Can I Get Pregnant With a Prolactinoma? Is Medication Safe?

Yes, you can absolutely get pregnant if you have a prolactinoma. While a prolactinoma can cause temporary infertility, treatment with dopamine agonist medications (like cabergoline or bromocriptine) is highly effective at restoring your fertility. Furthermore, these medications are generally safe to take while trying to conceive, and most women with prolactinomas go on to have healthy, normal pregnancies.

How a Prolactinoma Affects Fertility

Prolactin is the hormone naturally responsible for breast milk production. When a prolactinoma (a benign tumor of the pituitary gland) produces too much prolactin, it signals to your brain that your body is already pregnant or nursing ^[1].

High prolactin levels suppress the release of gonadotropin-releasing hormone from the hypothalamus, which in turn drops the levels of LH (luteinizing hormone) and FSH (follicle-stimulating hormone) ^[2]. Without normal levels of LH and FSH, your ovaries stop releasing eggs (ovulation). This leads to irregular periods or no periods at all (amenorrhea), and temporary infertility ^[1][3].

Restoring Fertility with Medication

The good news is that infertility caused by a prolactinoma is very treatable. Medications called dopamine agonists—most commonly cabergoline or bromocriptine—mimic the natural dopamine in your brain to lower prolactin levels and shrink the tumor ^[4].

Once your prolactin levels drop back into the normal range, your brain resumes its normal hormone signaling, and regular ovulation typically returns ^[5][2]. For many women, fertility is fully restored within a few months of starting medication. If your cycles do not return after several months of normal prolactin levels, your doctor may recommend seeing a fertility specialist to check for other causes.

Are Dopamine Agonists Safe When Trying to Conceive?

Yes. Both bromocriptine and cabergoline have excellent safety profiles when used to achieve pregnancy. Extensive research shows that taking these medications during conception and early pregnancy does not increase the risk of miscarriage, preterm delivery, or birth defects compared to the general population ^[6][7][8].

While both medications are considered safe, your doctor may have a preference depending on your specific situation:

• Bromocriptine has been used for decades and has the longest track record of safety data during pregnancy ^[9][10].
• Cabergoline is often the preferred choice for treating prolactinomas because it works faster and has fewer side effects, and modern studies continue to confirm it is also highly safe during early pregnancy ^[11][7].

What Happens to Medication Once You Are Pregnant?

As soon as you have a positive pregnancy test, you should contact your endocrinologist. The standard of care usually involves stopping your dopamine agonist immediately upon confirming pregnancy ^[11][12].

However, the exact plan depends on the size of your tumor:

If You Have a Microprolactinoma

A microprolactinoma is a tumor smaller than 10 millimeters in diameter. The risk of a microprolactinoma growing enough to cause symptoms during pregnancy is very low ^[13]. If you have a microprolactinoma, you will almost certainly be advised to stop your medication as soon as you are pregnant ^[7]. You likely won’t need routine MRI scans during your pregnancy, though your doctor will monitor you for symptoms like new severe headaches or vision changes ^[7][8].

If You Have a Macroprolactinoma

A macroprolactinoma is a tumor 10 millimeters or larger. During all pregnancies, the pituitary gland naturally swells, which can increase the risk of a larger tumor pressing on the optic nerves (which control vision) ^[13].

Because of this risk, your care team will tailor a plan specific to your tumor:

• If your macroprolactinoma is very large or invasive, your doctor might recommend continuing your dopamine agonist throughout your entire pregnancy to prevent the tumor from growing ^[9][8].
• Your doctor will likely suggest getting a baseline visual field test (an eye exam to check your peripheral vision) before you start trying to conceive, so they have a comparison point.
• If you stop the medication, you will be monitored more closely during your pregnancy, often with repeat visual field tests ^[14][13].
• If the tumor does begin to grow and cause symptoms (like severe headaches or vision changes), your doctor can simply restart the dopamine agonist. Restarting the medication is highly effective at shrinking the tumor safely during pregnancy ^[12][15].

Why Your Doctor Won’t Check Your Prolactin Levels During Pregnancy

Patients with prolactinomas are used to getting their prolactin levels checked frequently. However, during pregnancy, doctors usually stop ordering this blood test. This is because prolactin levels naturally skyrocket in all pregnant women to prepare the body for breastfeeding ^[16][17]. Because the blood test cannot distinguish between normal “pregnancy prolactin” and “tumor prolactin,” checking the levels is not useful and would likely only cause unnecessary anxiety ^[17].

Postpartum Care and Breastfeeding

Many women with prolactinomas wonder if they will be able to breastfeed. The short answer is yes: breastfeeding is generally considered safe and does not increase the risk of your tumor growing or recurring ^[18][19].

However, because dopamine agonists work by directly suppressing prolactin, restarting your medication will severely reduce or stop your breast milk production ^[20][18]. If your tumor was small and stable during pregnancy, your doctor will likely support you staying off your medication so you can breastfeed. If your tumor caused symptoms during pregnancy and you need to restart medication immediately after delivery, you may not be able to breastfeed. This is an important conversation to have with your endocrinologist well before your due date.