What are the effects of a drop in Dehydroepiandrosterone (DHEA) levels during menopause?

Effects of DHEA Drop During Menopause

The drop in DHEA levels during menopause contributes significantly to menopausal symptoms and can affect sexual function, bone health, and overall quality of life, with supplementation potentially beneficial for specific symptoms like vaginal dryness and sexual dysfunction. 1, 2

Physiological Changes in DHEA During Menopause

• DHEA secretion, primarily from the adrenal glands, decreases by an average of 60% at the time of menopause and continues to decline thereafter 2
• After menopause, DHEA becomes the only source of both estrogens and androgens during all postmenopausal years 2
• DHEA is transformed intracellularly into cell-specific amounts of estrogens and androgens which act locally in peripheral tissues 3
• The decline in DHEA contributes to many symptoms previously attributed solely to estrogen deficiency 3

Clinical Manifestations of DHEA Decline

Sexual Function

• Decreased DHEA levels contribute to vaginal dryness, pain with sexual activity (dyspareunia), and reduced sexual desire 1, 4
• DHEA supplementation has been shown to improve sexual function, including desire, arousal, and satisfaction in postmenopausal women 4
• Vaginal DHEA (prasterone) has demonstrated significant improvements in sexual desire, arousal, pain, and overall sexual function 5

Bone Health

• Low DHEA levels may contribute to accelerated bone loss in postmenopausal women 6
• Evidence suggests DHEA supplementation may have beneficial effects on osteoporosis in postmenopausal women 7, 6
• Bone density decreases by approximately 2% each year during the first 5 years after menopause, followed by an annual loss of about 1% thereafter 5

Other Effects

• Some evidence suggests DHEA may be associated with:
  • Mood changes and potential effects on depression and anxiety 7
  • Changes in skin, eyes, and hair quality 8
  • Possible effects on energy levels 8
• However, evidence is inconsistent regarding DHEA's effect on overall quality of life 4

Therapeutic Considerations

Potential Benefits of DHEA Supplementation

• Most beneficial for women with the lowest circulating levels of DHEA 6
• May help with specific symptoms like vaginal dryness and sexual dysfunction 1, 7
• Could potentially benefit women with low bone mineral density 7, 6

Safety Considerations

• DHEA supplementation may be associated with androgenic side effects, primarily acne 4
• Should be used with caution in women with history of hormone-dependent cancers 1
• The FDA-approved form (prasterone) is contraindicated in women with known or suspected breast cancer 5

Dosing Guidelines

• Typical recommended dose ranges from 10-50 mg daily for women, with 25 mg being a common starting dose 1
• Treatment efficacy should be monitored through serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels 1
• Vaginal DHEA (prasterone) is available as an FDA-approved option for vaginal symptoms 5

Clinical Approach

• Consider DHEA supplementation particularly for:
  • Women with significant vaginal dryness and sexual dysfunction 5, 1
  • Those with low bone mineral density or osteoporosis 7, 6
  • Women with measured low DHEA levels and significant menopausal symptoms 6
• Monitor for androgenic side effects like acne 4
• Consider alternative treatments for menopausal symptoms if DHEA is contraindicated or ineffective

While DHEA supplementation shows promise for specific symptoms, particularly sexual dysfunction and vaginal dryness, its effects on overall quality of life and other menopausal symptoms remain uncertain 4, 7. The decision to use DHEA should be based on specific symptom profiles and individual risk factors.