High prolactin levels, also called hyperprolactinemia, can affect both men and women, disrupting hormones, fertility, and overall health. If you're wondering how to recognize these issues, understanding the symptoms can help you identify if you have high prolactin and when to seek medical advice.

Prolactin is a hormone produced by the pituitary gland that plays a critical role in reproductive health, lactation, and immune function. Elevated levels can cause emotional stress or anxiety, especially if symptoms like infertility or changes in libido occur, so understanding these effects can help you feel more supported.

What Is Prolactin, and What Does It Do?

Prolactin is a hormone produced by the pituitary gland, a small gland at the base of the brain. Its main role is to help the body produce breast milk after childbirth. It also supports other functions, such as regulating reproductive health, immune system activity, and hormone balance.

Key functions of prolactin include:

• Stimulating and maintaining lactation in lactating women
• Regulating the menstrual cycle and ovulation
• Regulate testosterone production and sperm function in men
• Supporting immune system regulation
• Promote sexual drive(libido)
• Helps with metabolic regulation and body composition

What is the normal prolactin level

Non-Pregnant Women: Lies in the range of 5–25 ng/mL (ranges may vary slightly by laboratory).

Men: Usually around 5–15 ng/mL

Pregnancy/Breastfeeding: Levels increase significantly and may reach 200–500 ng/mL or higher, depending on the stage.

Hyperprolactinemia: For women, high prolactin levels are generally considered to be above 25 ng/mL. In men, a level above 20 ng/mL typically indicates high prolactin, although some labs may use a lower threshold of 17 ng/mL.

Note: Reference ranges may differ slightly depending on the laboratory and method used.

Causes of High Prolactin Level

Pituitary Gland Disorders

The pituitary gland controls prolactin production. If a tumour like a prolactinoma occurs, it can cause high prolactin, but diagnosis and treatment options are available to help manage this condition, easing concerns about health risks.

Medications

Some medicines can raise prolactin because they affect brain chemicals that normally keep prolactin levels under control. Certain medications can elevate prolactin levels. These include some antidepressants, antipsychotics, blood pressure drugs, and hormone treatments. Often, prolactin levels can be normalised once medication is adjusted or discontinued, under a doctor's supervision.

Hormonal and Medical Conditions

Sometimes, hypothyroidism (low thyroid hormone) can signal the body to produce more prolactin along with conditions like PCOS, which can disturb hormone balance. At the same time, chronic kidney or liver disease can slow the removal of prolactin from the body, causing levels to build up.

Lifestyle

Prolactin can rise temporarily due to improper lifestyle issues such as stress, intense physical activity, poor sleep, etc. These spikes are usually short-term, and levels typically return to normal once the trigger is gone.

Symptoms of High Prolactin Levels in Women

Women are more frequently diagnosed with hyperprolactinemia, often because the symptoms are more noticeable, which may affect the menstrual cycle and fertility. Common signs include:

Menstrual Irregularities

High prolactin suppresses the hormones LH (luteinizing hormone) and FSH (follicle-stimulating hormone), affecting the menstrual cycle. Women may experience oligomenorrhea (infrequent periods) or amenorrhea (absence of periods).

Unwanted Milky discharge

Milky discharge from the breasts unrelated to pregnancy or breastfeeding is also called Galactorrhea. It occurs in approximately 30–80% of women with hyperprolactinemia. It may occur spontaneously or only upon breast pressure.

Infertility

By suppressing ovulation, elevated prolactin is a significant and often treatable cause of female infertility. Many women discover they have hyperprolactinemia only when seeking help for difficulty conceiving.

Low Libido and Vaginal Dryness

Suppressed prolactin levels can be due to reduced estrogen levels resulting from suppression of ovarian function, which can lead to decreased sex drive, vaginal dryness, and painful intercourse (dyspareunia).

Low Bone Density

Prolonged hyperprolactinemia due to low estrogen can accelerate bone loss, increase the risk of osteopenia and osteoporosis, even in young women.

Symptoms of High Prolactin Levels in Men

Men with hyperprolactinemia often go undiagnosed longer because the symptoms are less immediately noticeable. Key signs include:

Erectile Dysfunction and Low sex drive

High prolactin can lower testosterone production by inhibiting GnRH (gonadotropin-releasing hormone) release. This leads to hypogonadism, low testosterone, causing erectile dysfunction, reduced sexual desire, and decreased energy levels.

Infertility

Elevated prolactin reduces sperm production (oligospermia) and sperm motility, contributing to male infertility. Low testosterone may further diminish sperm quality.

Gynecomastia and Galactorrhea

Some men develop breast tissue enlargement (gynecomastia) and, less commonly, milky discharge from the nipples (galactorrhea). These symptoms can be psychologically distressing.

Headaches and Visual Disturbances

In men, prolactinomas are often larger at the time of diagnosis (macroprolactinomas). If left untreated, a growing tumour can compress surrounding structures, causing headaches and visual problems, particularly peripheral vision loss.

Low Bone density

Just as in women, abnormally low testosterone from hyperprolactinemia greatly reduces bone mineral density, raising the risk of fractures and osteoporosis in men.

How Is High Prolactin Level (Hyperprolactinemia) Diagnosed?

Diagnosis starts with the physical examination and checking of the symptoms, based on which a combination of blood tests and imaging is recommended, these include:-

Blood tests list

• Serum Prolactin Blood Test -Book now
  
• Macroprolactin Test- Book now
• Thyroid-Stimulating Hormone Test- Book now
• Free T4 Test- Book now
• Kidney Function Test (KFT Panel)- Book now

Imaging Tests such as MRI Pituitary with Contrast, CT Scan Brain (if MRI contraindicated) and Bone Density Scan (DEXA) can be done.

Treatment Options for High Prolactin Levels

The proper treatment depends on the underlying cause, the severity of symptoms, the patient's reproductive goals, and whether a tumour is present. Here are the main treatment strategies:

Dopamine Agonist Medications

These are the main treatments for high prolactin. They act like dopamine to reduce prolactin levels and often shrink tumours. Cabergoline is preferred because it works longer and has fewer side effects, while bromocriptine is cheaper and often used in pregnancy. Common side effects include nausea and dizziness.

Treating the Underlying Cause

If high prolactin is caused by another condition—such as certain medicines, hypothyroidism, or kidney disease—treating that issue can bring prolactin back to normal without specific hormone therapy.

Surgery

Surgery removes the tumour through the nose and is used if medicines don’t work, aren’t tolerated, or vision is affected. It works best for small tumours and is performed by specialised surgeons.

Radiation Therapy

Rarely used as the first treatment. It’s reserved for aggressive or treatment-resistant tumours and works slowly. It may affect normal hormone production over time.

Lifestyle Measures

Healthy habits like stress management, good sleep, moderate exercise, limiting alcohol, and maintaining a healthy weight can support hormone balance, but usually don’t replace medical treatment.

When Should You See a Doctor?

Seek medical evaluation if you experience any of the following:

• Irregular, infrequent, or absent menstrual periods
• Unexplained breast milk discharge (galactorrhea)
• Difficulty conceiving after 12 months of unprotected intercourse (or 6 months if over 35)
• Persistent low libido or erectile dysfunction
• Unexplained headaches and visual changes
• Gynecomastia (enlarged breast tissue) in men
• Low bone density or unexplained fractures

For the evaluation and management of hyperprolactinemia, an endocrinologist is the most qualified specialist. Prompt diagnosis and treatment are crucial, as they lead to significantly better outcomes and an improved quality of life.

Conclusion

Elevated prolactin is a treatable hormonal disorder that occurs in both men and women. While initial symptoms might be quiet, early medical evaluation and testing can find the cause and help restore hormonal balance. If you are experiencing unexplained hormonal, sexual, or reproductive issues, going for an appropriate blood test can offer vital information and direct the suitable course of treatment.