Bromocriptine is a dopamine agonist prescribed to treat infertility caused by hyperprolactinemia (excessive prolactin). The drug mimics dopamine, which inhibits prolactin production in the pituitary gland. Bromocriptine normalizes this hormonal imbalance, allowing the reproductive system to function properly. Treatment duration depends on achieving and maintaining a state where conception is possible until pregnancy is confirmed.
Understanding the Role of High Prolactin
Bromocriptine is needed because excessive prolactin (hyperprolactinemia) disrupts the reproductive axis. While prolactin is associated with milk production, abnormally high levels outside of pregnancy suppress fertility. High prolactin concentration interferes with the release of gonadotropin-releasing hormone (GnRH) from the hypothalamus, which initiates the menstrual cycle.
GnRH suppression reduces the pituitary gland’s production of Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). Insufficient LH and FSH prevent ovarian follicles from maturing, stopping ovulation. This causes irregular periods or amenorrhea (complete cessation of the menstrual cycle), preventing pregnancy. Bromocriptine removes this hormonal block, allowing reproductive hormones to resume their natural cascade.
Typical Timeline for Restoring Ovulation
The initial goal of Bromocriptine is to reduce elevated serum prolactin levels back into the normal range. Prolactin levels often normalize within the first few days to a few weeks of starting treatment. However, restoring a regular menstrual cycle and ovulation takes longer than the normalization of the hormone level itself.
Regular, ovulatory menstrual cycles typically resume within four to eight weeks after prolactin levels stabilize. Once consistent ovulation is confirmed, the treatment duration shifts to the time needed to achieve pregnancy. This period is highly variable and depends on individual fertility factors, similar to couples without hyperprolactinemia.
Conception after ovulation is restored can take a few months up to a year, reflecting the average time for healthy couples to conceive. Patients must continue taking the medication consistently during this phase to ensure prolactin levels remain suppressed and ovulation is maintained. Treatment continues until a positive pregnancy test confirms the goal of therapy has been met.
Managing Dosage and Monitoring Progress
Bromocriptine treatment typically begins with a low dose to allow the body to adjust and minimize potential side effects. The standard approach is “start low and go slow,” often beginning with 1.25 milligrams taken once daily. The medication is often taken at bedtime with food to reduce nausea. This initial dose is gradually increased over several days or weeks, based on patient tolerance and the effect on prolactin levels.
Regular monitoring of serum prolactin levels via blood tests ensures the drug reaches the target range. These tests help the prescribing physician determine if the current dosage is sufficient or if an upward adjustment is necessary. The dose is usually increased incrementally until the prolactin level is successfully normalized.
Common side effects, such as nausea, dizziness, or headache, often occur but improve as the body acclimates to the medication. Patients should report persistent or severe side effects to the physician. Dosage adjustments or switching the administration route, such as taking the drug vaginally, may be considered to improve adherence and comfort. Effective management involves finding the lowest tolerated dose that successfully maintains normal prolactin levels.
When to Stop Taking Bromocriptine
For most individuals, Bromocriptine treatment should be stopped immediately upon receiving a positive pregnancy test. The drug is generally discontinued once pregnancy is confirmed because hyperprolactinemia is no longer preventing conception. Discontinuation is recommended to minimize unnecessary fetal exposure to the medication.
An exception applies to individuals who have a pituitary tumor (prolactinoma), especially a larger tumor or macroadenoma. In these cases, the physician may advise continuing Bromocriptine throughout the pregnancy. This prevents the tumor from expanding due to the natural rise in prolactin that occurs during gestation. Studies show that continued use of Bromocriptine during pregnancy does not appear to increase the risk of miscarriage, birth defects, or other adverse outcomes.
Regardless of the underlying reason, the decision to stop or continue Bromocriptine after a positive pregnancy test must be made in consultation with the prescribing physician. Patients must contact the doctor immediately to establish the specific protocol for managing the medication during the remainder of the pregnancy.