Prolactinomas are a frequent cause of gonadal dysfunction and infertility, especially in women. Dopamine agonists are first-line therapy and their efficacy in the treatment of prolactinomas is well established. Current challenges related to the management of prolactinomas remain in the recurrence of the disease after withdrawal of dopamine agonists, the potential of increased risk of cardiac valvulopathy, which is observed in patients treated with high-dose cabergoline for Parkinson's disease, the effects of pregnancy, and impaired quality of life associated with pituitary adenomas in general, and prolactinomas in particular. Although most prolactinomas are biochemically well controlled by pharmaceutical treatment, long-term follow-up is required.