From the Guidelines
Yes, she can use both vaginal estrogen cream and Intrarosa (prasterone) concurrently, but with caution and consideration of the limited safety data.
Rationale
- The use of low-dose vaginal hormones, such as vaginal estrogen cream, and intravaginal dehydroepiandrosterone (prasterone), also known as Intrarosa, may be safe during concurrent use, as suggested by a growing body of evidence 1.
- However, it is essential to note that safety data is limited, and follow-up has been short, making it crucial to weigh the benefits and risks and have a conversation about the lack of data on risk.
- The low-dose vaginal hormones and intravaginal prasterone have shown promise in improving symptoms, but the lack of uniformity and clear cut-off definitions of serum estrogen/estradiol levels and variability in serum estrogen levels over time during aromatase inhibitor use are key challenges, as illustrated in the SOFT-EST sub-study 1.
- As a result, it is crucial to approach this concurrent use with caution and consider the individual patient's needs and circumstances.
- Non-hormonal therapies, such as vaginal moisturizers, lubricants, and gels, should be considered as first-choice treatment before moving to hormonal agents.
- Ultimately, the decision to use both vaginal estrogen cream and Intrarosa concurrently should be made on a case-by-case basis, taking into account the patient's specific situation and the limited available data.
From the Research
Concurrent Use of Vaginal Estrogen Cream and Intrarosa (Prasterone)
- There is no direct evidence in the provided studies that explicitly addresses the concurrent use of vaginal estrogen cream and Intrarosa (prasterone) 2, 3, 4, 5, 6.
- However, the studies suggest that both vaginal estrogen and prasterone are effective treatments for vaginal atrophy and dyspareunia in postmenopausal women 2, 3, 4, 5, 6.
- A study comparing intravaginal prasterone, conjugated estrogens, and estradiol found that prasterone was at least as efficacious as estrogens in treating vulvovaginal atrophy symptoms 4.
- Another study found that intravaginal prasterone improved libido and sexual dysfunction in postmenopausal women, suggesting that it may have beneficial effects on sexual function beyond just treating vaginal atrophy 5.
- The mechanism of action of prasterone involves local conversion to androgens and estrogens in the vagina, which may complement the effects of vaginal estrogen cream 6.
- However, without direct evidence on concurrent use, it is unclear whether using both treatments together would be safe and effective, or if it would increase the risk of adverse effects 2, 3, 4, 5, 6.