Vaginal
atrophy is a common symptom of postmenopausal
estrogen deficiency and can present as dryness, irritation,
infection and
dyspareunia and can affect sexual function and quality of life. Currently vaginal
atrophy is treated with the intravaginal application of preparations containing
estradiol or
estriol, which are both effective and safe. It has been proposed that intravaginally administered
dehydroepiandrosterone (
DHEA) can be used to treat vaginal
atrophy.
DHEA and its sulphate DHEAS are the most abundant circulating
sex steroid hormones in women, and provide a large precursor reservoir for the intracellular production of
androgens and
estrogens in non-reproductive tissues. Levels of
DHEA and DHEAS decline with age. Although there is some evidence to support the use of intravaginal
DHEA for postmenopausal women with symptoms of vaginal
atrophy, independent studies are required to confirm this. In addition studies regarding the effects of vaginal
DHEA on sexual function in women without vaginal
atrophy are needed. Given that the efficacy and long term safety of low dose vaginal
estradiol and
estriol therapy is well established and that vaginal
estrogen requires application of 2-3 times a week, rather than daily dosing; the benefit of daily vaginal
DHEA over
estrogen also needs to be considered as women may find it unpalatable to adhere to daily dosing with a cream preparation.