Vaginal DHEA is a prescription hormone treatment used inside the vagina to relieve moderate to severe pain during sex caused by menopause-related vaginal changes. In the United States, the FDA-approved vaginal DHEA product is Intrarosa, which contains 6.5 mg of prasterone, the medication form of dehydroepiandrosterone, or DHEA.
Information reviewed:
| At a glance | Vaginal DHEA |
|---|---|
| Medical name | Prasterone |
| Brand name in the U.S. | Intrarosa |
| Main use | Moderate to severe menopausal pain during sex |
| Form | Vaginal insert |
| Standard dose | One 6.5 mg insert at bedtime each day |
| Hormone type | DHEA precursor converted into estrogen and androgens |
| Prescription required | Yes |
How Does Vaginal DHEA Work?
Vaginal prasterone is converted inside vaginal tissue into small amounts of active hormones, including estrogen and androgens. These hormones may improve the health, elasticity, lubrication and function of vaginal tissue affected by lower estrogen levels during menopause. The precise mechanism is not fully established.
Menopause-related vaginal changes are often called genitourinary syndrome of menopause, or GSM. GSM can cause vaginal dryness, burning, itching, reduced lubrication, painful sex, urinary urgency and recurrent urinary tract infections.
What Is Vaginal DHEA Used For?
Vaginal DHEA is FDA-approved for moderate to severe dyspareunia, which means painful sexual intercourse caused by menopausal vulvar and vaginal atrophy. Clinical trials studied daily treatment for 12 weeks and found greater improvement in pain during sex with prasterone than with placebo.
Healthcare professionals may also discuss vaginal DHEA when menopause-related vaginal symptoms include dryness or irritation. It does not treat every cause of vaginal pain. Infections, skin conditions, pelvic-floor problems and unexplained bleeding need separate evaluation.
How Is Vaginal DHEA Used?
The prescribing instructions for Intrarosa are:
- Insert one 6.5 mg vaginal insert once a day at bedtime.
- Use the supplied single-use applicator.
- Insert the product only as far as is comfortable. Do not force it.
- Follow the instructions from your healthcare professional and the product label.
Vaginal DHEA is intended for vaginal use. It is different from an oral DHEA supplement, and an over-the-counter DHEA product should not replace a prescribed vaginal insert. Prescription vaginal prasterone and the oral capsules sold in shops are separate products, and DHEA supplements you can order online are the oral kind, with their strength and ingredient panel on the listing.
Is Vaginal DHEA the Same as Vaginal Estrogen?
No. Vaginal DHEA and vaginal estrogen both treat menopause-related vaginal tissue changes, but they deliver different hormones.
| Feature | Vaginal DHEA | Vaginal estrogen |
|---|---|---|
| Active treatment | Prasterone, a DHEA precursor | Estrogen |
| How it works | Converts into estrogen and androgens in vaginal tissue | Supplies estrogen directly |
| Typical use | Menopausal pain during sex | Vaginal dryness, irritation, painful sex and other GSM symptoms |
| Systemic exposure | Some absorption and hormone conversion occur | Some absorption can also occur, depending on the product |
| Choice depends on | Symptoms, medical history, cancer history and treatment preferences | The same factors |
Vaginal DHEA is not hormone-free. The prescribing information reports that prasterone and its metabolites, including testosterone and estradiol, can be detected in the bloodstream after use.
What Are the Side Effects?
The most commonly reported side effect is vaginal discharge. Changes in Pap smear results were also reported in the product information and longer-term study data.
Contact a healthcare professional about unexpected bleeding, new pelvic pain, severe irritation or symptoms that do not improve. Postmenopausal bleeding should be evaluated before starting treatment.
Who Should Not Use Vaginal DHEA Without Medical Advice?
People with undiagnosed abnormal genital bleeding should not use Intrarosa until the cause has been evaluated. The prescribing information also states that Intrarosa has not been studied in women with a current or previous history of breast cancer. Because prasterone can be converted into estrogen, anyone with current or past breast cancer should discuss vaginal DHEA with a gynecologist and, when appropriate, an oncologist before using it.
People who are pregnant, planning pregnancy or breastfeeding should also speak with a healthcare professional. Intrarosa is intended for women who are past menopause, and its effects in these situations have not been established.