Dehydroepiandrosterone (DHEA) replacement therapy may help alleviate common symptoms many women face during the menopause transition. Treatment may also reduce certain health risks associated with menopause, including a loss of bone density and lean muscle mass. However, research findings about the efficacy of DHEA vary. This is why individualized treatment recommendations are essential.(1)
DHEA is a precursor sex steroid, or prohormone, that gets synthesized into estrogens and androgens in the body. It’s mainly produced in the adrenal glands, as well as the brain, testes, and ovaries.(2) Levels of DHEA drop as women age. This decline may contribute to the development of menopausal symptoms due to DHEA’s role in hormone production.
This article will explore the circumstances in which DHEA treatment may be recommended for women during menopause.
DHEA & Menopause: The Connection and Declining Levels
Women have the highest levels of DHEA in their mid-20s.(1) However, levels decrease as women age, with marked hormonal changes occurring during menopause.
Research findings show that women have DHEA concentrations between 1.12 ng/mL and 7.43 ng/mL (nanograms per milliliter) before menopause. After menopause, these levels fall to a range of 0.6 ng/mL to 5.7 ng/mL and continue to decrease with age.(3) Most women begin perimenopause in their mid-40s and reach menopause at the average age of 52.(4) By the time a woman is in their 70s or 80s, they may have only 10% to 20% of the DHEA levels they had in their 20s.(3)
Symptoms of Low DHEA Levels
Symptoms may be different depending on the cause of DHEA deficiency. Women with low DHEA levels due to adrenal gland dysfunction may experience dizziness, nausea, vomiting, dehydration, or weight loss.(5)
On the other hand, aging-related DHEA deficiency may cause symptoms of low libido or vulvovaginal changes.(5) Low levels of DHEA-S (the sulfated form of DHEA) have been linked with stress and depression.(1)(6)It’s important to consult with a doctor to determine the cause of low DHEA levels. DHEA deficiency can present with similar symptoms and share some of the same health risks as menopause.
Symptoms and health risks that DHEA deficiency and menopause may share include the following:(1)(4)(5)(7)(8)
Low sex drive
Vaginal dryness
Dizziness
Increased risk of depression
Increased risk of cardiovascular disease
Increased risk of osteoporosis
Potential Benefits of DHEA Supplementation for Menopause Symptoms
Although studies have produced conflicting results, some menopausal women may experience the following benefits of DHEA supplementation:
Improved Libido and Sexual Function
Vaginal dryness, irritation, or painful sex may occur during menopause due to physiological changes in the vagina caused by hormonal fluctuations.(1) These symptoms of genitourinary syndrome of menopause (GSM) can negatively affect sex drive and arousal.
Women with severe GSM symptoms may benefit from DHEA treatment. Studies have shown that intravaginal DHEA (prasterone) may reduce pain during sex and increase lubrication, orgasm, and sexual desire among postmenopausal women.(1)(9)
Enhanced Mood and Well-Being
DHEA and DHEA-S are known to influence stress levels, mood, and psychological health. In fact, low DHEA levels have been linked with feelings of sadness. Researchers from a scientific review cited one study in which postmenopausal women using DHEA experienced improved vitality and overall well-being.(1)
Improved Bone Health
DHEA is believed to play a role in the body’s bone formation and breakdown cycle. A study found that women aged 55 and older who were treated with oral DHEA for one year experienced increases in bone mineral density (BMD) in the lumbar spine and upper femur bone. Total hip BMD was also preserved.(10)(11)
Increased Lean Body Mass
Hormonal shifts can cause weight gain, particularly an increase in abdominal fat, and a loss of muscle mass. A study found that DHEA, specifically, may increase lean body mass and decrease fat mass, although no effect on body mass index (BMI) or body weight was observed.(1)(12)
DHEA may also enhance the effects of resistance training on strength and muscle mass. However, studies have produced mixed results, and DHEA is not recommended for weight management or for improving body composition.(1)(12)
Improved Skin Health
The skin loses elasticity during menopause. Oral DHEA has demonstrated positive effects on signs of skin aging in older adults. It has been shown to increase skin oil production, boost hydration, and increase skin thickness.(13)(14)
Topical DHEA may enhance skin brightness and support collagen production. However, more research is needed on the relationship between DHEA treatment and skin health.(13)(15)
Diagnosing Low DHEA and Considering Supplementation
A DHEA-S test may be recommended if a person shows signs of low DHEA levels. The test can help doctors detect gonadal disorders or problems with the adrenal glands. It can also help determine the cause of physical male characteristics that develop in females.(5)
While DHEA-S testing is a tool that can assist in diagnosing certain health conditions, Winona does not use hormone testing to diagnose menopause symptoms and determine treatment recommendations for hormone replacement therapy (HRT) or DHEA supplementation.
When is DHEA supplementation recommended during menopause?
DHEA may be recommended during menopause if women present with specific symptoms. The medication has been shown to be more effective in improving metabolism and addressing low energy, fatigue, or low sex drive. DHEA may be appropriate for patients seeking relief from these types of symptoms.
Types of DHEA Supplements Available
DHEA is available in the following systemic and localized forms:
Capsules
Tablets
Creams
Gels
Oral sublingual drops
Vaginal inserts
Some forms of DHEA can be purchased over the counter (OTC), while others require a prescription. It’s crucial to discuss which form of DHEA may be best with a healthcare provider.
DHEA Dosage and Safety
There’s no one-size-fits-all recommended dosage of DHEA for menopausal women. Supplementation can also come with side effects, so it’s important to be aware of potential health risks.
Finding the Right DHEA Dose for Menopause
The optimal dose of DHEA may be different for each patient. Determining how much DHEA a menopausal woman should take will depend on individual symptoms, health needs, and medication use.
A doctor will typically prescribe a lower dose and may increase it as needed. Most women experience improvement in symptoms with a 25 milligram (mg) dose. This may be increased to a maximum dose of 50 mg in some cases.
Potential DHEA Side Effects
DHEA is generally well-tolerated. However, some women may experience mild side effects, including acne, abdominal discomfort, or excessive body hair growth.(16)
DHEA may also pose risks to people with certain health conditions. The treatment may worsen mood disorders, liver issues, polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids, breast cancer, and certain gynecological cancers. It may also affect cholesterol levels.(16)
DHEA is not recommended for women who are pregnant or breastfeeding. Women with existing health conditions should consult with their doctor about whether DHEA is safe for them to use.(16)
Combining DHEA and HRT
DHEA is not typically prescribed on its own for menopausal symptom treatment. There are some cases in which DHEA treatment alone may be beneficial for women who are earlier in their menopause journey, such as those in perimenopause. However, it’s not usually strong enough to reduce symptoms of hot flashes, night sweats, mood changes, or brain fog. This is why DHEA is usually recommended as a complementary treatment to standard HRT.
One study found that postmenopausal women who were treated with oral DHEA in combination with transdermal estradiol and oral micronized progesterone for one year experienced a more significant increase in levels of testosterone and estradiol compared to women treated only with HRT.(17) However, because DHEA increases levels of estrogen and testosterone in the body, it’s critical that dosages of DHEA and HRT be carefully taken into consideration to avoid potential side effects or health risks.
Women who are interested in DHEA replacement therapy as a complementary treatment to HRT should speak to their doctor about potential benefits, risks, and drug interactions.
Is DHEA right for your menopause journey?
DHEA can help restore hormonal balance during menopause. When used in combination with HRT, it may help relieve menopausal symptoms that significantly impact quality of life. However, DHEA may not be a good fit for all women, so it’s important to seek personalized medical advice.
Interested in learning if DHEA supplements may be right for your menopause journey? Consult with a Winona doctor for personalized menopause care.
