Purpose <p>To evaluate outcomes of prolactinoma management in postmenopausal women, focusing on treatment withdrawal strategies in premenopausal-diagnosed patients and treatment response in postmenopausal-diagnosed patients.</p> Methods <p>This retrospective study analyzed postmenopausal patients with prolactinomas treated at Peking Union Medical College Hospital from 2014 to 2024. Patients were stratified by diagnosis timing (premenopausal vs. postmenopausal), with premenopausal-diagnosed cases further divided by treatment status.</p> Results <p>Among premenopausal-diagnosed patients (<i>n</i> = 53), 35 attempted to discontinue the medication, and 16 of them experienced recurrence, with median time to recurrence of six months (IQR 4.25–9.75). All recurrent cases regained remission upon retreatment. History of unguided withdrawal attempts before menopause were identified in over half (<i>n</i> = 9, 56.25%) of recurrent cases. Subsequent prolactin measurement revealed statistically higher in the recurrence group than in the remission group in last follow-up before withdrawal, 1–6 months (<i>p</i> = 0.000136) and 6–12 months (<i>p</i> = 0.006717) after withdrawal. The postmenopausal-diagnosed subgroup (<i>n</i> = 6) consisted primarily of microadenomas (<i>n</i> = 5) and most showed excellent dopamine agonist response.</p> Conclusions <p>This study represents the largest retrospective analysis to date to explore the management of prolactinoma in postmenopausal women. The current evidence indicates that dopamine agonist withdrawal represents a promising therapeutic strategy for postmenopausal patients, and further research is warranted to confirm.</p> Clinical trial number <p>Not applicable.</p>