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DHEA for dyspareunia associated with menopause.

Two hundred fifty-three women with dyspareunia associated with menopause were randomly assigned to receive, in double-blind fashion, placebo, 3.25 mg of dehydroepiandrosterone (DHEA), or 6.5 mg of DHEA, administered intravaginally once a day before bedtime for 12 weeks. Compared with placebo, the higher dose of DHEA decreased dyspareunia by 46% (p < 0.02) and decreased moderate-to-severe vaginal dryness by 42% (p < 0.02). The higher dose of DHEA also produced histological improvements (a 45.8% decrease in the mean percentage of parabasal cells [p < 0.0001] and a 4.7% increase in the percentage of superficial cells [p < 0.0001]) and decreased mean vaginal pH by 0.83 units (p < 0.0001). The effect of the lower dose of DHEA was less pronounced, and the reduction in dyspareunia compared with placebo was not statistically significant. No significant adverse effects were reported.

Comment: These results indicate that daily intravaginal administration of 6.5 mg of DHEA (but not 3.25 mg of DHEA) resulted in clinical and histological improvement in women with dyspareunia associated with menopause. DHEA is metabolized in part to estrogen and testosterone, which may account for its beneficial effect on dyspareunia. However, DHEA may also have physiological actions unrelated to its function as a precursor to estrogen and testosterone, since DHEA receptors have been identified on some human cells. In previous research, intravaginal administration of DHEA did not cause endometrial proliferation and produced little or no change in serum concentrations of estrogen and testosterone. Because it appears to be effective at low doses, intravaginal administration of DHEA may be preferable to oral or transdermal administration when treating symptoms related to vaginal atrophy.

Archer DF et al. Treatment of pain at sexual activity (dyspareunia) with intravaginal dehydroepiandrosterone (prasterone). Menopause. 2015;22:950-963

by Alan R. Gaby, MD

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Title Annotation:Literature Review & Commentary; dehydroepiandrosterone
Author:Gaby, Alan R.
Publication:Townsend Letter
Article Type:Brief article
Date:Feb 1, 2016
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