Dehydroepiandrosterone (DHEA) is a steroid hormone that the body naturally produces, primarily in the adrenal glands. This compound acts as a precursor, meaning it is converted into more potent hormones, including both estrogens and androgens (like testosterone). Menopause marks the permanent cessation of menstrual cycles, a biological transition characterized by a significant decline in the production of ovarian hormones. This hormonal shift leads to a variety of symptoms, and the question is whether supplementing DHEA can mitigate these effects.
DHEA’s Function and Decline
DHEA and its sulfated form, DHEA-S, are among the most abundant circulating steroid hormones in the human body. The primary function of DHEA is to serve as a reservoir for the local production of sex hormones within various tissues, a process known as intracrinology. Enzymes within cells convert DHEA into either estrogen or testosterone as needed by that specific tissue.
DHEA levels peak dramatically in early adulthood, typically around the age of 20 to 30 years. Following this peak, the production from the adrenal glands begins a long, steady decline, often referred to as “adrenopause.” By the time a woman reaches 70 or 80 years old, her DHEA levels may drop to only 10 to 20% of the peak concentration seen in her younger years.
The decline in DHEA levels precedes menopause but accelerates the overall hormonal deficiency that postmenopausal women experience. Since the ovaries virtually stop producing estrogen and progesterone after menopause, the body becomes more reliant on DHEA conversion in peripheral tissues for maintaining sex hormone balance. This age-related drop in DHEA provides the physiological rationale for investigating its use as a potential treatment to counteract some symptoms of hormonal aging.
Evidence of Effectiveness for Menopausal Symptoms
The scientific evidence for DHEA’s effectiveness varies significantly depending on the specific menopausal symptom being addressed and the method of administration. The strongest and most consistent evidence supports the use of DHEA for genitourinary symptoms, often referred to as vulvovaginal atrophy (VVA). VVA, which causes symptoms like vaginal dryness and pain during sexual intercourse (dyspareunia), is directly linked to low estrogen levels.
Localized application of DHEA, such as a vaginal insert, has demonstrated clear efficacy in clinical trials for treating moderate to severe dyspareunia. This method allows the DHEA to be converted into active sex hormones directly within the vaginal tissue, without causing a significant increase in systemic hormone levels. An intravaginal formulation of DHEA, known as prasterone, has received approval from the U.S. Food and Drug Administration (FDA) specifically for the treatment of dyspareunia associated with menopause.
Evidence is less compelling for systemic symptoms, such as hot flashes and night sweats, which are known as vasomotor symptoms. Research indicates that DHEA is generally not effective for relieving these symptoms, especially when compared to traditional menopausal hormone therapy. The current body of large-scale evidence does not support DHEA as a primary treatment for vasomotor symptoms.
Similarly, the benefits of DHEA for bone density and muscle mass remain mixed or limited. Some data suggests DHEA may play a role in bone maintenance, but other studies have failed to show a consistent improvement in bone mineral density (BMD) in postmenopausal women. The impact on mood and cognition is also conflicting; DHEA has shown some ability to improve mood in women with hormone deficiencies, but this benefit is not consistently observed in otherwise healthy postmenopausal women.
Safety Concerns and Methods of Use
The safety profile of DHEA is closely tied to its potential to convert into other sex hormones and the way it is administered. Because DHEA acts as a precursor, systemic use, such as oral supplementation, can lead to increased levels of androgens and estrogens throughout the body. This systemic conversion raises the possibility of androgenic side effects, which may include acne, oily skin, and unwanted hair growth, particularly at doses of 50 milligrams or higher.
DHEA is available in two distinct forms, which impacts its regulation and safety profile. It is widely sold as an over-the-counter dietary supplement, a category that is not strictly regulated by the FDA for potency, purity, or consistency. This means that the actual amount of DHEA in a supplement can vary significantly from what is listed on the label.
In contrast, the localized vaginal insert is a prescription-only medication that is manufactured and regulated to a pharmaceutical standard. This method minimizes systemic absorption, thereby reducing the risk of widespread side effects associated with oral intake. However, even with localized use, potential side effects can include vaginal discharge or an abnormal Pap smear result.
Due to its role as a precursor to sex hormones, DHEA is generally not recommended for individuals with hormone-sensitive cancers, such as certain breast or ovarian cancers. It may also interact with other medications and could potentially worsen existing conditions like liver problems or polycystic ovary syndrome (PCOS). Consulting with a healthcare professional is necessary before beginning DHEA supplementation to determine the appropriate method, monitor hormone levels, and ensure there are no underlying contraindications.