Does hyperprolactinemia always need to be treated if the patient has regular menses, no galactorrhea, no desire for fertility and MRI of the pituitary is normal?  

No, it does not, although there is some soft data that hyperprolactinemia may be associated with metabolic dysfunction. However, a diagnosis is needed. Asymptomatic hyperprolactinemia may be due to macroprolactinemia. If monomeric prolactin is normal, you can reassure the patient that the only treat...

No, it does not need to be treated in such a case.