DHEA Supplementation in Postmenopausal Women

Primary Recommendations

The American College of Obstetricians and Gynecologists recommends DHEA supplementation at 25 mg orally once daily in the morning for postmenopausal women with specific indications, such as vaginal atrophy, low libido, or low energy levels, particularly in those with adrenal insufficiency 1, 2, 3

The North American Menopause Society suggests that intravaginal DHEA is the most evidence-based indication, showing significant improvements in vaginal dryness, dyspareunia, sexual desire, arousal, and overall sexual function in postmenopausal women 4, 5, 2
The American College of Obstetricians and Gynecologists recommends that for women with hormone-positive breast cancer on aromatase inhibitors who have not responded to lubricants and moisturizers, vaginal DHEA may be offered after thorough discussion of risks and benefits 4, 5

The Endocrine Society recommends that women with primary adrenal insufficiency experiencing persistent low libido or low energy despite optimized glucocorticoid/mineralocorticoid replacement should receive 25 mg DHEA daily 3, 1

The standard starting dose is 25 mg orally once daily in the morning, with a dose range that can be adjusted between 10-50 mg daily based on clinical response and laboratory monitoring 1, 2, 3

The American College of Obstetricians and Gynecologists recommends implementing a 6-month trial period before determining long-term use, and evaluating treatment effect after 3-6 months 1, 3
Therapy should be continued only if the patient reports subjective improvement in target symptoms, and consideration should be given to limiting therapy to 24 months due to limited long-term safety data 1, 3

DHEA is generally contraindicated in breast cancer survivors due to potential risks of hormone-dependent cancers, and should be used with extreme caution in patients receiving aromatase inhibitor therapy 2, 3, 1
The American Society of Clinical Oncology recommends that women with BRCA1/2 mutations without personal history of breast cancer may consider DHEA after prophylactic bilateral salpingo-oophorectomy 3

The American College of Obstetricians and Gynecologists recommends not prescribing DHEA without establishing baseline hormone levels, and not ignoring signs of virilization, as these indicate excessive androgen exposure requiring immediate dose adjustment 1
For women on concurrent hormone therapy, recognize that DHEA and testosterone have additive effects, and monitor total androgen levels carefully 1