Dehydroepiandrosterone (DHEA) is a naturally occurring steroid hormone. Menopause marks a biological transition in women, characterized by the cessation of menstrual cycles and various symptoms due to shifting hormone levels. This article explores DHEA’s potential as a management option for menopausal symptoms, examining its natural role, its relationship with menopausal changes, and its benefits and safety.
Understanding DHEA
Dehydroepiandrosterone (DHEA) is an endogenous steroid hormone precursor, meaning the body converts it into other hormones. It is one of the most abundant circulating steroids in humans, produced primarily by the adrenal glands, with smaller amounts from the gonads and brain. DHEA has limited direct biological effects but serves as an intermediate in the biosynthesis of more potent sex steroids. DHEA can be converted into androgens, such as testosterone, and estrogens, like estradiol. This conversion occurs in various tissues throughout the body, allowing for local hormone production as needed.
DHEA’s Role in Menopause
DHEA levels naturally decline with age, with a significant drop occurring by menopause, potentially reaching 60-70% lower than peak levels. By age 70, DHEA levels may be approximately 25% of their peak. During menopause, the ovaries cease producing sex hormones like estrogen, making adrenal DHEA a primary precursor for extragonadal production of estrogens and androgens in postmenopausal women. The reduction in DHEA may contribute to menopausal symptoms by limiting the body’s ability to locally produce sufficient levels of other sex hormones.
Potential Benefits for Menopausal Symptoms
Intravaginal DHEA shows promise for vaginal dryness and atrophy, improving vaginal moisture, reducing irritation, and decreasing painful intercourse. This localized application helps stimulate vaginal maturation and can improve sexual function parameters like desire, arousal, and lubrication without significant systemic hormonal changes. DHEA may also help with decreased libido, with some studies indicating improvements in sexual interest and activity in postmenopausal women; however, results have been inconsistent, and further research is ongoing.
DHEA supplementation may reduce the frequency and severity of hot flashes. DHEA also plays a role in bone density maintenance, as its levels positively correlate with bone mineral density in postmenopausal women. DHEA can be converted to estrone in osteoblasts, contributing to bone health and potentially reducing the risk of osteoporosis. For mood changes, some research suggests DHEA supplementation may help improve mood and reduce depressive symptoms in postmenopausal women, although consistent effects on anxiety have not been broadly established.
Safety Considerations and Side Effects
Understanding DHEA’s safety profile and possible side effects is important. As DHEA can convert into other sex hormones, its use may lead to androgenic side effects. These can include oily skin, acne, and increased hair growth on the face or body (hirsutism). Other reported side effects may involve hair loss, voice deepening, and changes in the menstrual cycle for women who are perimenopausal. Less common but reported side effects include upset stomach, headache, fatigue, and mood changes.
DHEA use is not suitable for everyone and has several contraindications. It should not be used by individuals with hormone-sensitive cancers, such as breast, ovarian, or prostate cancer, or those at risk for these conditions, as DHEA might increase the risk. It is also not recommended for individuals with liver disease, high cholesterol, or certain heart conditions. DHEA can interact with various medications, including antipsychotics, antidepressants (SSRIs), and drugs for seizures or bipolar disorder, potentially reducing their effectiveness or increasing side effects. Pregnant or breastfeeding individuals should avoid DHEA due to the risk of affecting the baby.
Navigating DHEA Use for Menopause
Consulting a healthcare provider before starting any DHEA supplementation is important due to its hormonal nature. In the United States, DHEA is classified as a dietary supplement, meaning it is available over-the-counter and not regulated with the same strictness as prescription medications. This difference in regulation means product purity and dosage can vary significantly among brands. A healthcare professional can help determine if DHEA is appropriate, considering an individual’s health history, existing conditions, and other medications.
Proper diagnosis of menopausal symptoms and individualized dosing are important for safe and effective use. DHEA is available in various forms, including oral capsules, topical creams, and vaginal inserts. Vaginal DHEA is the only form approved by the FDA for specific menopausal indications, particularly for moderate to severe painful intercourse due to vaginal atrophy. Regular monitoring by a healthcare provider is advised to assess the effectiveness of DHEA and to detect and manage any potential side effects. DHEA should be considered as part of a comprehensive, medically guided approach to managing menopause, rather than a self-prescribed solution.