DHEA Cream for Menopausal Symptoms and Low Libido
Vaginal DHEA (prasterone) can be considered for treating vaginal dryness and sexual pain in postmenopausal women, with evidence showing improvements in sexual desire, arousal, pain, and overall sexual function, though safety data for hormone-sensitive cancers are limited. 1
Efficacy of DHEA for Menopausal Symptoms
Vaginal Dryness and Pain
- Vaginal DHEA (prasterone) has been shown to be effective at reducing dyspareunia (painful intercourse) in postmenopausal women 1
- A randomized controlled trial of 464 cancer survivors demonstrated that vaginal DHEA led to significant improvements in sexual desire, arousal, pain, and overall sexual function 1
- However, a systematic review and meta-analysis from 2015 concluded that it remains uncertain whether vaginal DHEA significantly improves vaginal dryness 1
Sexual Function and Libido
- For low libido, vaginal DHEA has shown some benefit in improving sexual desire in postmenopausal women 1
- The evidence for systemic DHEA (oral supplements) for improving libido is less convincing, with a meta-analysis showing no significant improvement in sexual function compared to placebo 2
- Plain vaginal moisturizers also improved symptoms in some studies, suggesting part of the benefit may be from the moisturizing effect rather than hormonal action 1
Safety Considerations
General Safety Profile
- DHEA is FDA-approved (as prasterone) for vaginal use, though safety data for long-term use are limited 1
- Vaginal DHEA increases levels of circulating androgens, which may have systemic effects 1
- The FDA label for prasterone warns that exogenous estrogens are contraindicated in women with a history of breast cancer 1
Special Populations
- DHEA should be used with caution in women receiving aromatase inhibitor therapy, as increased circulating androgens could potentially impact the effectiveness of these medications 1
- The safety of vaginal hormones, including DHEA, has not been firmly established in survivors of estrogen-dependent cancers 1
- For women with a history of hormone-sensitive cancers, non-hormonal options should be considered first 1
Alternative Options for Menopausal Symptoms
Non-Hormonal Options
- Vaginal moisturizers and lubricants can help alleviate symptoms such as vaginal dryness and sexual pain 1
- Pelvic floor physical therapy may improve sexual pain, arousal, lubrication, orgasm, and satisfaction 1
- Vaginal dilators can be helpful for women with pain during sexual activity, particularly those with vaginal stenosis from pelvic radiation 1
Other Hormonal Options
- Vaginal estrogen is considered the most effective treatment for vaginal dryness leading to sexual dysfunction 1
- Ospemifene, an FDA-approved selective estrogen receptor modulator (SERM), effectively treats vaginal dryness and dyspareunia in postmenopausal women without a history of breast cancer 1
- For low sexual desire specifically, FDA-approved options for premenopausal women include flibanserin and bremelanotide 1
Clinical Approach
- For women with primarily vaginal symptoms (dryness, pain with intercourse), consider vaginal DHEA if there are no contraindications 1
- For women with primarily low libido without vaginal symptoms, evidence for DHEA is less robust, and other options may be more appropriate 2, 3
- For women with a history of hormone-sensitive cancers, use DHEA with caution and consider non-hormonal alternatives first 1
- Monitor for systemic effects, particularly in women taking medications that could interact with androgens 1