DHEA for Menopause

DHEA is sold as a hormone that falls with age, and many women try it for menopause. The trials don't support taking it as a pill. The Cochrane review pooled 28 randomised trials in 1,273 peri- and postmenopausal women: DHEA did not improve quality of life, and the effect on menopausal symptoms was unclear because the trials disagreed and measured symptoms in different ways (Scheffers 2015). In a placebo-controlled trial of 93 postmenopausal women, 50 mg a day for 26 weeks made no difference to menopause-specific quality of life (Panjari 2009).

The one form with clear benefits is vaginal DHEA (prasterone), a prescription insert. In trials it modestly improved vaginal dryness and pain during sex (Labrie 2016; Lemos 2026), and menopause specialists list it as an option for these genitourinary symptoms (NAMS 2022). That evidence does not transfer to over-the-counter capsules, which a systematic review found may provide no benefit for the same symptoms (Danan 2024).

DHEA is one of the body's main precursors of androgens, which are converted in turn into testosterone and estrogens (Scheffers 2015). After menopause, all estrogens and almost all androgens are made in the tissues from DHEA (Zhu 2021). The idea behind supplementing is that topping up the precursor raises estrogen and testosterone enough to relieve symptoms caused by falling estrogen, such as hot flushes and vaginal dryness (Scheffers 2015).

Oral DHEA does raise these hormones. A meta-analysis of randomised trials found estradiol rose by about 7.6 pg/mL in postmenopausal women taking DHEA (Zhu 2021), and in an uncontrolled six-month study of 50 mg a day, testosterone rose from the first month and estradiol and estrone after one to two months (Stomati 2000).

A rise in blood hormone levels is not the same as relief. Despite raising estradiol and testosterone, oral DHEA did not improve quality of life in the pooled trials (Scheffers 2015), or menopause symptoms in women given 50 mg a day for 26 weeks (Panjari 2009). Estrogen-based hormone therapy, not DHEA, is what menopause specialists consider the most effective treatment for hot flashes (NAMS 2022).

Vaginal DHEA works differently: the trial developers report that it acts locally in vaginal tissue while blood hormone levels stay in the normal postmenopausal range (Labrie 2016). That is why its results can't be used to argue for capsules.

There is no evidence-based oral dose of DHEA for menopause. Most trials used 50 mg a day: the 52-week trial in postmenopausal women (Panjari 2009), the hot flash pilot (Barton 2006), the six-month hormonal study (Stomati 2000), and all four trials in a review of cognition (Sultana 2023). None of the placebo-controlled trials at this dose showed a clear improvement in symptoms.

The vaginal form that does have trial support is a different dose and route: 6.5 mg of DHEA (a 0.50% insert) placed in the vagina once a day, assessed over 12 weeks (Labrie 2016). It is a prescription medicine, not a supplement. The Endocrine Society recommends against routine use of DHEA because of limited data on its effectiveness and safety (Wierman 2014).

The Cochrane review included 28 randomised trials in 1,273 menopausal women, 16 of which could be pooled. Compared with placebo, DHEA did not improve quality of life (SMD 0.16, 95% CI -0.03 to 0.34, P = 0.10; 8 studies, 287 women; moderate-quality evidence). It was unclear whether DHEA affected menopausal symptoms, because results were inconsistent and measured in incompatible ways (Scheffers 2015).

A second meta-analysis pooled 23 trials of systemic DHEA in 1,188 postmenopausal women with normal adrenal function. Libido and sexual function did not improve significantly (SMD 0.35, 95% CI -0.02 to 0.73, P = 0.06), and there was no effect on lipids, glucose, weight or bone mineral density. The authors rated their confidence as low (Elraiyah 2014).

In a pilot study, 22 evaluable women took 50 mg DHEA a day for 4 weeks and their hot flash score fell by 50% from baseline, with better hot-flash-related quality of life (Barton 2006). An older six-month study of 50 mg a day in postmenopausal women reported a progressive improvement in the Kupperman menopause index, mostly in vasomotor symptoms (Stomati 2000). Neither had a placebo group, so neither can show how much of the improvement was due to DHEA; the pilot's authors called for a placebo-controlled trial.

In the placebo-controlled trial of 93 postmenopausal women, 50 mg a day made no significant difference to the Menopause-Specific Quality of Life Questionnaire, which includes vasomotor symptoms, after 26 weeks (Panjari 2009). The North American Menopause Society does not recommend supplements or herbal remedies for hot flashes (NAMS 2023).

In a phase III trial of 482 women with moderate to severe pain during sex, daily 6.5 mg vaginal DHEA for 12 weeks improved vaginal cells and pH (P < 0.0001), reduced pain at sexual activity by 0.36 severity units more than placebo (P = 0.0002), and improved dryness by 0.27 units more (P = 0.004) (Labrie 2016). A 2026 meta-analysis of five trials in 1,611 women confirmed small improvements in dryness (mean difference -0.23) and painful sex (-0.40) (Lemos 2026).

A systematic review for the US Agency for Healthcare Research and Quality rated these benefits as low certainty, and found systemic DHEA may provide no benefit for the same symptoms (Danan 2024). Most of the vaginal trials came from the product's developer. See vaginal dryness for other options.

Across all routes, the Cochrane review found DHEA slightly improved sexual function (SMD 0.31, 95% CI 0.07 to 0.55), but the oral trials alone showed no significant effect (SMD 0.11, 95% CI -0.13 to 0.35; 5 studies, 340 women) (Scheffers 2015). The full picture is on DHEA for low libido.

A review of four trials of 50 mg oral DHEA in postmenopausal women found no reliable benefit for cognitive performance; the only positive result came from a 4-week crossover in 24 women (Sultana 2023). For bones, the results conflict: one meta-analysis found no effect on bone mineral density in postmenopausal women (Elraiyah 2014), while another, in healthy older adults, found a small increase at the hip in women (P = 0.03) (Lin 2019). Neither measured fractures.

Androgenic side effects are the main problem. Women on DHEA had higher odds of androgenic side effects, mainly acne, than on placebo (odds ratio 3.77, 95% CI 1.36 to 10.4; 5 studies, 376 women), with no association found for other adverse effects (Scheffers 2015). In the 52-week trial, more women on 50 mg a day had acne and increased hair growth (Panjari 2009).

Over that year, 50 mg a day did not change blood lipids or insulin resistance, breakthrough bleeding was similar to placebo, and there were no significant adverse effects on the endometrium (Panjari 2009, safety report). Serious adverse effects were not more common in the pooled trials (Elraiyah 2014). Long-term safety is unknown: the trials lasted a year or less, and the Endocrine Society cites limited safety data in recommending against routine use (Wierman 2014).

Women with hormone-sensitive cancers need particular caution. DHEA raises estradiol in postmenopausal women (Zhu 2021), estrogen-dependent cancers are a recognised reason not to use hormone therapy (NAMS 2023), and few trials of menopause treatments enrolled women with a history of cancer (Danan 2024).

No formal drug-interaction studies of DHEA in menopausal women were found. Because it is converted into estrogens and testosterone (Scheffers 2015), it adds to the effect of hormone therapy and can work against medicines that block those hormones.