If you have PCOS and recently learned your prolactin levels are elevated, you might feel confused about what this means for your health. High prolactin can complicate PCOS symptoms and affect your fertility, menstrual cycles, and overall hormone balance. Understanding the connection between these two conditions helps you make informed decisions about treatment.
Prolactin is a hormone produced by your pituitary gland that primarily regulates milk production during breastfeeding. In women with PCOS, elevated prolactin levels occur more frequently than in the general population, creating overlapping symptoms that can make diagnosis and treatment more complex.
Understanding Prolactin Levels in PCOS
Normal prolactin levels typically range from 4 to 25 nanograms per milliliter in non-pregnant women. Levels between 25 and 100 ng/mL are considered mildly elevated, while readings above 100 ng/mL indicate significantly high prolactin that requires medical attention. Women with PCOS often fall into the mildly elevated category.
The relationship between high prolactin and PCOS is complex. Both conditions affect the hypothalamic-pituitary-ovarian axis, the communication system between your brain and reproductive organs. When prolactin rises, it can suppress the hormones needed for ovulation, compounding the ovulatory dysfunction already present in PCOS.
Studies show that approximately 15 to 30 percent of women with PCOS have mildly elevated prolactin levels. This overlap means that testing prolactin should be standard when evaluating PCOS, especially if you experience irregular periods, difficulty conceiving, or breast discharge.
Symptoms of Elevated Prolactin with PCOS
High prolactin creates symptoms that may overlap with or worsen existing PCOS symptoms. Irregular or absent menstrual periods become more pronounced when prolactin levels rise. While PCOS alone can cause cycle irregularities, adding high prolactin often means longer gaps between periods or complete absence of menstruation.
Galactorrhea, the production of breast milk when you are not pregnant or breastfeeding, is a hallmark sign of elevated prolactin. This symptom does not typically occur with PCOS alone, making it an important distinguishing feature. Some women notice just a few drops when their breasts are squeezed, while others experience more noticeable leaking.
Fertility challenges intensify when both conditions are present. High prolactin suppresses ovulation by interfering with the hormones that trigger egg release. Combined with the insulin resistance and hormonal imbalances of PCOS, this creates significant obstacles for women trying to conceive.
Additional Warning Signs
Decreased libido affects many women with elevated prolactin. High levels suppress estrogen and testosterone, reducing sexual desire. Headaches and vision problems can occur if a prolactin-secreting tumor called a prolactinoma is present, though this is less common. Any vision changes or severe headaches warrant immediate medical evaluation.
Mood changes including depression and anxiety may worsen with high prolactin. While PCOS itself is associated with mood disorders, elevated prolactin adds another layer of hormonal disruption affecting mental health. If you notice worsening mood symptoms alongside other signs of high prolactin, discuss testing with your healthcare provider.
Causes of High Prolactin in Women with PCOS
Several factors contribute to elevated prolactin levels in women who have PCOS. Medications rank as the most common cause. Antipsychotics, antidepressants, blood pressure medications, and anti-nausea drugs can all raise prolactin. If you take any of these medications and have high prolactin, discuss alternatives with your doctor.
Hypothyroidism creates a cascade of hormonal changes that can elevate prolactin. When thyroid hormone levels drop, your pituitary gland produces more thyroid-stimulating hormone, which can simultaneously trigger prolactin release. Women with PCOS have higher rates of thyroid disorders, making this connection particularly relevant.
Prolactinomas are benign tumors of the pituitary gland that secrete excess prolactin. These tumors are usually small and respond well to medication. While they can occur independently, having PCOS does not increase your risk of developing prolactinomas. However, the overlapping symptoms make distinguishing between the two conditions important.
Stress and Lifestyle Factors
Chronic stress elevates cortisol, which can influence prolactin production. Women with PCOS often experience higher stress levels due to symptom management challenges, creating a cycle where stress worsens hormone imbalances. Sleep deprivation also raises prolactin levels, as this hormone naturally peaks during sleep.
Excessive exercise, particularly endurance training without adequate recovery, can temporarily raise prolactin. While physical activity helps manage PCOS symptoms, balance is crucial. Overtraining combined with insufficient calorie intake creates metabolic stress that disrupts multiple hormones including prolactin.
High Prolactin PCOS Treatment Options
Treatment approaches depend on the underlying cause and severity of elevation. When medication causes high prolactin, switching to alternatives often resolves the issue. Your doctor may adjust doses or try different drugs that do not affect prolactin levels. Never stop prescribed medications without medical guidance.
For prolactinomas or significantly elevated prolactin levels, dopamine agonists like cabergoline or bromocriptine are first-line treatments. These medications effectively lower prolactin by mimicking dopamine, which naturally inhibits prolactin secretion. Cabergoline is typically preferred due to better tolerability and less frequent dosing.
Most women notice prolactin levels normalizing within weeks of starting dopamine agonist therapy. Menstrual cycles often resume, and fertility improves as ovulation returns. Side effects can include nausea, dizziness, and headaches, especially when starting treatment. Taking medication with food and starting with low doses minimizes these effects.
Treating Underlying Thyroid Issues
When hypothyroidism contributes to high prolactin, thyroid hormone replacement therapy addresses both problems simultaneously. As thyroid levels normalize, prolactin typically decreases without additional intervention. Regular monitoring ensures your thyroid medication dose remains appropriate.
The connection between thyroid function and PCOS makes comprehensive hormone testing essential. Many women find that optimizing thyroid health improves multiple PCOS symptoms beyond just prolactin levels. Working with a healthcare provider familiar with both conditions ensures coordinated treatment.
Natural Ways to Reduce Prolactin in PCOS
While medication may be necessary for significantly elevated prolactin, lifestyle modifications support healthy levels. Stress management stands as a cornerstone approach. Practices like meditation, yoga, deep breathing exercises, and adequate sleep help regulate the stress response that can elevate prolactin.
Vitamin B6 plays a role in dopamine production, the neurotransmitter that inhibits prolactin. Some studies suggest B6 supplementation may help reduce mildly elevated prolactin levels. Typical doses range from 100 to 200 milligrams daily, though you should consult a healthcare provider before starting supplements.
Vitamin E functions as an antioxidant that may help balance hormones including prolactin. Research on vitamin E for prolactin reduction shows mixed results, but adequate intake supports overall reproductive health. Food sources include nuts, seeds, and leafy greens.
Herbal Support and Dietary Approaches
Vitex agnus-castus, also known as chasteberry, has traditional use for hormone balance and may help reduce mildly elevated prolactin. This herb affects dopamine receptors in ways that can lower prolactin production. However, evidence remains limited and vitex can interact with medications, so medical supervision is important.
Maintaining stable blood sugar through a balanced diet helps overall hormone regulation in PCOS. While no specific foods directly lower prolactin, reducing insulin resistance through proper nutrition may indirectly support healthy hormone levels. Focus on protein, healthy fats, and fiber while limiting refined carbohydrates.
Similar to how PCOS tea can support overall hormone balance, certain herbal approaches may complement medical treatment. Always discuss herbal supplements with your healthcare provider, especially if you take prescription medications.
Monitoring and Testing Prolactin Levels
Accurate prolactin testing requires proper timing and preparation. Levels fluctuate throughout the day, typically peaking at night and during sleep. Blood tests should occur in the morning, at least two hours after waking, to capture baseline levels. Fasting is not necessary, but avoid breast stimulation and sexual activity for 24 hours before testing.
Stress during blood draws can temporarily spike prolactin, sometimes leading to false positives. If your first test shows elevation, your doctor should repeat testing before starting treatment. Some providers test three times with an IV line in place for 20 minutes to allow stress-related prolactin spikes to settle.
Regular monitoring helps assess treatment effectiveness. Most doctors recheck levels every three to six months once treatment begins, adjusting medication doses as needed. Once levels stabilize in the normal range, less frequent monitoring may be appropriate.
Impact on Fertility and Pregnancy
High prolactin significantly affects fertility by preventing ovulation. Even mildly elevated levels can disrupt the hormonal signals needed for egg maturation and release. For women with PCOS trying to conceive, addressing elevated prolactin often restores ovulation and improves pregnancy chances.
Treatment with dopamine agonists effectively restores fertility in most cases. Many women ovulate within months of starting medication and achieving normal prolactin levels. This improvement happens independently of other PCOS treatments, though combining approaches often yields better results.
During pregnancy, prolactin naturally rises in preparation for breastfeeding. Women who conceived while taking dopamine agonists typically discontinue medication once pregnancy is confirmed, as prolactin elevation during pregnancy is normal and necessary. Your doctor will provide specific guidance based on your situation.
Breastfeeding Considerations
Women with PCOS and a history of high prolactin can successfully breastfeed. While elevated prolactin outside of pregnancy and breastfeeding and PCOS may cause concern, the appropriate prolactin rise during lactation is healthy and expected. Some women with PCOS experience low milk supply, but this relates more to insulin resistance and hormone imbalances than previous prolactin issues.
Differentiating PCOS from Hyperprolactinemia
Distinguishing between PCOS and hyperprolactinemia as primary diagnoses matters for treatment planning. Both conditions cause irregular periods and fertility problems, but key differences exist. Galactorrhea strongly suggests elevated prolactin rather than PCOS alone. The presence of multiple ovarian cysts on ultrasound and elevated androgens points toward PCOS.
Some women have both conditions simultaneously, requiring treatment for each. Blood tests measuring prolactin, androgens like testosterone, LH, FSH, and thyroid hormones help clarify the diagnosis. Pelvic ultrasound showing polycystic ovaries supports PCOS diagnosis.
Understanding which condition drives your symptoms guides treatment choices. If prolactin elevation is mild and related to PCOS-associated stress or metabolic factors, treating PCOS may normalize prolactin without additional intervention. Significantly elevated prolactin requires specific treatment regardless of PCOS status.
For women navigating these complex hormone interactions, tools like a signs of PCOS quiz can help identify whether symptoms align more with classic PCOS or suggest additional hormonal issues requiring investigation.
Long-Term Management Strategies
Successfully managing high prolactin with PCOS requires ongoing attention. Regular follow-up with your healthcare provider ensures prolactin levels remain controlled and treatment effectiveness continues. Many women need long-term medication for prolactinomas, though some small tumors shrink enough to allow medication discontinuation.
Lifestyle factors play an important supporting role. Prioritizing seven to nine hours of quality sleep each night helps regulate prolactin's natural rhythm. Managing stress through whatever techniques work for you, whether meditation, exercise, therapy, or creative pursuits, reduces hormone-disrupting cortisol.
Nutrition strategies that improve insulin sensitivity benefit both PCOS and hormone balance overall. While no specific diet lowers prolactin directly, eating budget friendly PCOS meals that stabilize blood sugar and reduce inflammation supports your endocrine system. Including good snacks for PCOS prevents blood sugar crashes that stress your hormonal system.
When to Seek Medical Attention
Certain symptoms require prompt medical evaluation. Vision changes, severe headaches, or sudden worsening of galactorrhea may indicate a growing pituitary tumor needing urgent attention. While most prolactinomas are benign and slow-growing, rapid changes warrant immediate assessment.
If you are taking dopamine agonists and experience severe side effects like uncontrollable nausea, extreme dizziness, or mood changes, contact your healthcare provider. Dose adjustments or medication changes often resolve these issues without discontinuing treatment.
Difficulty conceiving after six months of trying with treated prolactin levels should prompt fertility evaluation. While normalizing prolactin restores ovulation in many cases, some women need additional fertility treatments to address PCOS-related ovulatory dysfunction.
Comprehensive PCOS Management
Addressing high prolactin represents one piece of comprehensive PCOS management. Other aspects include managing insulin resistance, reducing androgen levels, supporting ovulation when desired, and addressing symptoms like acne and excess hair growth.
Many women benefit from supplements that support hormone balance. Research best supplements for PCOS and discuss options like inositol, NAC, or vitamin D with your healthcare provider. Some supplements like DIM supplement for PCOS support estrogen metabolism and may complement prolactin management.
A personalized meal planning service that prioritizes well being by helping you eat better, feel better, and effectively manage PCOS symptoms in a friendly, trustworthy way takes the guesswork out of nutrition. Consistent, balanced eating supports all aspects of hormone health including prolactin regulation.
Remember that managing PCOS and high prolactin is possible with the right combination of medical treatment, lifestyle modifications, and support. Stay informed, work closely with your healthcare team, and be patient with the process as hormone balance takes time to restore.
Research Methodology and Scientific Sources
This article draws from peer-reviewed medical research and authoritative health organizations specializing in endocrine disorders. Information about prolactin and its relationship to PCOS comes from clinical studies published in reproductive endocrinology journals.
The National Institute of Child Health and Human Development provides comprehensive information about pituitary disorders including hyperprolactinemia. Their resources inform our discussion of prolactin testing, normal ranges, and treatment approaches.
Guidelines on PCOS diagnosis and management come from the American College of Obstetricians and Gynecologists and international consensus statements on PCOS. These evidence-based guidelines shape our recommendations for when to test prolactin in women with PCOS.
Information about dopamine agonist medications and their efficacy comes from clinical trials and prescribing information reviewed by the Food and Drug Administration. We prioritize treatments with established safety profiles and proven effectiveness.
Data on the prevalence of elevated prolactin in PCOS populations derives from epidemiological studies and systematic reviews. The National Institute of Diabetes and Digestive and Kidney Diseases offers resources on hormonal disorders affecting metabolism and reproduction that inform our content.
We update this article regularly as new research emerges to ensure recommendations reflect current medical understanding and best practices in treating women with both PCOS and elevated prolactin.
Frequently Asked Questions
What is the normal prolactin level for PCOS patients?
Normal prolactin levels for women with PCOS are the same as for women without PCOS, typically ranging from 4 to 25 nanograms per milliliter. However, women with PCOS experience elevated prolactin more frequently than the general population. Levels between 25 and 100 ng/mL indicate mild elevation that may require treatment depending on symptoms and fertility goals. Levels above 100 ng/mL are significantly elevated and warrant investigation for prolactinomas or other underlying causes. Your doctor should test prolactin as part of comprehensive PCOS evaluation, especially if you have irregular periods, difficulty conceiving, or any breast discharge. Remember that prolactin fluctuates throughout the day and testing should occur in the morning for accurate baseline readings. More information about testing and ranges can be found in resources about prolactin levels PCOS.
Can high prolactin cause PCOS or make it worse?
High prolactin does not cause PCOS, but the two conditions can coexist and worsen each other's symptoms. PCOS results from insulin resistance, hormonal imbalances, and genetic factors unrelated to prolactin. However, when prolactin levels rise in women who already have PCOS, it compounds ovulatory dysfunction and makes fertility challenges more severe. Elevated prolactin suppresses the hormones needed for ovulation, adding to the ovulatory problems already present with PCOS. This creates a situation where irregular periods become more pronounced and conception becomes more difficult. The relationship between these conditions is complex because both affect the hypothalamic-pituitary-ovarian axis that regulates reproductive hormones. Treating elevated prolactin in women with PCOS often improves symptoms significantly, restoring more regular cycles and better fertility outcomes. Understanding this connection helps explain why comprehensive hormone testing matters for accurate diagnosis and effective treatment planning.
How long does it take for prolactin levels to normalize with treatment?
Most women see prolactin levels decrease within two to four weeks of starting dopamine agonist medication like cabergoline or bromocriptine. Levels typically normalize completely within two to three months of consistent treatment. However, the timeline varies based on how elevated prolactin was initially and the underlying cause. Women with prolactinomas may need longer treatment periods, sometimes six months or more, especially if tumors are larger. Menstrual cycles often resume before prolactin levels completely normalize, usually within one to three months of starting medication. Ovulation may return even sooner, which is important to know if pregnancy is not desired. Your doctor will monitor levels every few months during initial treatment to ensure medication effectiveness and adjust doses if needed. If prolactin does not decrease appropriately, further investigation into underlying causes may be necessary. Natural approaches like stress management and vitamin B6 supplementation may help mildly elevated levels but typically take longer to show effects, usually several months of consistent lifestyle modifications.
Should I take dopamine agonists if I have PCOS and slightly high prolactin?
Whether you need dopamine agonist medication depends on how high your prolactin levels are and what symptoms you experience. Mildly elevated prolactin between 25 and 40 ng/mL without significant symptoms may not require medication, especially if you are not trying to conceive. Your doctor might recommend lifestyle modifications, stress management, and monitoring instead. However, if you have moderate elevation above 40 ng/mL, experience galactorrhea, have fertility goals, or suffer from irregular periods significantly affecting quality of life, medication makes sense. Dopamine agonists effectively restore ovulation and normalize cycles in most women, improving both PCOS symptoms and prolactin-related issues simultaneously. These medications have good safety profiles when properly monitored, though side effects like nausea and dizziness can occur initially. The decision should involve discussion with your healthcare provider about your specific situation, symptoms, and goals. Some women prefer trying natural approaches first for borderline elevations, while others benefit immediately from medical treatment. If you are trying to conceive, treating elevated prolactin significantly improves your chances regardless of how mild the elevation appears.
Can stress from having PCOS cause high prolactin levels?
Yes, chronic stress associated with managing PCOS can contribute to elevated prolactin levels. Stress triggers cortisol release, which can stimulate prolactin production through complex hormonal pathways. Women with PCOS often experience higher stress levels due to symptom management challenges, body image concerns, fertility worries, and metabolic issues. This creates a cycle where PCOS-related stress elevates prolactin, which then worsens PCOS symptoms like irregular cycles and fertility problems. However, stress alone typically causes only mild prolactin elevation, not the significant increases seen with prolactinomas or medication side effects. If your prolactin is only slightly elevated and no other cause is identified, stress management becomes particularly important. Techniques like meditation, adequate sleep, regular moderate exercise, and therapy can help lower stress hormones and may reduce prolactin levels over time. That said, do not assume stress is the only cause without proper medical evaluation. Other factors like thyroid problems, medications, or pituitary tumors need to be ruled out. Addressing stress helps overall hormone balance but should complement rather than replace appropriate medical treatment when prolactin elevation is significant.
Community Comments
Add a comment for High Prolactin and PCOS
Get Your 7-Day Customized PCOS Meal Plan
Finally know exactly what to eat to stabilize blood sugar, reduce symptoms, and support weight loss—customized for your preferences and goals.
Breakfast, lunch, dinner & snacks
Organized by store section
Protein, carbs, fat & calories
✓ Instant confirmation • ✓ Delivered in 2-3 days • ✓ Money-back guarantee
See Also
What should your calorie intake be if you want to lose weight with PCOS?
Decoding PCOS: Early Signs in Children and Long-Term Health Implications
Deciphering PCOS: How Genetic Clusters Influence Disease Pathways and Outcomes
Mastering PCOS Management Through Diet: Your Ultimate Nutrition Guide
The Link Between PCOS and Mental Health: Strategies for Support
Understanding the Evolution of Menstrual Fatigue: Age-Related Changes
Exercise and PCOS: Finding the Right Balance for Hormonal Health
PCOS and Fertility: Navigating Your Path to Parenthood
Effective Supplements for PCOS Management: An Evidence-Based Guide