Dopamine agonist therapy for hyperprolactinemia

Hyperprolactinemia significantly impairs the normal functioning of the reproductive system in women by its detrimental effects on gonadotropin secretion, ovarian follicular development, oocyte release, and corpus luteum function. Fortunately, hyperprolactinemia and the infertility that frequently accompanies it respond well to treatment with dopamine agonists, which inhibit pituitary prolactin release and thereby restore normal reproductive function. In addition, dopamine agonists usually facilitate the return of regular ovulatory menstrual cyclicity. Bromocriptine and cabergoline, the two dopamine agonists most commonly used for first-line treatment of hyperprolactinemia, have demonstrated efficacy even in the presence of pituitary adenomas. Cabergoline, with its improved tolerability, or other dopamine agonist alternatives may be used in patients who are intolerant of or resistant to bromocriptine. In amenorrheic, hyperprolactinemic women who desire to become pregnant, bromocriptine should be prescribed. However, women who are taking a long-acting dopamine agonist should discontinue the medication 1 month before trying to conceive.