health condition. Always consult a doctor before starting, stopping, or changing any medication or treatment. 

When to Consult a Doctor?

You should consult a doctor if you have symptoms like recurrent irregular periods, breast discharge without pregnancy, infertility, headaches, or reduced sexual desire (especially if you are diagnosed with hyperprolactinemia). Early diagnosis may help identify the specific cause and avoid complications. Medical advice is especially important if symptoms persist or worsen over time^1,4.

Also Read: Best Estrogen Rich Foods to Support Estrogen Levels Naturally 

Conclusion

High prolactin levels, commonly known as hyperprolactinemia, might affect males and females differently. While the symptoms may appear worrying, it may be successfully treated once the underlying cause is determined. An accurate diagnosis, regular monitoring, and timely treatment can help restore hormonal balance and enhance overall health. If you are experiencing any symptoms associated with hyperprolactinemia, consider speaking with a qualified doctor for getting tested early. 

Frequently Asked Questions (FAQs)

References

1. Prolactin Levels. 2024. Available from: https://medlineplus.gov/lab-tests/prolactin-levels/ 

2. Prolactin blood test. 2024. Available from: https://medlineplus.gov/ency/article/003718.htm

3. Abdulateef DS. Correlation of serum prolactin with sleep duration, wake-up hour, and phases of the menstrual cycle in healthy adult subjects. Sleep and Biological Rhythms. 2023;21(3):319. doi:10.1007/s41105-023-00448-2  Available from: https://pubmed.ncbi.nlm.nih.gov/38469081/

4. Kaur J, Bhusal K. Hyperprolactinemia. 2025. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK537331/ 

5. Huang W, Molitch ME. Prolactin and Other Pituitary Disorders in Kidney Disease. Seminars in Nephrology. 2021;41(2):156-167. doi:10.1016/j.semnephrol.2021.03.010 Available from: https://pubmed.ncbi.nlm.nih.gov/34140094/

6. Thyroid function tests. 2025. Available from: https://www.healthdirect.gov.au/thyroid-function-tests 

7. Hyperprolactinemia. 2022. Available from: https://www.endocrine.org/patient-engagement/endocrine-library/hyperprolactinemia 

8. Puglia LT, Lowry J, Tamagno G. Vitex agnus castus effects on hyperprolactinaemia. Front Endocrinol. 2023;14:1269781. doi:10.3389/fendo.2023.1269781 Available from: https://pubmed.ncbi.nlm.nih.gov/38075075/

9. Pirchio R, Graziadio C, Colao A, Pivonello R, Auriemma RS. Metabolic effects of prolactin. Front Endocrinol. 2022;13:1015520. doi:10.3389/fendo.2022.1015520 Available from:  https://pubmed.ncbi.nlm.nih.gov/36237192/

10. Kaiser UB. Hyperprolactinemia and infertility: new insights. J Clin Invest. 2012;122(10):3467-3468. doi:10.1172/JCI64455 Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3461927/

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