From the Guidelines
The management of a postmenopausal woman with elevated DHEA levels should prioritize addressing any symptoms of vaginal dryness or sexual dysfunction, and vaginal DHEA (prasterone) can be considered as a treatment option, despite the need for caution in survivors receiving aromatase inhibitor therapy. When evaluating a postmenopausal woman with elevated DHEA levels, it is essential to consider the potential benefits and risks of treatment, particularly in the context of sexual dysfunction and vaginal health. According to the NCCN guidelines 1, vaginal DHEA has been shown to be effective in reducing dyspareunia in postmenopausal individuals, although safety data are limited, especially in survivors of hormonally mediated cancers.
Key considerations in the management approach include:
- Evaluating the underlying cause of elevated DHEA levels to rule out any pathological conditions
- Assessing symptoms of vaginal dryness, sexual dysfunction, or virilization
- Considering treatment options such as vaginal DHEA, vaginal estrogen, or ospemifene for vaginal dryness and sexual dysfunction
- Monitoring for potential risks, particularly in survivors receiving aromatase inhibitor therapy
In terms of treatment, vaginal DHEA can be considered as a treatment option for postmenopausal women with elevated DHEA levels and symptoms of vaginal dryness or sexual dysfunction, as it has been shown to improve sexual desire, arousal, pain, and overall sexual function 1. However, it is crucial to use caution in survivors receiving aromatase inhibitor therapy due to the potential impact on AI activity. Alternative treatment options, such as vaginal estrogen or ospemifene, may also be considered, depending on the individual patient's needs and medical history.
From the Research
Management Approach for Postmenopausal Women with Elevated DHEA Levels
- The management of elevated Dehydroepiandrosterone (DHEA) levels in postmenopausal women is a complex issue, with various studies suggesting different approaches 2, 3, 4, 5, 6.
- According to a 2015 study, DHEA did not improve quality of life in postmenopausal women, but was associated with androgenic side effects, such as acne 2.
- Another study from 2001 found that DHEA administration in postmenopausal women resulted in increased bone formation and higher bone mineral density, accompanied by elevated levels of osteocalcin, a marker of bone formation 3.
- A 2007 review concluded that DHEA supplementation may be of benefit in two specific groups of women: those with the lowest circulating levels of DHEA, and those for whom osteoporosis is a particular problem 4.
- A 2010 review found that the potential value of oral DHEA therapy for postmenopausal women is called into question, but vaginally administered DHEA may improve vaginal atrophy with concomitant improvements in sexual function in women who are estrogen deficient due to menopause 5.
- A 2011 review suggested that intravaginally administered DHEA can be used to treat vaginal atrophy, but independent studies are required to confirm this, and the effects of vaginal DHEA on sexual function in women without vaginal atrophy need to be studied 6.
Key Considerations
- The effectiveness and safety of DHEA therapy in postmenopausal women are still uncertain 2, 3, 4, 5, 6.
- DHEA may have beneficial effects on osteoporosis and vaginal atrophy, but its use is not without risks, such as androgenic side effects 2, 3, 4, 5, 6.
- More research is needed to fully understand the effects of DHEA in postmenopausal women and to determine the optimal management approach for those with elevated DHEA levels 2, 3, 4, 5, 6.