Prolactin Disorders Explained: Galactorrhea, Infertility, and Treatment Options
Feb, 4 2026
What Are Prolactin Disorders?
When your pituitary gland makes too much prolactin-a hormone that normally helps with breastfeeding-it causes prolactin disorders. These conditions affect about 20-25% of women at some point in life, though they can also happen in men. The most common symptom is galactorrhea, which is milky nipple discharge outside of pregnancy or breastfeeding. This isn't just a cosmetic issue-it often points to underlying hormonal problems that can impact fertility.
Galactorrhea isn't a disease itself. It's a symptom of something else, usually high prolactin levels (hyperprolactinemia). Think of it like a fever-it's not the illness but a sign something's wrong in your body. The discharge is typically milky and can happen in one or both breasts. Many people worry it's breast cancer, but galactorrhea usually has no pain or lumps. That's why it's important to get checked properly.
What Causes High Prolactin Levels?
Several things can cause prolactin to spike. The most common reason is a small tumor on the pituitary gland called a prolactinoma. These tumors are usually benign but pump out extra prolactin. Medications also play a big role-antidepressants, antipsychotics, and even some blood pressure drugs can raise prolactin. For example, sertraline (Zoloft) is known to trigger galactorrhea in some users. Other causes include thyroid problems (low TSH), kidney issues, or even stress. Sometimes, the cause is unknown (idiopathic), which happens in about 35% of cases.
It's worth noting that prolactin levels can temporarily rise due to things like nipple stimulation, sleep, or exercise. That's why doctors always repeat blood tests to confirm high levels. If your prolactin is over 25 ng/mL, it's considered hyperprolactinemia. Levels above 100 ng/mL usually mean a pituitary tumor is present, which needs an MRI scan.
How Prolactin Causes Infertility
High prolactin doesn't just cause discharge-it can shut down your reproductive system. Prolactin suppresses the hormones that trigger ovulation. For women, this often means missed periods or irregular cycles. About 80-90% of women with hyperprolactinemia stop ovulating, leading to infertility. Men with high prolactin may experience low libido and erectile dysfunction. This is why treating the underlying cause is crucial for those trying to conceive.
Dr. Richard S. Legro, a fertility specialist at Penn State College of Medicine, puts it simply: "Dopamine agonists don't just stop the milk-they restore ovulation in most women. I've seen patients get pregnant within months of starting treatment." That's why addressing prolactin issues early is so important for fertility.
Diagnosing Prolactin Disorders
Diagnosis starts with a blood test. Doctors check prolactin levels, thyroid function (TSH), and sometimes kidney function. If prolactin is high, they'll repeat the test to rule out temporary spikes. A physical exam checks for breast discharge patterns and any lumps. If levels are very high (over 100 ng/mL), an MRI scans the pituitary gland for tumors. Brain MRIs can detect even tiny prolactinomas as small as 5mm.
One common mistake is not considering medications. Many people don't realize their antidepressant or antipsychotic could be the cause. For instance, switching from sertraline to bupropion (Wellbutrin) often resolves galactorrhea in patients. Always review all medications with your doctor before jumping to conclusions about tumors.
Treatment Options
The good news is prolactin disorders are highly treatable. Most cases respond well to medication. Dopamine agonists like cabergoline and bromocriptine are first-line treatments. Cabergoline (Dostinex) is preferred because it works better with fewer side effects. It's taken twice a week, versus daily for bromocriptine. Clinical trials show 83% of patients normalize prolactin within 3 months on cabergoline compared to 76% for bromocriptine.
| Feature | Cabergoline | Bromocriptine |
|---|---|---|
| Dosing Frequency | Twice weekly | Daily |
| Side Effects | Mild nausea in 10-15% of users | Nausea in 25-30% of users |
| Cost (Monthly) | $300-$400 | $50-$100 |
| Efficacy (3 months) | 83% normalize prolactin | 76% normalize prolactin |
New developments are making treatment even better. In January 2025, the FDA approved an extended-release cabergoline formulation (Cabergoline ER) that only needs once-weekly dosing. Early trials show 89% effectiveness at six months-better than standard cabergoline. Novartis is also testing a new drug that blocks prolactin receptors directly, which could offer an alternative for people who don't respond to current medications.
Surgery is rarely needed-only for large tumors that don't shrink with medication. Radiation therapy is an option for cases where surgery isn't possible. Most patients see discharge stop within 2-4 weeks of starting medication, and fertility returns in about 4 months for women.
Real Patient Experiences
Real people share how treatment changed their lives:
- "After 3 months on cabergoline 0.5mg twice weekly, my discharge stopped completely and my period returned after 18 months of absence." - u/HealthyHope2023, Reddit
- "The cabergoline saved my fertility-I conceived naturally 4 months after starting treatment." - BabyCenter community post, November 2024
- "Switching from sertraline to bupropion made my galactorrhea go away in 2 weeks. I didn't even need medication for prolactin." - MyHealth Alberta forum, March 2025
But not all experiences are positive. Some struggle with side effects. "Bromocriptine made me so nauseous I had to take it at bedtime, and I still threw up twice weekly for the first month," shared a user on Reddit. This is why doctors often start with cabergoline to avoid these issues.
Frequently Asked Questions
Can stress cause galactorrhea?
Yes, stress can temporarily raise prolactin levels by 10-20 ng/mL. This is why doctors always repeat blood tests-they want to rule out temporary spikes from things like stress, exercise, or improper blood draw technique. If your prolactin is slightly high but you feel fine otherwise, your doctor might retest after a few weeks.
What's the most common cause of galactorrhea?
The most common cause is medication side effects. Antidepressants like sertraline, antipsychotics, and some blood pressure drugs are frequent culprits. Pituitary tumors (prolactinomas) account for about 30% of cases, but medications are actually more common. Always review your medications with your doctor before assuming a tumor is the cause.
Can galactorrhea happen in men?
Yes, though it's less common. Men with high prolactin may experience breast discharge, low sex drive, or erectile dysfunction. In men, prolactinomas are the leading cause, often larger than in women. Treatment is the same-dopamine agonists like cabergoline usually work well. Early diagnosis is key to prevent long-term effects on fertility and bone health.
Do I need an MRI if my prolactin is high?
Only if your prolactin level is over 100 ng/mL. For levels between 25-100 ng/mL, doctors usually check thyroid function and review medications first. An MRI is recommended when prolactin exceeds 100 ng/mL to look for pituitary tumors. Small tumors (microprolactinomas under 10mm) respond well to medication, so surgery is rarely needed.
How long does treatment take to work?
Most people see discharge stop within 2-4 weeks of starting dopamine agonists. Fertility usually returns in 3-6 months. For pituitary tumors, it takes 6-12 months for the tumor to shrink significantly. Consistent medication use is key-skipping doses can delay results. If symptoms don't improve after 3 months, your doctor may adjust the dose or try a different medication.