Prolactinoma management
Ongoing care for a prolactinoma, a usually benign pituitary growth that raises the hormone prolactin, most often treated with tablets that lower prolactin and shrink the growth.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Prolactinomas are almost always benign, and most are controlled with tablets rather than surgery.
- Cabergoline and similar tablets usually lower prolactin and shrink the growth, but they control rather than always cure it, and treatment often continues for years.
- These tablets can rarely trigger impulse-control problems, such as gambling or compulsive behaviours, which should be discussed and watched for.
- Monitoring with blood tests, scans and, where needed, eye checks is an essential part of safe management.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Lowers prolactin in most people, often within weeks
A raised prolactin is not always a prolactinoma; medicines, an underactive thyroid, pregnancy and other causes must be excluded first.
After starting tablets, side effects such as nausea or dizziness may appear and often settle as the dose is built up slowly. Prolactin is usually...
A clear plan for how and when to take tablets, with advice on managing early side effects
After starting tablets, side effects such as nausea or dizziness may appear and often settle as the dose is built...
Prolactin commonly normalises, symptoms such as periods and sex drive can improve, and a follow-up MRI checks...
The dose is adjusted to the lowest that controls prolactin. Scans and, where relevant, eye checks confirm the...
Monitoring continues over years. In some people with good control, a carefully supervised trial of reducing or...
What is prolactinoma management?
A prolactinoma is a growth in the pituitary gland that makes too much of the hormone prolactin. It is almost always benign (not cancer). High prolactin can stop or disrupt periods, reduce fertility, cause milk leakage from the breasts, lower sex drive and testosterone in men, and, if the growth is large, press on nearby structures including the nerves to the eyes.
Management is usually ongoing care led by an endocrinologist. The mainstay is tablets called dopamine agonists, most commonly cabergoline, which lower prolactin and, in most people, shrink the growth. Monitoring with blood tests and scans tracks the response, and an eye check is used if the growth is near the nerves to the eyes.
The aim is to control prolactin, shrink or stabilise the growth, restore affected functions such as periods and fertility, and protect vision and bone health. Treatment often continues for years, and surgery or radiotherapy is reserved for specific situations rather than used first.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
How prolactinomas are usually managed
| Approach | When it is typically used |
|---|---|
| Dopamine agonist tablets (e.g. cabergoline) | First choice for most prolactinomas, large or small |
| Surgery (trans-sphenoidal) | If tablets fail or are not tolerated, or in specific situations |
| Radiotherapy | Selected cases not controlled by tablets or surgery |
| Monitoring only | Some very small growths with stable, mildly raised prolactin |
Unlike most pituitary growths, prolactinomas are usually treated with tablets first rather than surgery.
Preparing for your treatment
- Bring a full list of your medicines and supplements, as some medicines themselves raise prolactin.
- Tell your endocrinologist about any history of mood problems, gambling, compulsive shopping, eating or sexual behaviour, as the tablets can rarely worsen impulse control.
- Mention if you are planning pregnancy now or in future, as this affects the choice and timing of treatment.
- Note symptoms such as headaches, vision changes, milk leakage, irregular or absent periods, or reduced sex drive.
- Ask whether your tablets should be taken with food to reduce nausea and dizziness.
- Bring previous prolactin results and any scans so changes over time can be tracked.
- Tell the team about heart valve problems or significant heart disease, which can affect monitoring.
What happens
After the diagnosis is confirmed with blood tests and an MRI, an endocrinologist usually starts a dopamine agonist tablet, most often cabergoline, at a low dose that is increased gradually. Taking it with food and building the dose up slowly helps reduce side effects such as nausea and dizziness.
Prolactin is rechecked after starting treatment and often falls within a few weeks. A follow-up MRI checks whether the growth is shrinking, and an eye (visual field) test is repeated if the growth is near the nerves to the eyes.
Over time, the dose may be adjusted to the lowest that keeps prolactin controlled. If tablets do not work, cannot be tolerated, or in specific situations such as a growth that does not respond, surgery (usually through the back of the nose) or, occasionally, radiotherapy may be considered. Treatment and monitoring usually continue for years.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- A raised prolactin is not always a prolactinoma; medicines, an underactive thyroid, pregnancy and other causes must be excluded first.
- These tablets may need caution or avoidance in people with significant mental health conditions or a history of impulse-control problems.
- Long-term high-dose treatment may not suit people with certain heart valve problems without careful monitoring.
- Stopping treatment abruptly or self-managing the dose risks prolactin and the growth returning.
Delay or rearrange if…
- Other causes of high prolactin, such as a medicine or thyroid problem, have not been excluded.
- You are or could be pregnant, when treatment decisions need specific review.
- You have active, unstable mental health problems that need addressing alongside or before treatment.
- Urgent symptoms such as sudden severe headache or vision change are present, which need emergency assessment first.
- Baseline scans, prolactin levels or eye checks needed to guide treatment are missing.
Alternatives to discuss
- Monitoring only for some very small growths with stable, mildly raised prolactin
- Switching to a different dopamine agonist if the first is not tolerated
- Surgery (trans-sphenoidal) if tablets fail or cannot be tolerated, or in specific situations
- Radiotherapy in selected cases not controlled by tablets or surgery
- Treating an underlying cause, such as stopping a prolactin-raising medicine, where appropriate
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Lowers prolactin in most people, often within weeks
- Shrinks or stabilises the growth in the majority treated with tablets
- Can restore periods, fertility and sex drive affected by high prolactin
- Can relieve pressure on the nerves to the eyes and protect vision when the growth is large
- Avoids surgery for most people, as tablets are usually tried first
- Helps protect bone health by correcting long-standing hormone disruption
Risks & complications
- Nausea, dizziness on standing and headaches, especially when starting or increasing the dose
- Tiredness, constipation or tummy discomfort
- Symptoms returning if the tablets are stopped, as the growth may produce prolactin again
- Needing regular blood tests and scans for monitoring
- Low mood or mood changes
- Impulse-control problems, such as gambling, compulsive shopping, eating or hypersexuality
- Nasal stuffiness or, rarely, leakage of fluid from the nose if a large growth shrinks quickly
- Need for surgery if tablets do not control the growth or are not tolerated
- Sudden bleeding into the growth (pituitary apoplexy), causing severe headache and vision change — an emergency
- Concerns about heart valves with long-term high-dose treatment, which is why monitoring may be advised
- Serious complications of surgery, if surgery is needed
The most important points are that the tablets can rarely trigger impulse-control problems (such as gambling or compulsive behaviours), which you and those close to you should watch for, and that stopping treatment without advice can let prolactin and the growth return. Large growths can occasionally bleed or affect vision. Ask about side effects, what monitoring you need (including any heart-valve checks on long-term high doses), and what to do in an emergency.
Published figures to discuss
Outcomes vary between individuals and depend on the size of the growth, the dose used and how it is tolerated. Reported figures from specialist series give a sense of typical response but are not guarantees, and rare serious events such as bleeding into the growth or heart-valve concerns are not well captured by a single percentage. The ranges below are drawn cautiously from published reviews and should be discussed with your endocrinologist in the context of your own situation.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Prolactin returns to normal on dopamine agonist tablets | Commonly reported in roughly four out of five people (up to around 80-85%) in specialist series | Response varies with the individual and the dose; some growths respond less well and need a change of approach. | Society for Endocrinology — Pituitary Society consensus guideline on prolactinoma (2024)endocrinology.orgPublished figure |
| The growth shrinks with tablet treatment | Reported in roughly two-thirds to four-fifths of people (around 67-80%) across studies | Shrinkage is more likely when prolactin is well controlled, but is not certain in every case. | Society for Endocrinology — Pituitary Society consensus guideline on prolactinoma (2024)endocrinology.orgPublished figure |
| Medicine side effects | Common early nausea, dizziness or headache; rarer impulse-control or mood effects | Patients should be warned about gambling, compulsive shopping, hypersexuality or marked mood change on dopamine agonists. | Guide sourcesClinical context |
| Pregnancy and tumour growth planning | Depends on micro- versus macroprolactinoma | Pregnancy plans should be agreed with endocrinology, particularly if the tumour is near the optic chiasm. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no procedure to recover from with tablet treatment. What matters is how quickly prolactin responds, how side effects are managed, and how your care continues over time.
- Early, often temporary, nausea, dizziness or headache when starting or increasing tablets
- Prolactin falling over weeks rather than immediately
- Periods and other functions taking some months to return
- Ongoing need for blood tests and scans as part of normal care
Aftercare
- Take your tablets exactly as prescribed, usually with food, and do not stop them without advice.
- Watch for, and report, any new gambling, compulsive shopping, eating or sexual behaviours, and tell those close to you to do the same.
- Attend blood tests and scans so prolactin and the growth can be monitored.
- Report new or worsening headaches or any vision change promptly.
- Tell your endocrinologist before trying to conceive, as treatment may need adjusting.
- Report low mood or significant side effects rather than simply stopping treatment.
- Keep any recommended heart-valve checks if you are on long-term higher doses.
- List of all medicines and supplements written down
- Note of any history of mood or impulse-control problems
- Pregnancy plans discussed with your endocrinologist
- Symptoms noted, including headaches, vision and hormone-related changes
- Previous prolactin results and scans gathered
- Emergency advice understood for sudden severe headache or vision change
⚠ Get urgent help if…
- Sudden, severe headache, especially with vision changes, double vision, nausea or collapse — this can be bleeding into the growth and is an emergency
- New or rapidly worsening loss of vision or side vision
- Double vision or a drooping eyelid
- A clear, watery discharge from the nose, particularly after a large growth shrinks
- New gambling, compulsive spending, eating or sexual behaviour while on treatment
- Severe or worsening low mood or thoughts of harming yourself — seek help promptly
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
Good management usually means prolactin is brought back into the normal range, the growth shrinks or stays stable, and symptoms such as irregular periods, reduced fertility, milk leakage or low sex drive improve. Where the growth was pressing on the nerves to the eyes, vision often improves as it shrinks.
Tablets control rather than always cure a prolactinoma, and prolactin and the growth can return if treatment stops, so monitoring continues. In some people with long-standing good control, a supervised attempt to reduce or stop treatment can be tried, but this needs close follow-up. No treatment can guarantee a particular outcome, and the plan is tailored to your response.
Prolactinoma treatment is usually long-term, often over many years. Tablets generally work while they are taken, and prolactin can rise again if they are stopped, so any attempt to reduce or stop treatment is done cautiously and with monitoring. Some small growths remain stable for a long time, and needs can change around pregnancy and the menopause.
Related tests, treatments or support
Prolactinoma care is coordinated with checks of the rest of the pituitary gland, because a large growth can affect other hormones. It overlaps with eye monitoring when the growth is near the nerves to the eyes, and with bone-health assessment if hormones have been disrupted for a long time. Where pregnancy is planned, fertility and obstetric care are coordinated with the endocrine plan.
Follow-up & long-term care
Follow-up is usually led by an endocrinologist, with repeat prolactin blood tests, MRI scans, and visual field checks where relevant. The dose is adjusted to the lowest effective level, and a supervised trial off treatment may be considered after a long period of good control. Surgery or radiotherapy involves additional specialist follow-up. Care continues over years, with reviews around pregnancy and other life stages.
- Regular prolactin blood tests to confirm ongoing control
- Periodic MRI scans to monitor the growth
- Visual field checks if the growth is near the nerves to the eyes
- Monitoring for impulse-control and mood side effects at each review
- Heart-valve assessment where advised for long-term higher-dose treatment
- Bone-health review if hormones were disrupted for a long time
Repeat, follow-on and what comes next
- The dose is commonly adjusted over time to the lowest that keeps prolactin controlled.
- Some people are switched to a different tablet for side effects or poor response.
- A minority need surgery or, rarely, radiotherapy if tablets do not control the growth.
- Prolactin and the growth can return after stopping treatment, so any trial off treatment is supervised.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear plan for how and when to take tablets, with advice on managing early side effects
- Explicit warning about impulse-control and mood changes, with a route to report them
- Scheduled prolactin tests, scans and, where relevant, eye and heart-valve monitoring
- A named contact and clear emergency advice about sudden headache or vision change
- Coordinated care around pregnancy and any move towards reducing or stopping treatment
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The number and length of endocrinology appointments over time
- Which medicine is used and the cost of long-term prescriptions
- How often prolactin blood tests are done
- How often MRI scans are needed, including the reporting radiologist's fee
- Whether visual field or eye assessments are required
- Whether surgery or radiotherapy becomes necessary, which adds substantial separate costs
- Any heart-valve monitoring on long-term higher-dose treatment
- The endocrinologist consultation and follow-up fees
- Which medicine is included and how prescriptions are provided
- Prolactin blood tests and how often they are charged
- MRI scans, contrast if used, and the reporting radiologist's fee
- Any eye, visual field or heart-valve monitoring
- What surgery or radiotherapy would cost if it became necessary
- A written plan you and your GP can keep, including emergency advice
On the NHS? Prolactinomas are managed on the NHS by endocrinology services when diagnosed; private care is mainly used for speed, choice or a second opinion.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not explaining the small but important risk of impulse-control problems such as gambling
- Assuming all raised prolactin is a prolactinoma without excluding other causes
- Not discussing that treatment often continues for years and that stopping can let it return
- Overlooking heart-valve monitoring on long-term higher doses
- Not giving clear emergency advice about sudden severe headache or vision change
Marketing red flags
- Promising a permanent cure from a short course of tablets
- Recommending surgery first when tablets are usually the appropriate first treatment
- Downplaying impulse-control or mood side effects
- Offering treatment without proper monitoring with blood tests, scans or eye checks
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Is my prolactinoma small or large, and is it near the nerves to my eyes?
- Which tablet do you recommend, and how should I take it to limit side effects?
- What impulse-control or mood changes should I watch for, and who should I tell?
- How often will I need blood tests, scans and eye checks?
- How should treatment change if I want to try for a baby?
- Might I be able to reduce or stop treatment in future, and how would that be monitored?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Do I need surgery for a prolactinoma?
How quickly do the tablets work?
Will I need to take tablets forever?
What are the most important side effects to know about?
Can I get pregnant with a prolactinoma?
Is a prolactinoma cancer?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Pituitary Foundation — Prolactinoma treatment Pituitary Foundation — Prolactinoma diagnosis Society for Endocrinology — You and Your Hormones: prolactinoma Society for Endocrinology — Pituitary Society consensus guideline on prolactinoma (2024) Treatment of Prolactinoma — review, PMC Prolactinoma Management — Endotext, NCBI Bookshelf MHRA Drug Safety Update — dopamine agonists: risk of impulse-control disorders (gambling, hypersexuality) BNF (NICE) — Cabergoline
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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