When your breasts leak milk but you’re not pregnant or nursing, it’s not normal-and it’s not just a weird quirk. This condition, called galactorrhea, affects about 1 in 5 women at some point in their lives. It’s not cancer. It’s not a sign you’re about to breastfeed. It’s your body sending a signal: something’s off with your hormones. And more often than not, that something is too much prolactin.
Prolactin is the hormone that tells your body to make milk. It’s supposed to rise during pregnancy and after birth. But when it stays high when it shouldn’t, trouble follows. You might notice milk leaking from one or both nipples. You might stop getting your period. Or you might try for years to get pregnant-and nothing happens. These aren’t separate problems. They’re all connected. And the fix often starts with a simple blood test.
What Galactorrhea Really Means
Galactorrhea isn’t a disease. It’s a symptom. And like a fever, it’s pointing to something deeper. The discharge is usually milky, not bloody or clear. It often comes out on its own, without squeezing. Most cases are bilateral-both breasts-but about 1 in 4 people have it on just one side. That doesn’t mean cancer. But it does mean you need to check.
Normal prolactin levels in non-pregnant women range from 2.8 to 29.2 ng/mL. Anything above 25 ng/mL is considered high. Levels over 100 ng/mL almost always mean a pituitary tumor-usually a tiny, noncancerous one called a prolactinoma. These tumors push out extra prolactin like a faucet left on. But here’s the catch: not everyone with high prolactin has a tumor. In fact, about 35% of cases have no clear cause. That’s called idiopathic hyperprolactinemia.
Stress, sleep, even how your blood is drawn can spike prolactin temporarily. That’s why doctors always repeat the test. If you get your blood drawn right after a workout, a stressful phone call, or even a breast exam, your prolactin can jump 10-20 ng/mL. That’s not disease. That’s noise. Real diagnosis needs calm, clean testing.
How High Prolactin Kills Fertility
If you’re not getting your period and you’re leaking milk, the link is direct. High prolactin shuts down your reproductive system. It blocks the signals from your brain that tell your ovaries to release an egg. No ovulation. No period. No pregnancy.
Studies show that 80-90% of women with hyperprolactinemia and missed periods will start ovulating again once prolactin levels drop. That’s not a guess. That’s what happens when you treat the root cause. One woman on Reddit shared: “My period vanished for 18 months. After three months on cabergoline, it came back. Four months later, I got pregnant.” That’s not rare. It’s routine.
Men aren’t immune. High prolactin can lower testosterone. That means low sex drive, erectile dysfunction, and sometimes reduced sperm count. It’s less talked about, but just as real. And just as treatable.
The big takeaway? If you’re struggling to get pregnant and you have any kind of nipple discharge-even if it’s just a drop when you squeeze-get your prolactin checked. Don’t wait. Don’t assume it’s stress. Don’t blame yourself. This is a hormone glitch. And it’s fixable.
What Causes High Prolactin?
It’s not just tumors. In fact, tumors are only part of the story. Here’s what else can do it:
- Medications: Antidepressants like SSRIs (sertraline, fluoxetine), antipsychotics (risperidone, haloperidol), and even some stomach drugs (metoclopramide, domperidone) can raise prolactin. Switching to bupropion (Wellbutrin) often fixes it without losing mental health control.
- Thyroid problems: Underactive thyroid (hypothyroidism) triggers the pituitary to overproduce prolactin. Simple blood test for TSH fixes this one fast.
- Chronic kidney disease: Your kidneys clear prolactin. If they’re not working well, it builds up.
- Physical irritation: Frequent breast stimulation-tight bras, vigorous exercise, chest wall injury-can trigger prolactin release.
- Pituitary tumors: Microadenomas (under 10 mm) are common. Macroadenomas (over 10 mm) are rarer but need more attention.
Doctors start by asking: Are you on any new meds? Any thyroid symptoms? Any chest trauma? That’s often enough to find the cause. If not, they order an MRI.
Treatment: Dopamine Agonists Are the Gold Standard
The go-to treatment? Dopamine agonists. These drugs trick your brain into thinking prolactin is already high-so it stops making more. Two drugs dominate: cabergoline and bromocriptine.
Cabergoline (Dostinex) is now the first choice. Why? You take it twice a week. Dose: 0.25-1 mg. Side effects? Nausea in only 10-15% of people. And 83% of patients normalize their prolactin within three months. It also shrinks tumors. In 90% of small prolactinomas, the tumor disappears or shrinks so much it’s undetectable within six months.
Bromocriptine (Parlodel) works too-but you have to take it daily. And nausea hits 25-30% of users. Some people can’t tolerate it. One patient wrote: “I took it at bedtime and still threw up twice a week for a month.” That’s why cabergoline took over 65% of the U.S. market by late 2024.
Cost is a factor. Cabergoline runs $300-$400 a month. Bromocriptine is $50-$100. But most insurance covers it. And the payoff? Fertility returns. Discharge stops. Quality of life improves.
There’s a new option on the horizon. In January 2025, the FDA approved Cabergoline ER, an extended-release version you take just once a week. Early trials show 89% effectiveness-slightly better than the standard version. It’s not everywhere yet, but it’s coming.
When Treatment Doesn’t Work
Most cases respond. But not all. Here’s when you need more:
- If prolactin stays high after 6 months of dopamine agonists, your doctor will check for drug resistance or a larger tumor.
- If you have a macroadenoma (over 10 mm) and it’s pressing on your optic nerves, surgery may be needed.
- If the discharge is bloody, one-sided, or comes from a single duct-get a mammogram or ultrasound. That’s not galactorrhea. That’s a red flag for cancer.
And here’s something critical: if your prolactin is slightly high but you have no symptoms-no discharge, no missed periods-you might not need treatment at all. About 15-20% of women with mildly elevated levels never develop symptoms. Treating them just for a number can cause side effects for no benefit. Doctors are getting better at watching, not rushing.
What You Can Do Now
If you’re experiencing any of this, here’s your action plan:
- Stop squeezing or stimulating your breasts. It can make it worse.
- Review all your meds-prescription, over-the-counter, supplements-with your doctor. Even herbal ones like fenugreek can trigger it.
- Ask for a prolactin blood test. Do it in the morning, before eating, after 10 minutes of rest. No exercise or stress beforehand.
- Get your thyroid checked (TSH). It’s cheap, fast, and often the missing piece.
- If prolactin is above 25 ng/mL, ask about an MRI. Especially if you’re not getting your period or having trouble conceiving.
- If diagnosed, ask about cabergoline. It’s the most effective, least disruptive option.
Don’t ignore it. Don’t feel embarrassed. This is a common, treatable hormone issue. Thousands of women and men get diagnosed every year-and go on to live normal, fertile lives.
What’s Next for Prolactin Treatment?
The field is evolving. Novartis is testing a new drug-a selective prolactin receptor blocker-that stops prolactin from acting on breast tissue, without touching the brain. It could be a game-changer for people who can’t tolerate dopamine agonists. Phase 2 trials end in late 2026.
Meanwhile, clinics are starting to combine endocrinology and breast imaging under one roof. Mayo Clinic’s integrated clinics cut diagnosis time from over two months to just three and a half weeks. That’s huge for people anxious about discharge or infertility.
And in the future? Genetic testing might tell you whether you’re more likely to respond to cabergoline or bromocriptine based on your dopamine receptor type. Personalized treatment is coming. But for now, the basics still work: test, treat, track.
Galactorrhea isn’t scary. It’s a clue. And with the right steps, it leads to answers-and recovery.
