Prolactin Disorders: Understanding Galactorrhea, Infertility, and Effective Treatments

When you notice milky discharge from your nipples and you’re not pregnant or breastfeeding, it’s natural to panic. Is it cancer? Is something seriously wrong? The truth is, this symptom-called galactorrhea-is rarely a sign of breast cancer. More often, it’s a signal that your body’s hormone levels are off, especially your prolactin. And when prolactin runs high, it doesn’t just cause milk to leak-it can stop your periods, make it harder to get pregnant, and leave you feeling confused and anxious. The good news? Most cases are treatable, and fertility often returns once the root cause is fixed.

What Exactly Is Galactorrhea?

Galactorrhea is the spontaneous flow of milky fluid from one or both breasts in people who aren’t nursing or pregnant. It affects about 1 in 5 women at some point in their lives, according to Mayo Clinic data from early 2025. It can happen in men too, though much less often. The discharge is usually clear or white, not bloody or greenish. It often comes out without touching the breast, and you might notice it soaking through your shirt after a shower or when you’re lying down.

Unlike cancer-related discharge-which is typically one-sided and bloody-galactorrhea is usually bilateral and milky. It doesn’t hurt. It doesn’t come with lumps. And it’s not caused by poor hygiene or tight bras. It’s a hormonal signal. The hormone responsible? Prolactin. Produced by the pituitary gland in your brain, prolactin’s main job is to trigger milk production after childbirth. But when it’s too high-something doctors call hyperprolactinemia-it can cause milk to flow even when there’s no baby.

Prolactin levels above 25 ng/mL are considered abnormal in non-pregnant women. Normal range is 2.8 to 29.2 ng/mL. But here’s the catch: stress, sleep deprivation, or even how your blood was drawn can temporarily spike prolactin by 10-20 ng/mL. That’s why doctors always repeat the test before jumping to conclusions.

Why Does High Prolactin Cause Infertility?

High prolactin doesn’t just make your breasts leak-it shuts down your reproductive system. It blocks the signals from your brain that tell your ovaries to release an egg each month. Without ovulation, you don’t get your period. And without periods, pregnancy becomes nearly impossible.

Studies show that up to 90% of women with untreated hyperprolactinemia stop ovulating. That’s why so many women come to fertility clinics after months or even years of trying to conceive, only to find out their prolactin levels are sky-high. In fact, prolactin disorders are one of the most common reversible causes of infertility in women under 35.

But here’s what most people don’t realize: treating the prolactin issue doesn’t just stop the discharge. It brings your periods back-and your fertility with them. Research from Penn State College of Medicine shows that 80-90% of women who take dopamine agonists (the standard treatment) start ovulating again within 3-6 months. Many conceive naturally soon after.

What Causes Prolactin to Rise?

There are over a dozen reasons your prolactin might be elevated. Some are simple. Others need serious medical attention.

• Pituitary tumors (prolactinomas): These are the most common serious cause. They’re usually benign, slow-growing tumors in the pituitary gland that overproduce prolactin. Microprolactinomas (under 10 mm) are the most frequent and respond very well to medication.
• Medications: Many common drugs raise prolactin. Antidepressants like SSRIs (sertraline, fluoxetine), antipsychotics (risperidone), and even some blood pressure pills (verapamil) can do it. Switching to a different drug-like bupropion instead of sertraline-often fixes the problem.
• Thyroid problems: Low thyroid function (hypothyroidism) can trigger high prolactin. That’s why every patient with galactorrhea gets a TSH test.
• Chronic kidney disease: When kidneys don’t filter well, prolactin builds up in the blood.
• Idiopathic: In about 35% of cases, no clear cause is found. These are called “idiopathic hyperprolactinemia.” Many of these cases resolve on their own within a year.

Doctors don’t just guess-they test. Blood work checks prolactin, TSH, and kidney function. If prolactin is over 100 ng/mL, an MRI of the brain is ordered to look for a pituitary tumor. If it’s under 100, and you’re on meds or have mild symptoms, they might start treatment without imaging.

Treatment Options: Medications That Work

The go-to treatment for high prolactin is dopamine agonists. These drugs mimic dopamine, the natural hormone that tells your pituitary to stop making prolactin.

There are two main ones:

Cabergoline (Dostinex)

This is the first choice for most doctors. Why? It works better and has fewer side effects. You take it just twice a week-0.25 to 1 mg. Most people see their prolactin levels drop within weeks. Discharge stops in 2-8 weeks. Periods return in 1-3 months. In clinical trials, 83% of patients normalized their prolactin within 3 months. And for those with microprolactinomas, 90% see the tumor shrink or disappear in 6 months.

Side effects? Mild nausea or dizziness in 10-15% of users. Taking it with food or at night helps. A new extended-release version (Cabergoline ER), approved by the FDA in January 2025, allows once-weekly dosing and shows 89% effectiveness in early trials.

Bromocriptine (Parlodel)

This older drug works too, but you have to take it daily-usually 1.25 to 2.5 mg. It’s cheaper ($50-$100/month), but side effects hit harder. Nausea affects 25-30% of users. Some people can’t tolerate it at all. One Reddit user wrote: “Bromocriptine made me so nauseous I had to take it at bedtime, and I still threw up twice weekly for the first month.”

Cost isn’t the only difference. Cabergoline is more expensive-$300-$400 a month-but it’s often covered by insurance. And because it’s more effective and easier to take, most endocrinologists start with it now.

When Surgery or Other Treatments Are Needed

Most people don’t need surgery. But if a tumor is huge (over 10 mm), doesn’t shrink with meds, or is pressing on your optic nerves (causing vision problems), surgery may be necessary. That’s rare-only about 10% of cases.

There’s also a new drug in development: a selective prolactin receptor blocker. Novartis is testing it in phase 2 trials (NCT05678912), with results expected by late 2026. If it works, it could offer a new option for people who can’t tolerate dopamine agonists.

And here’s something important: if your discharge is bloody, clear and sticky, or only coming from one breast, don’t assume it’s galactorrhea. That’s the red flag for breast cancer. Those cases need a mammogram or ultrasound right away. Only 5% of galactorrhea cases have bloody discharge-but 60% of cancer-related discharges do.

What to Expect After Starting Treatment

Most patients feel better quickly. One woman on BabyCenter wrote: “The cabergoline saved my fertility-I conceived naturally 4 months after starting treatment.” Another said: “After 3 months on cabergoline 0.5mg twice weekly, my discharge stopped completely and my period returned after 18 months of absence.”

But not everyone responds the same. Some need higher doses. Some need to switch from bromocriptine to cabergoline. A few find their symptoms improve just by stopping a medication that was raising their prolactin-like switching from sertraline to bupropion.

And here’s a hopeful note: 30% of people with idiopathic galactorrhea get better on their own within a year, even without treatment. That’s why some doctors wait a few months before prescribing meds if the prolactin is only slightly high and symptoms are mild.

Living With It: What You Need to Know

You don’t have to live in fear. Galactorrhea is not contagious. It’s not caused by stress alone (though stress can make it worse). It’s not your fault. And it’s not a life sentence.

Wear breast pads if the discharge bothers you. Avoid nipple stimulation-it can trigger more prolactin. Don’t squeeze your breasts. And if you’re trying to get pregnant, track your ovulation. Once your prolactin drops, your cycle should return.

Follow-up blood tests are key. You’ll need them every 3-6 months until your levels stabilize. If you’re on cabergoline long-term, your doctor might check your heart valves every few years-though this is only a concern at very high doses (over 2 mg/day for more than a year). At standard doses, the risk is nearly zero.

And remember: you’re not alone. About 1.5 million people in the U.S. experience galactorrhea each year. Around 300,000 get medical treatment. Endocrine clinics and fertility centers handle these cases all the time. The tools to fix this are well-established. The success rate is high. And new treatments are on the way.

What’s Next for Prolactin Disorder Treatment?

The field is moving toward personalization. By 2027, doctors may use genetic tests to see how your body responds to dopamine agonists. Some people have variations in dopamine receptors that make them respond better to cabergoline than bromocriptine. That kind of precision medicine could cut trial-and-error time in half.

Also, clinics are combining endocrinology with breast imaging specialists. Mayo Clinic started integrated clinics in 2024. They cut diagnosis time from over 8 weeks to just 3.5. That means faster answers, less anxiety, and quicker treatment.

The global market for hyperprolactinemia drugs is growing-projected to hit $1.8 billion by 2029. That means more research, better drugs, and more options in the future.