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Bromocriptine Treatment for High Prolactin Levels and Induction of Ovulation with Infertility

What is prolactin?

  • Prolactin is a hormone made in the pituitary gland at the base of the brain
  • The only known function of prolactin in humans is stimulation of breast milk production
  • Prolactin is also present in men, but there is no known function

Why would prolactin levels be elevated?

There are several causes for high prolactin levels (called hyperprolactinemia), including:

  • Prolactin producing tumors in the pituitary gland - these are called prolactinomas
  • Use of certain medications including tranquilizers such as Haldol, some antidepressants, Reglan (used for reflux) and some drugs used to treat hypertension
  • Hypothyroidism
  • Pituitary tumors other than prolactinomas or tumors in the area around the pituitary
  • Stimulation of the breast, or orgasm shortly before the blood is drawn for the test

Symptoms and problems caused by high prolactin levels in women

  • High prolactin will decrease FSH (follicle stimulating hormone) levels. This leads to irregular ovulation and irregular menstrual periods, or no periods at all - amenorrhea.
  • Galactorrhea - spontaneous milky nipple discharge (outside of nursing)
  • Fertility problems
  • A substantial pituitary tumor can cause headaches, and pressure on the optic nerve can cause visual problems

Symptoms and problems caused by elevated prolactin in men

  • Low testosterone (male hormone)
  • Low sperm count
  • Reduced interest in sex, impotence
  • Headaches and visual problems, as in women

Treatment for anovulation caused by elevated prolactin levels

There are many causes of anovulation, lack of regular ovulation. Ovulation problems caused by hyperprolactinemia is an uncommon cause of ovulation problems.

High prolactin can cause reduced FSH levels which then results in ovulation problems. The ovulation and fertility problems are treated with drugs to reduce prolactin levels back to normal so that regular ovulation will resume.

Treatment and Success

The first line of treatment for hyperprolactinemia and prolactinomas is medication. In rare cases the tumor is so large that surgery may be first-line treatment. There are two oral medications used to treat high prolactin levels:

  • Bromocriptine (Parlodel)
  • Cabergoline (Dostinex)

With mild to moderate elevations in prolactin, bromocriptine is effective in reducing the level to the normal range in most cases. This usually allows normal, regular ovulation to occur monthly. Women with very high levels of prolactin are less likely to respond well to bromocriptine.

Bromocriptine is better tolerated when started at a low dose and gradually increased over time. Side effects of this medication are related to nausea, dizziness, etc. These side effects decrease over time.

A common way to start Parlodel is:

  • 1.25 mg taken with a snack at bedtime. This dose is equal to half of a 2.5 mg tablet.
  • After 3 days the dose can be increased to 2.5 mg per day (1.25 mg with breakfast and 1.25 mg with a bedtime snack).
  • Prolactin levels should be monitored and the drug dose can be increased, if needed
  • Eventually, the prolactinoma should decrease in size and prolactin levels should go down to normal.

Bromocriptine can also be taken vaginally, which helps with the nausea problem.

Prolactin levels can be normalized with medications alone (bromocriptine or cabergoline) in about 80% of patients.

Recommended tumor testing for women with high prolactin levels

Women with unexplained elevations of prolactin over about 50-100 (normal prolactin is below about 20-30, depending on the lab) should have CT or MRI scans of the area of the pituitary gland and sella turcica at the base of the brain.

  • Usually, MRI scans are done to get the best images - without radiation
  • Imaging is done to look for any tumor, and to measure anything that is found
  • Future scans can then be done to look for significant tumor growth or shrinkage
  • Larger tumors (such as greater than 1 cm. in size) might eventually require surgery if there is not enough response to medication

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I am so grateful for Advanced Fertility Center. I just had my son Leland. I want to thank Dr. Catenacci and all of the nurses that helped us. Especially Ashley in the Crystal Lake office. You made this process easier by being supportive and positive. Thank you very much!


Dr. Sherban and his staff are the most amazing, compassionate, and supportive people. After almost 5 years of trying to conceive, going through numerous tests and meeting with another clinic closer to home, who told me my chances even with IVF were still very low, a good friend recommended advanced fertility center of Chicago. Best decision we ever made! We now have 2 amazing children who are now 5 and 3 years old! I cannot stress enough how amazing this staff is, they make you feel like family!


Our experience was amazing with Dr. Cantanucci and all of the nurses (especially Ashley). After ttc for 4 years and at 41 years of age, we became pregnant after 1 round of IVF, and had our beautiful boy this past October. Can't thank them enough!


2/7/15 our son was born all thanks to the assistance of Dr. Sherbahn and his staff. Everyone was so helpful and here for all our questions, worries, etc. They want this for you just as much as you want this for you! Handled with pure professionalism and care from the very start! Thank you advanced fertility!