Hyperprolactinemia Treatment: What Works and When to Act

If you’ve been told your prolactin level is high, you’re probably wondering what to do next. The good news is that most cases can be managed with a few well‑known steps. Below we break down the main medicines, lifestyle tweaks, and warning signs that tell you it’s time to get professional help.

First‑line meds: Dopamine agonists

The go‑to drugs for high prolactin are dopamine agonists such as cabergoline and bromocriptine. They work by tricking your brain into thinking there’s enough dopamine, which naturally suppresses prolactin. Most patients notice a drop in levels within a few weeks, and symptoms like irregular periods or unwanted milk production start to fade.

Cabergoline is usually preferred because you take it once or twice a week and it causes fewer nausea issues. Bromocriptine, on the other hand, is taken daily and can feel a bit harsh on the stomach, but it’s cheaper and still effective. Your doctor will start you on a low dose and adjust it based on follow‑up blood tests.

When medication isn’t enough: Surgery and other options

In about 10‑15 % of cases a pituitary tumor (prolactinoma) is the culprit and doesn’t shrink enough with meds. If the tumor is large or pressing on nearby structures, surgery may be recommended. Transsphenoidal surgery—going through the nose—has a high success rate and a short recovery time. If surgery isn’t an option, radiation therapy can be considered, but it’s usually a last resort because it takes months to lower prolactin levels.

Some people also ask about natural ways to lower prolactin. While lifestyle changes won’t replace medication, they can support your treatment. Reducing stress, getting enough sleep, and avoiding estrogen‑heavy foods (like soy in large amounts) may help keep prolactin from spiking.

Alcohol and high‑dose nicotine can raise prolactin, so cutting back can be a simple win. Regular moderate exercise also balances hormones and improves overall well‑being.

Finally, keep an eye on your symptoms. Persistent headaches, vision changes, or worsening menstrual irregularities mean you need a doctor’s review right away. Routine blood tests every 3‑6 months are standard until your prolactin stays in the normal range.

Bottom line: most hyperprolactinemia cases are treatable with a short course of dopamine agonists, occasional lifestyle tweaks, and regular monitoring. If meds don’t work, surgery or radiation are the next steps. Stay proactive, follow up on lab results, and you’ll get your hormones back on track.