Hyperprolactinemia: Prolactin and Infertility
- On 02/09/2025
What is Prolactin? Causes, Symptoms, and Treatments
The pituitary gland is responsible for secreting prolactin, a hormone. It influences galactorrhea in breastfeeding women and regulates ovarian activity.
Hyperprolactinemia is defined as a condition in which the levels of this hormone exceed 30 ng/mL in the blood.
The normal ranges are:
Women: 2 to 29 ng/mL
Men: 2.5 to 17 ng/mL
Hyperprolactinemia is not always a concern, since prolactin levels may rise naturally at certain phases of the cycle. For example, women who are pregnant or breastfeeding naturally present with elevated prolactin levels. However, these levels usually return to normal after breastfeeding and the resumption of menstrual cycles.
That said, when prolactin levels exceed 100 ng/mL, this can negatively affect female fertility.
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Factors Favoring Hyperprolactinemia
Physiological factors
Pregnancy and breastfeeding
Stress (physical or emotional)
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Sleep (prolactin levels naturally rise during sleep)
Pathological factors
Pituitary adenoma (prolactinoma) – the most common cause
Primary hypothyroidism (through increased TRH stimulating prolactin release)
Chronic diseases such as kidney failure or liver disease (reduced clearance of prolactin)
Other brain or pituitary stalk lesions compressing the hypothalamic-pituitary connection
Drug-related factors
Antipsychotics (neuroleptics): haloperidol, risperidone, etc.
Antidepressants (tricyclics, SSRIs)
Anti-nausea medications: metoclopramide, domperidone
Antihypertensives: methyldopa, verapamil
Estrogens and some oral contraceptives
Symptoms of High Prolactin Levels in Women
Menstrual cycle disturbances: irregular periods, oligomenorrhea (scanty periods), or amenorrhea (absence of periods).
Infertility: difficulty conceiving due to disrupted ovulation.
Galactorrhea: abnormal milk secretion outside of pregnancy or breastfeeding.
Decreased libido and reduced sexual desire.
Vaginal dryness, which may cause discomfort during intercourse.
Headaches and vision problems (especially if caused by a pituitary adenoma compressing nearby structures).
Bone fragility/osteopenia over time, due to low estrogen levels caused by hormonal imbalance.
Symptoms of High Prolactin Levels in Men
Nipple discharge (galactorrhea)
Erectile dysfunction or impotence
Reduced sexual desire (low libido)
Enlargement of the breasts (gynecomastia)
Reduced facial and body hair growth
Hyperprolactinemia: Consequences
As already mentioned, women normally secrete only small amounts of prolactin. When prolactin levels are high, ovulation may slow down or stop, making it difficult to achieve a natural pregnancy.
In some cases, even if prolactin levels are not high enough to fully disrupt ovulation, they can still interfere with progesterone production. Progesterone is the hormone that prepares the endometrium after ovulation in case embryo implantation occurs. If progesterone levels are insufficient, the endometrium will not reach the necessary thickness to allow and sustain a pregnancy.
In men, prolactin affects testosterone synthesis. If testosterone levels are not adequate, this impacts the proper development of reproductive organs, sperm production, as well as traits such as body hair growth, muscle development, and bone strength. This explains some of the symptoms previously described in men. Male fertility may also be compromised if sperm production decreases or if erectile dysfunction occurs.
Can a Woman Get Pregnant with Hyperprolactinemia?
When a woman experiences menstrual or fertility issues, doctors usually request a prolactin level test. This test is a standard and highly informative part of fertility evaluations because high prolactin levels prevent women, especially in the early postpartum months, from having periods and ovulating. Prolactin acts as a natural regulator of reproductive capacity.
If hyperprolactinemia is an obstacle to conception, treatment can be prescribed to regulate prolactin production. In vitro fertilization (IVF) may also help women facing difficulty achieving pregnancy. However, it is essential to monitor prolactin levels closely with a specialist, as elevated prolactin complicates conception, whether naturally or through fertility treatments.
Treatment of Hyperprolactinemia
Dopaminergic medications (first-line treatment):
Bromocriptine
Cabergoline (often better tolerated and more effective)
These drugs reduce prolactin secretion and shrink pituitary adenomas.
Surgery (adenoma removal): Reserved for cases resistant to medication or when there is significant visual compression.
Radiotherapy: Rarely used, only if medical and surgical treatments fail.
Hypothyroidism: Treated with levothyroxine (hormone replacement therapy).
Kidney or liver insufficiency: Management focuses on treating the underlying condition, as it can affect prolactin clearance.
Herbal and Natural Approaches for Hyperprolactinemia
Vitex agnus-castus (Chasteberry)
Most studied herb for regulating prolactin.
Works by stimulating dopamine, which naturally inhibits prolactin secretion.
Can help restore menstrual regularity and support fertility.
Maca root
Adaptogenic plant that may support hormonal balance and fertility.
Can improve libido and energy levels.
Ginkgo biloba (limited evidence)
May support blood flow and reduce mild hormonal imbalance symptoms.
Supplements supporting prolactin regulation
Vitamin B6 (pyridoxine): helps dopamine synthesis, reducing prolactin levels.
Zinc and magnesium: support pituitary and hormonal function.
Lifestyle-based “natural” approaches
Stress reduction: meditation, yoga, deep breathing.
Adequate sleep: prolactin naturally rises at night, so regular sleep helps balance it.
Balanced diet: rich in fruits, vegetables, whole grains, and omega-3s; avoid excess caffeine and alcohol.