Hyperprolactinemia: Symptoms, Causes & Treatment Guide

Prolactin is a hormone with many different functions in the body, but its most well known role is in stimulating lactation for breast milk production. When you have too much of this hormone it’s known as hyperprolactinemia. Both men and women normally have low prolactin levels in their blood, but people who are pregnant or just had a baby have naturally higher levels. What does high prolactin mean? High prolactin levels mean that your blood prolactin levels are higher than normal and may or may not cause symptoms. When levels are higher than normal, it can lead to a variety of health issues in both men and women and can interfere with the production of other hormones, namely FSH, LH. progesterone and estrogen. Although levels can rise and fall naturally (and temporarily), most people don’t notice an issue until they have symptoms of excess prolactin levels or it appears on a blood test. 

Hyperprolactinemia means your prolactin levels are higher than normal. High prolactin levels can affect your periods, ovulation, sex hormones, and fertility, but in many cases the cause is treatable once it’s identified. While not life threatening, it can cause issues that impact your life. But it’s also highly treatable and does not always mean a tumor or permanent health damage. In this article we’ll cover what hyperprolactinemia is, as well as its symptoms, common causes, diagnosis and treatment options. We’ll also go over how high prolactin affects hormones and fertility and discuss normal prolactin levels by age. Let’s go! 

What Is Hyperprolactinemia?

Hyperprolactinemia is when you have higher than normal levels of prolactin in your blood. In and of itself, it is not a diagnosis but rather a lab finding with many possible causes. Different labs have different reference ranges since the values can vary slightly. In clinical terms, hyperprolactinemia is not diagnosed after one slightly abnormal blood test but rather findings of repeated elevated levels in the context of symptoms, medications, and your health history.

Prolactin’s main role is in promoting lactation (breast milk production) but it plays a role in a number of other functions and systems, and there are a variety of purposes for this hormone. It’s crucial for overall health and wellbeing in both women and men as it is involved in regulating behavior, the immune system, metabolism, reproductive systems, and blood cell formation. Prolactin levels are normally higher during pregnancy and breastfeeding for obvious reasons, but it can also rise due to other factors like stress, exercise, injury, or nipple stimulation (outside of breastfeeding).

Hyperprolactinemia is the medical term for prolactin levels that stay above the normal range long enough to disrupt your hormones, periods, or sexual function. Diagnosing hyperprolactinemia starts with a blood test interpreted by your healthcare provider in the context of your overall health history and any symptoms present. If you need help navigating the world of hormone testing, interpreting results, or building a plan to discuss with your clinician, our experts offer hormone and fertility support. Not only can they guide you through an in-depth exploration of your hormone health but they can even give personalized guidance, offer realistic recommendations, and support your plans with your healthcare provider if needed. 

Normal Prolactin Levels by Age

When it comes to normal prolactin levels by age, your specific test results will depend on the testing laboratory. Different labs use different measurements or test different samples and as such, normal prolactin levels by age can vary among different labs. Labs report prolactin levels within a “normal range” that varies by sex, age, and the specific lab. Your lab report includes a reference range for prolactin levels so you can see whether your result falls within, slightly above, or clearly above the normal range for your age and sex. Men have relatively stable prolactin levels throughout their life, whereas women can experience different levels depending on pregnancy and menstruation. The test can also be affected by how much you’ve eaten and how much stress you’ve been under.

Normal Prolactin Levels by Age and Sex 

(measured in nanograms per milliliter ng/mL)

Symptoms of High Prolactin Levels in Women and Men

Not everyone will experience symptoms when there is an issue with their prolactin levels. Symptoms depend on sex, age, hormone status, and also how high your prolactin levels actually are. High prolactin levels can cause symptoms like irregular periods, sexual problems, or milk-like breast discharge, but some people feel completely normal and only find out after a blood test. Although men and women can experience some of the same symptoms, like infertility and bone loss, we’ll cover the symptoms of high prolactin in women and men separately.

Symptoms of high prolactin in women are often subtle and pattern-based so it can be helpful to track them over time. The free Mira App can help keep your symptoms all in one place so you can clearly see what’s happening. Tracking your symptoms can not only help you understand what’s going on but also allows you to describe changes clearly to your clinician with the data you’ve collected. 

Symptoms of High Prolactin in Women

In women, symptoms of high prolactin can include missed or irregular periods, difficulty getting pregnant, low libido, and milk-like breast discharge (galactorrhea) when you’re not pregnant or breastfeeding. Additional possible symptoms of high prolactin in women include pain during sex due to vaginal dryness, headaches or vision changes. These symptoms may stem from very high prolactin levels due to a pituitary tumor called a prolactinoma.

Levels of prolactin are naturally higher during pregnancy and breastfeeding. High prolactin levels in women who are not pregnant or breastfeeding are a common reason for endocrine referral, especially since prolactin interacts with other pituitary hormones like luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Since both LH and FSH stimulate the function of the ovaries, high prolactin can cause low estrogen. 

High prolactin levels can interfere with your hormonal balance and disrupt the menstrual cycle. 

If you’re trying to conceive and asking “am I ovulating?” it may be worth tracking your sex hormones to see if you have an underlying hormone imbalance. Using Mira’s Hormone Monitor and testing wands you can measure key reproductive hormones and their metabolites in urine to get an idea of what your hormone patterns look like. This data can provide essential context when speaking with your healthcare provider to investigate the root cause of any hormonal imbalances. 

Symptoms of High Prolactin in Men

In men, high prolactin levels often cause low testosterone, which can lead to low libido, erection problems, reduced fertility, and sometimes breast changes or discharge. Many of these symptoms arise because elevated prolactin essentially suppresses testosterone production as it inhibits the release of GnRH, a hormone that regulates the production of LH and FSH which are crucial for testosterone production. Without periods to serve as a warning sign for any issues, men in general may present later for symptoms of high prolactin in men. 

What Causes High Prolactin Levels?

High prolactin levels have several different causes ranging from physiological to medications. Normal physiological causes include pregnancy and breastfeeding, when prolactin levels are naturally higher. The most common causes of high prolactin levels include certain medications, small pituitary tumors called prolactinomas, and thyroid issues or kidney problems - but many of these causes can be treated once they’re identified.

In this table you can see what causes high prolactin levels broken down by category:

Since prolactin is involved in so many systems and processes in the body, the underlying causes of hyperprolactinemia must be investigated thoroughly for the appropriate treatment. What causes high prolactin levels is highly individual and a comprehensive evaluation is crucial for early diagnosis and treatment.

Many factors can influence prolactin levels and it’s important to seek help from a medical professional, especially if you are trying to conceive. If you’re not sure where to start, it can be helpful to find support before you speak to your doctor. Mira’s own 1:1 Certified Hormone & Fertility Support has experts on hand to help you make sense of it all. With supportive and expert guidance, they can even help you prepare questions to ask your provider and understand next steps. 

When facing potential hormonal imbalances like high prolactin, comprehensive at-home blood tests like the Panorama Lab Test can offer valuable insights. Panorama’s panel specifically includes prolactin testing, allowing you to conveniently measure this key hormone alongside others crucial for reproductive health: AMH (Anti-Müllerian Hormone), TSH, free T4 (fT4), free testosterone, total testosterone, SHBG, and albumin.

With your results, you’ll get a broader understanding of your hormonal landscape and it can help identify if elevated prolactin is an isolated issue or part of a wider imbalance affecting your health. The detailed, personalized reports from Panorama can empower you to have more informed conversations with your doctor about potential causes and next steps. 

Can High Prolactin Cause Infertility?

High prolactin can cause fertility problems in both women and men by disrupting ovulation or lowering testosterone, but treating the underlying cause often improves your chances of conceiving. And although high prolactin increases the risk of fertility problems, it does not always cause infertility and treatment can improve fertility outcomes. 

In women, high prolactin levels can affect both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels which in turn prevents the ovaries from producing enough sex hormones (like estrogen and progesterone). This imbalance can lead to irregular cycles, missed periods, anovulation, and ultimately infertility. You can enhance your reproductive health with Mira Prenatal Vitamins to support your fertility hormones. They are rich in ingredients that promote reproductive wellness, maintain hormonal balance, and keep your body healthy. 

If you’re trying to get pregnant, this can be especially frustrating because timing matters. It may be worth tracking your sex hormones to see if you have an underlying hormone imbalance and gain a better understanding of your menstrual cycle. Tracking ovulation is the key to getting pregnant efficiently. This can be done at home with the Mira App and Monitor, which can measure PdG (pregnanediol glucuronide, the urine metabolite of progesterone), LH, FSH, and E3G (estrone-3-glucuronide, the urine metabolite of estradiol). While you work with your healthcare provider to unravel symptoms of high prolactin in women, you can have some peace of mind knowing your exact hormone levels and understanding your ovulation patterns.

When you’re TTC and faced with a hormonal imbalance, it can be helpful to anchor yourself with supportive rituals and routines while you are learning about your hormone patterns. And since stress is a known fertility foe, adding in a herbal supplement like the Mira Fertility Tea can help ease the stress of TTC. It’s full of hormone regulating ingredients that support your reproductive health and can help with overall stress management.

Although high prolactin levels can affect fertility for both men and women, the mechanisms differ slightly. In men, high prolactin can lower testosterone, decrease sperm count and quality, and therefore reduce fertility. Elevated prolactin can suppress the production of testosterone, leading to a range of symptoms related to low testosterone, including difficulties with sexual function and decrease in sexual desire. Prolactin in men can affect energy, sex drive, muscle mass and strength, and blood count.

Can high prolactin cause infertility? Although the methods are different, high prolactin can cause infertility in men and women. By disrupting reproductive hormones, it can both interfere with a woman’s ability to get pregnant and a man’s ability to impregnate his partner. Determining the underlying cause, and how to treat it, can alleviate many of the issues caused by high prolactin levels and improve fertility outcomes. 

How to Lower Prolactin Levels and Treat Hyperprolactinemia

Any approach to how to lower prolactin levels depends on the specific cause of elevated prolactin levels in the first place. Hyperprolactinemia treatment is highly specific to your individual cause and should always be undertaken with your healthcare provider. Never stop taking or change prescription medications just because they are elevating your prolactin levels.

The safest way to lower prolactin levels is to work with your doctor to treat the underlying cause - whether that means adjusting medications, correcting other hormone problems, or using targeted drugs to bring prolactin back into range. In some cases, lifestyle changes may be all that’s needed to treat your high prolactin levels, where in other cases, more targeted intervention is required. Many lifestyle measures can help address hormonal imbalances and improve overall well-being, in addition to cause-specific medical therapy. 

Medical Hyperprolactinemia Treatment Options

Medical treatment options are highly individualized and often very effective at normalizing prolactin and relieving symptoms. Different causes require different treatments, with your doctor typically monitoring treatment with prolactin level testing and periodic imaging.

Medical hyperprolactinemia treatment often relies on medications that act like dopamine to lower prolactin levels, shrink prolactin-secreting tumors, and ease symptoms over time. When medications like dopamine agonists fail to regulate your prolactin levels, you may need surgery or radiation as a last resort. And if what causes high prolactin levels for you is medication based, your doctor may change the prescription to one that doesn’t elevate your prolactin levels. 

Lifestyle Support to Help Lower Prolactin Levels

Naturally, when you are investigating how to lower prolactin levels, you will come across lifestyle strategies that can improve your overall health and help address hormonal imbalance issues like hyperprolactinemia. Although lifestyle changes alone rarely fix significantly elevated prolactin, they can support medical treatment and improve quality of life.

Healthy sleep, stress reduction, and managing other hormone issues won’t usually normalize very high prolactin on their own, but they can support your body and your treatment plan. Focus on a rich diet that can help balance hormones, manage stress with practices such as meditation, yoga or breathing exercises, prioritize quality sleep, and get enough exercise. There are even vitamins, minerals, and herbal supplements you might want to try to support hormone regulation and overall health. While they are not a standalone cure, lifestyle adjustments can go a long way in how you feel and your overall quality of life. 

When to See a Doctor for High Prolactin Levels

High prolactin levels can be treated, but you’ll need a doctor to assess the root cause of the excess prolactin in your body. There are numerous factors that can influence your prolactin levels and not all are a cause for concern. However, if you find yourself in certain situations, seek medical evaluation to investigate thoroughly.

Seek medical evaluation if:

• blood tests show high prolactin levels or unexplained abnormal prolactin levels

• you notice symptoms like milk-like discharge, irregular or absent periods, low libido, or unexplained sexual problems

• you are trying to conceive and suspect high prolactin may be involved

• you experience headaches or changes in vision along with possible hyperprolactinemia symptoms

Elevated prolactin levels and signs of hyperprolactinemia can stem from various factors including physiological changes, underlying medical conditions, and some medications. Reach out to your doctor for a professional medical evaluation and to explore the best path forward for your well-being and reproductive health. 

Frequently Asked Questions

What if my prolactin is only slightly high?

Stress, medication, or other factors can cause slightly elevated prolactin levels. This is not usually a cause for concern and often no treatment is needed. If levels are only slightly high, retesting at a different time is usually recommended.

Can breastfeeding or pregnancy hide hyperprolactinemia?

Yes. Prolactin levels are normally higher in both pregnancy and during breastfeeding making it harder to distinguish underlying causes (not related to breastfeeding or pregnancy). 

Does high prolactin affect bone health or long-term health risks?

Yes, it can. High prolactin can cause low estrogen and testosterone, which can result in long term health risks like bone loss and osteoporosis.

Can exercise or diet alone fix high prolactin levels?

It’s unlikely that diet or exercise alone can fix high prolactin levels. Diet and exercise are insufficient as a standalone treatment for high prolactin levels.

Do birth control pills interfere with prolactin testing?

Oral contraceptive pills, specifically those that contain estrogen, can interfere with prolactin testing. Not everyone who takes them will be affected, but some experience mild elevations in serum prolactin levels. This can then interfere with testing for prolactin levels.

Can you have normal periods or normal testosterone and still have hyperprolactinemia?

Yes. Although hyperprolactinemia usually causes disruptions to your cycle, it doesn’t always present this way. While you may present with other symptoms like headaches, infertility, or lactation, you may still experience regular cycles.