What is the relationship between topical estrogen and Dehydroepiandrosterone (DHEA) serum levels in menopausal women?

From the Guidelines

Topical estrogen therapy does not significantly affect serum DHEA levels in menopausal women. When women use vaginal or other topical estrogen preparations (such as estradiol cream, vaginal tablets, or estrogen rings), these formulations are designed to work locally with minimal systemic absorption 1. This means that while topical estrogen effectively treats local symptoms like vaginal dryness, atrophy, and urinary symptoms, it generally doesn't alter circulating hormone levels enough to impact DHEA production or metabolism. DHEA is primarily produced by the adrenal glands and serves as a precursor to both estrogen and testosterone. During menopause, while estrogen levels decline dramatically, DHEA levels also gradually decrease with age, but this occurs independently of estrogen therapy.

Some key points to consider:

• Topical estrogen is effective in treating vaginal dryness, itching, discomfort, and painful intercourse in postmenopausal women 1.
• Vaginal androgens (ie, DHEA; also known as prasterone) can be considered for vaginal dryness or pain with sexual activity, and have been shown to be effective at reducing dyspareunia in postmenopausal women 1.
• The safety of vaginal hormones has not been firmly established in survivors of estrogen-dependent cancers, and DHEA should be used with caution in survivors receiving AI therapy 1.
• Women using topical estrogen should follow prescribed dosing (typically starting with daily application for 1-2 weeks, then reducing to 2-3 times weekly for maintenance) and understand that while addressing local symptoms, these treatments won't restore systemic hormone balance or affect DHEA levels.

It's also important to note that the evidence base for interventions to treat female sexual dysfunction in survivors is weak and high-quality studies are needed 1. However, based on the available evidence, topical estrogen therapy is a recommended treatment option for vaginal dryness and sexual dysfunction in menopausal women, and its use is not expected to significantly impact serum DHEA levels. If a woman is concerned about declining DHEA levels, this would require separate evaluation and potentially different interventions than topical estrogen therapy.

From the Research

Relationship Between Topical Estrogen and DHEA Serum Levels

• The relationship between topical estrogen and Dehydroepiandrosterone (DHEA) serum levels in menopausal women is not directly addressed in the provided studies 2, 3, 4, 5, 6.
• However, studies have investigated the effects of DHEA supplementation on estrogen levels in postmenopausal women, which may provide some insight into the potential relationship between topical estrogen and DHEA serum levels.
• A meta-analysis found that DHEA supplementation significantly increased estradiol levels in women, particularly in postmenopausal women, those aged 60 years and above, and those receiving DHEA dosages of 50 mg/day 4.
• Another study found that 1-year therapy with 10 mg/day oral DHEA alone or in combination with hormone replacement therapy (HRT) affected the hormonal milieu in postmenopausal women, including increases in androgens and estrogens levels 5.
• The use of intravaginal DHEA, but not oral DHEA, has been shown to alleviate vaginal atrophy and improve sexual function in postmenopausal women, which may be related to the local effects of DHEA on estrogen levels 6.
• Topical estrogen therapy is known to increase estrogen levels locally, but its effects on DHEA serum levels are not well understood and require further investigation 3, 5, 6.

Key Findings

• DHEA supplementation increases estradiol levels in postmenopausal women 4.
• The combination of DHEA and HRT affects the hormonal milieu in postmenopausal women, including increases in androgens and estrogens levels 5.
• Intravaginal DHEA alleviates vaginal atrophy and improves sexual function in postmenopausal women, potentially related to local effects on estrogen levels 6.
• The relationship between topical estrogen and DHEA serum levels in menopausal women requires further investigation 2, 3, 4, 5, 6.