Can High Prolactin Levels Be Stopping You from Getting Pregnant
Patient: “Dr Malpani, my gynaecologist, said I’m not ovulating because my prolactin levels are high. She prescribed bromocriptine. Can this really help me get pregnant?”
Dr. Malpani: “Yes, it can — provided it’s used for the right reason. Bromocriptine is a very effective drug for women with hyperprolactinemia, a condition where the pituitary gland produces too much of the hormone prolactin. High prolactin levels interfere with ovulation, which is why many women with this problem have irregular cycles or don’t ovulate at all. About 1 in 10 women with anovulation have this issue — and for them, bromocriptine can be life-changing.”
How Bromocriptine Works
When prolactin levels rise above the normal range (usually less than 20 ng/ml), the ovaries receive the wrong hormonal signals and stop functioning normally. Bromocriptine lowers prolactin back to the normal range, allowing the ovaries to resume regular ovulation.
Once ovulation restarts, periods become more regular, and the chances of natural conception improve significantly.
When Bromocriptine Helps — and When It Doesn’t
It’s important to note that bromocriptine should only be used in women with significantly elevated prolactin levels. Sometimes, doctors misuse it for women with borderline or slightly high prolactin — this is not helpful and only exposes patients to unnecessary side effects.
That’s why the first step is always a proper diagnosis:
- Blood prolactin test (ideally repeated to rule out lab error or stress-related rise).
- Rule out other causes such as thyroid dysfunction.
- An MRI of the pituitary, if prolactin levels are very high, to check for a microadenoma.
Side Effects and How to Minimise Them
Bromocriptine is generally safe, but in the first few days, some women may experience:
- Nausea
- Dizziness
- Headache
These can usually be minimised by:
- Starting with a low dose and gradually increasing it.
- Taking the tablet with meals.
- Taking it at bedtime with dinner, so you sleep through the side effects.
If the side effects are still difficult, there is an excellent alternative: cabergoline, which is easier to tolerate and only needs to be taken once or twice a week.
Correct Dose and Monitoring
- The standard tablet is 2.5 mg.
- Starting dose: 2.5–5 mg daily at bedtime.
- Prolactin levels should be retested after at least a week.
- If levels remain high, the dose is gradually increased — some women may need up to 4–6 tablets daily.
- Once prolactin levels normalise, that becomes your maintenance dose.
Remember: Bromocriptine controls high prolactin; it does not cure the condition. You need to continue taking it daily until you conceive. Once you’re pregnant, the drug should be stopped.
Cost and Access
Bromocriptine is not cheap, and the cost can add up over months. However, some pharmaceutical companies offer patient-support programmes with reduced rates if your doctor applies on your behalf. Don’t hesitate to ask about this.
Takeaway
Bromocriptine can restore fertility for women with hyperprolactinemia by lowering prolactin levels and restarting ovulation. But like all fertility treatments, it works only if used correctly, for the right diagnosis, and under proper monitoring.