Prolactin Disorders: Understanding Galactorrhea, Infertility, and Effective Treatments

What Is Galactorrhea, and Why Does It Happen?

Galactorrhea is when your breasts produce milk even when you’re not pregnant or breastfeeding. It’s not a disease itself - it’s a sign that something else is going on in your body. About 20 to 25% of women will experience this at least once in their lives, according to Mayo Clinic data from early 2025. You might notice a milky discharge from one or both nipples, sometimes only when you squeeze the breast, other times leaking on its own. The discharge usually doesn’t hurt, and it’s not bloody or clear - that’s important, because those colors can signal something else entirely.

The root cause is almost always too much prolactin in your blood. Prolactin is the hormone your pituitary gland makes to trigger milk production after childbirth. But when it’s high for no clear reason, it can mess with your whole system. Normal prolactin levels for non-pregnant women range from 2.8 to 29.2 ng/mL. Once you hit 25 ng/mL or higher, doctors start looking for the cause. In about 70 to 80% of cases, the discharge comes from both breasts. If it’s only one side, that raises a red flag - but even then, it’s still more likely to be hormonal than cancerous.

How Prolactin Disorders Cause Infertility

High prolactin doesn’t just make your breasts leak - it shuts down your fertility. That’s because prolactin suppresses the hormones that make your ovaries release eggs. When prolactin stays too high, your body stops ovulating. You might miss periods entirely, or have very irregular cycles. This is called hyperprolactinemic amenorrhea. In fact, up to 90% of women with untreated high prolactin stop ovulating, according to Dr. Richard S. Legro at Penn State College of Medicine.

Many women don’t realize their infertility is tied to this. They assume it’s just stress, age, or something wrong with their partner. But if you’ve been trying to get pregnant for over a year and your periods are off, checking your prolactin level is one of the first things a fertility specialist should do. The good news? Once prolactin drops back to normal, ovulation returns in 80 to 90% of cases. One patient on Reddit shared: “After 3 months on cabergoline, my discharge stopped and my period came back after 18 months of absence.” That’s not rare - it’s the norm when treatment works.

What Causes High Prolactin Levels?

There are a lot of reasons your prolactin might be elevated. The most common is a benign tumor on the pituitary gland called a prolactinoma. These are small in most cases - under 10 mm - and they’re called microprolactinomas. About 90% of these shrink or disappear with medication. But not all high prolactin comes from tumors.

Medications are a big culprit. Antidepressants like SSRIs (sertraline, fluoxetine), antipsychotics, and even some blood pressure pills can spike prolactin. A patient on MyHealth Alberta’s forum reported: “My discharge stopped within 2 weeks of switching from sertraline to bupropion.” That’s because bupropion doesn’t affect prolactin the same way.

Other causes include hypothyroidism (low thyroid function), chronic kidney disease, chest wall injuries, or even excessive breast stimulation during sex or frequent breast exams. Stress can also raise prolactin temporarily by 10 to 20 ng/mL, which is why doctors always ask you to rest for 20 minutes before the blood test. And here’s something surprising: 35% of cases have no known cause at all - they’re called idiopathic. Even then, many resolve on their own within a year without any treatment.

How Doctors Diagnose the Problem

Diagnosing prolactin disorders isn’t complicated, but it’s methodical. First, your doctor will check your prolactin level with a blood test. But one high reading isn’t enough. Because stress, recent sex, or even a bad night’s sleep can bump it up, they’ll likely repeat the test. If it stays high, they’ll also test your thyroid (TSH) and kidney function - both can mimic or worsen the issue.

If your prolactin is over 100 ng/mL, an MRI of your brain is almost always next. That’s to check for a pituitary tumor. Tumors under 10 mm (microprolactinomas) are common and usually harmless. Larger ones (macroadenomas) are rarer but can press on nearby nerves, causing headaches or vision problems. If your discharge is bloody, clear, or only from one breast, your doctor will probably order a mammogram or ultrasound to rule out breast cancer. Remember: only 5% of galactorrhea cases involve bloody discharge, but 60% of cancer-related discharges do.

Some clinics now use a simple test called nipple cytology - scraping a bit of the discharge onto a slide to look for cells. It’s not always needed, but in ambiguous cases, it helps avoid unnecessary imaging.

Top Treatments: Cabergoline vs. Bromocriptine

The go-to treatment for high prolactin is dopamine agonists - drugs that trick your brain into thinking there’s enough dopamine, so it stops overproducing prolactin. Two drugs dominate the market: cabergoline and bromocriptine.

Cabergoline (brand name Dostinex) is now the first choice for most doctors. It’s taken just twice a week, usually 0.25 to 1 mg total. Clinical trials show 83% of patients get prolactin levels back to normal within three months. It’s also better tolerated: only 10 to 15% of users get nausea, compared to 25 to 30% with bromocriptine. One patient said: “Bromocriptine made me so nauseous I had to take it at bedtime, and I still threw up twice weekly.” That’s why many switch.

Bromocriptine is older and cheaper - around $50 to $100 a month versus $300 to $400 for cabergoline. It’s taken daily, often starting at 1.25 mg. It works well too - 76% of patients normalize prolactin - but side effects are harder to handle. It can cause dizziness, low blood pressure, and nasal congestion. Still, it’s used when cost is a barrier or if someone can’t tolerate cabergoline.

In early 2025, the FDA approved a new version: Cabergoline ER. It’s extended-release, so you only need one pill a week. Early trials show 89% effectiveness at six months - better than the original. This could change how treatment works in the next few years.

What About Surgery or Other Options?

Surgery is rarely needed. Only about 5% of patients with prolactinomas don’t respond to medication, or have tumors so large they’re pressing on the optic nerve. In those cases, removing the tumor through the nose (transsphenoidal surgery) can help. But even then, most still need medication afterward.

There’s also new research on the horizon. Novartis is testing a selective prolactin receptor blocker in phase 2 trials (NCT05678912), expected to finish in late 2026. This would be the first drug that blocks prolactin directly, instead of tricking the brain into making less. It could be a game-changer for people who don’t respond to current meds.

For those with idiopathic galactorrhea and no desire to get pregnant, sometimes the best treatment is no treatment. About 30% of these cases resolve on their own within a year. Doctors now recommend watchful waiting - especially if prolactin is only slightly high and there are no other symptoms.

What to Expect During Treatment

Most people start feeling better within weeks. Discharge usually stops in 2 to 6 weeks. Periods return in 1 to 3 months. Fertility often comes back quickly - one woman on BabyCenter wrote: “The cabergoline saved my fertility - I conceived naturally 4 months after starting treatment.”

Side effects are usually mild and temporary. Nausea, dizziness, and headaches are common at first, especially with bromocriptine. Taking the pill with food or at bedtime helps. Most people adjust within a few weeks. Serious side effects like heart valve damage only happen with very high doses (over 2 mg/day) for over a year - which is extremely rare in standard treatment.

Regular follow-ups are key. Your doctor will recheck your prolactin level after 3 months, then every 6 to 12 months. If you’re trying to get pregnant, you’ll likely stay on medication until conception, then stop - since these drugs aren’t recommended during pregnancy. Once you’re pregnant, your body naturally lowers prolactin again.

When to See a Specialist

You don’t always need an endocrinologist. Most primary care doctors can handle mild cases. But if your prolactin is over 100 ng/mL, you have headaches or vision changes, you’re trying to get pregnant and not succeeding, or you’ve tried one medication and it didn’t work - it’s time to see a specialist. Endocrine clinics that work with breast specialists are becoming more common. Mayo Clinic’s integrated clinics cut diagnosis time from over 8 weeks down to just 3.5 weeks.

If you’re a man with galactorrhea, that’s even rarer - and more likely to point to a tumor or medication side effect. Men with high prolactin often have low libido or erectile dysfunction, not just breast discharge. Don’t ignore it - it’s a sign something’s wrong.

Living With Prolactin Disorders

Most people with prolactin disorders live normal, healthy lives once treated. You won’t need to change your diet, exercise, or lifestyle dramatically. But you do need to be patient. Healing takes time. Don’t panic if your period doesn’t come back right away. Don’t stop your medication just because you feel better. And don’t let embarrassment stop you from talking to your doctor.

Support helps. Online communities like Reddit’s r/Endocrinology and BabyCenter have thousands of people sharing their stories. You’re not alone. Satisfaction rates are high - 78% of patients report good outcomes, according to Healthgrades. The biggest complaints? Side effects from meds, not the condition itself.

And remember: this isn’t cancer. It’s not permanent. It’s not your fault. It’s a simple hormonal glitch - and today, we know how to fix it.