High prolactin: when should I worry?

June 30, 2024

The pituitary gland, located at the base of the brain, produces the hormone prolactin. Its levels vary greatly throughout life, so let’s examine when we should be concerned about high prolactin levels.

We’ll discuss symptoms, causes, and remedies. Let’s begin!

What is prolactin?

Prolactin is a hormone that plays a crucial role in breast milk production during lactation, but it also has other important functions in our body.

When prolactin levels in the blood exceed normal values, it’s called hyperprolactinemia. But when should we actually worry about having high prolactin? And what are the symptoms of excess prolactin?

Hyperprolactinemia symptoms

Hyperprolactinemia can manifest with a range of symptoms that can vary from person to person and depending on the severity of the condition.

In women, one of the most common symptoms is menstrual irregularity, which can manifest as oligomenorrhea (infrequent menstrual cycles) or amenorrhea (absence of menstruation).

Some women may also experience galactorrhea, which is milk production outside of the breastfeeding period.

In men, hyperprolactinemia can cause decreased libido, erectile dysfunction, and, in rare cases, gynecomastia (enlargement of breast tissue).

Both sexes may experience infertility as a result of high prolactin levels.

Other common symptoms include

  • headaches
  • vision changes (especially if a pituitary tumor causes hyperprolactinemia)
  • fatigue
  • mood changes.

It’s important to note that some individuals with hyperprolactinemia may be completely asymptomatic, making regular monitoring of hormone levels essential, especially in the presence of risk factors.

What are the causes of high prolactin?

The causes of hyperprolactinemia can be multiple and range from physiological conditions to more serious pathologies.

One of the most common causes is physical and emotional stress, which can temporarily increase prolactin levels.

Intense physical activity, pregnancy, and breastfeeding are also physiological conditions that increase prolactin.

Among the pathological causes, we find prolactinomas, benign pituitary tumors that secrete excess prolactin. Other conditions that can cause hyperprolactinemia include hypothyroidism, chronic kidney diseases, and some liver diseases.

Some medications can also increase prolactin levels.

These include antidepressants, antipsychotics, some drugs for treating hypertension, and some oral contraceptives. It’s always important to inform your doctor about all medications taken, including over-the-counter drugs and supplements, to assess any interference with hormone levels.

In some cases, hyperprolactinemia can be idiopathic, meaning without an apparent cause. In these cases, constant monitoring is essential to exclude the development of more serious conditions over time.

High prolactin in pregnancy values

During pregnancy, it’s completely normal and physiological for prolactin levels to increase. This increase is essential to prepare the woman’s body for breastfeeding.

Prolactin values considered normal during pregnancy are significantly higher than those of a non-pregnant woman.

In the first trimester, prolactin values can reach 20-30 ng/ml. In the second trimester, these values can rise up to 50-150 ng/ml, while in the third trimester they can reach even 200-400 ng/ml.

It’s important to emphasize that these are indicative values and can vary from woman to woman.

After childbirth, prolactin levels remain elevated to support breast milk production. During breastfeeding, values can fluctuate between 100 and 300 ng/ml. These elevated levels are essential to maintain milk production and can remain so as long as breastfeeding continues.

Women during pregnancy and breastfeeding mustn’t worry about high prolactin values unless other symptoms or complications are present.

high prolactin

How to lower prolactin?

If prolactin levels are high and causing symptoms or health problems, there are several strategies to try to lower them.

The choice of treatment will depend on the underlying cause of hyperprolactinemia and the severity of the condition.

In many cases, treatment begins with lifestyle modifications. Reducing stress through relaxation techniques like yoga or meditation can help normalize prolactin levels.

Regular, but not excessive, exercise can also help maintain hormonal balance.

A balanced diet can play an important role. Some studies suggest that a diet rich in vitamin B6, zinc, and vitamin E can help regulate prolactin levels. Foods such as nuts, seeds, legumes, fish, and leafy green vegetables can be particularly beneficial.

In case of hyperprolactinemia caused by medications, the doctor might advise modifying the therapy, replacing the responsible drug with an alternative that doesn’t affect prolactin levels.

When to worry about high prolactin?

For more severe cases or when lifestyle modifications are not sufficient, pharmacological treatment may be necessary.

The most commonly prescribed drugs are dopamine agonists, such as bromocriptine or cabergoline.

These drugs act by mimicking the action of dopamine, which normally inhibits prolactin production.

In the presence of a prolactinoma, treatment will depend on the size of the tumor and the severity of symptoms.

In many cases, drug therapy with dopamine agonists is sufficient to reduce tumor size and normalize prolactin levels. In more severe cases or those resistant to drug treatment, surgery or radiotherapy might be necessary.

It’s important to emphasize that any treatment to lower prolactin should be undertaken only under strict medical supervision. Self-diagnosis and self-treatment can be dangerous and lead to complications.

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Thapa S, Bhusal K. Hyperprolactinemia. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan available here: https://www.ncbi.nlm.nih.gov/books/NBK537331/

About the Author

Severino Cirillo

Health, Wellness and Education Expert. With a degree in Community Health, he is the CEO of Informed Parent and is responsible for validating the blog's scientific information and coordinating the editorial team of experts, consisting of gynecologists, midwives, psychotherapists, and others in pregnancy, perinatal, and parenting wellness and health.