Evidence explainerWomen's Libido & Hormones
DHEA for Women: Libido, Menopause and Side Effects, Oral Pills vs the Vaginal Insert
Oral DHEA is sold as a supplement for libido, energy and aging. Pooled trials found little or no benefit and more acne. The one FDA-approved form is a low-dose vaginal insert for painful sex after menopause.
Key takeaways
- DHEA is a hormone precursor the body converts to testosterone and estrogens [2].
- In a meta-analysis of 23 randomized trials (1,188 postmenopausal women), oral or systemic DHEA did not significantly improve libido or sexual function, and the evidence was low confidence [1].
- A Cochrane review of 28 trials (1,273 women) found no improvement in quality of life, a possible small gain in sexual function, and more androgenic side effects, mainly acne (odds ratio 3.77) [2].
- The Endocrine Society recommends against routine DHEA use in women because of limited data on effectiveness and safety [3].
- Intrarosa (prasterone 6.5 mg vaginal insert, nightly) is FDA-approved for moderate to severe pain with sex due to menopause [4].
What DHEA is
Dehydroepiandrosterone (DHEA) levels decline with age [1]. It is a precursor: the body converts it into testosterone and estrogens, which is the rationale for taking it in menopause [2].
In the US, oral DHEA is sold as a dietary supplement. The FDA does not have the authority to approve dietary supplements before they are marketed and does not test them before they are sold [5]. 7-keto-DHEA is a different supplement; see our 7-keto-DHEA monograph.
Oral DHEA: what the pooled trials show
A 2014 systematic review commissioned for the Endocrine Society pooled 23 randomized trials with 1,188 postmenopausal women with normal adrenal function. DHEA was not associated with a significant improvement in libido or sexual function (standardized mean difference 0.35, confidence interval -0.02 to 0.73), and had no significant effect on lipids, glucose, weight or bone density [1]. The authors rated the evidence low confidence because of imprecision, bias and inconsistent results [1].
A 2015 Cochrane review of 28 trials (1,273 women) reached a similar view: no improvement in quality of life, uncertainty about menopausal symptoms, and possibly a slight improvement in sexual function (standardized mean difference 0.31) [2]. When oral DHEA was analyzed on its own, the sexual-function effect was not significant (0.11, confidence interval -0.13 to 0.35) [2].
The Endocrine Society guideline recommends against the routine use of DHEA in women, citing limited data on effectiveness and safety [3]. The 2019 global consensus statement on testosterone goes further for low desire: systemic DHEA cannot be recommended for women with hypoactive sexual desire disorder [7].
Side effects
Because DHEA converts to androgens, the Cochrane review found more androgenic side effects, mainly acne, than placebo (odds ratio 3.77, 5 studies, 376 women) [2]. No other adverse-effect associations were found in that review, but trials were short and small [2].
Supplement doses are set by the manufacturer, and FDA does not routinely analyze what supplements contain [5]. That makes the dose in a bottle less predictable than in a prescription product.
Vaginal DHEA (Intrarosa): the FDA-approved form
Intrarosa (prasterone) is a 6.5 mg vaginal insert used once daily at bedtime, approved for moderate to severe dyspareunia (pain with sex), a symptom of vulvar and vaginal atrophy due to menopause [4]. Its first pivotal trial enrolled 255 postmenopausal women aged 40 to 75 [4].
The most common side effect in the 12-week trials was vaginal discharge; in a 52-week open-label trial, vaginal discharge and abnormal Pap smears were most common [4]. Because estrogen is a metabolite of prasterone, the label warns about use in women with current or past breast cancer, a group it was not studied in [4].
The 2022 hormone therapy position statement lists vaginal DHEA alongside low-dose vaginal estrogen as an option for genitourinary symptoms not relieved by over-the-counter products [6].
Where that leaves you
Some telehealth menopause services prescribe oral DHEA for libido. The pooled trials above are the evidence behind that use; ask what result to expect and how it will be monitored.
- For low desire, the treatments with the most trial data are covered in our low libido in women guide.
- For pain with sex after menopause, vaginal DHEA or vaginal estrogen are the evidence-based routes [4][6].
- For hot flashes and night sweats, hormone therapy is the most effective treatment [6]; see our menopause hub.
- DHEA for fertility is a separate question this page does not cover.
Quick answers
Does DHEA increase libido in women?
Not reliably. A meta-analysis of 23 trials found no significant improvement in libido or sexual function in postmenopausal women [1], and a Cochrane review found at most a slight improvement, not significant for oral DHEA on its own [2].
What are the side effects of DHEA for women?
Androgenic effects, mainly acne, were more common than with placebo in a Cochrane review (odds ratio 3.77) [2]. The vaginal insert's most common side effect was vaginal discharge [4].
What dose of DHEA do women take?
There is no FDA-approved oral DHEA dose for women; supplement doses are chosen by manufacturers [5]. The only FDA-approved DHEA product for women is the 6.5 mg vaginal insert used nightly for painful sex after menopause [4].
Is DHEA cream the same as the vaginal insert?
No. The FDA-approved product is Intrarosa, a 6.5 mg vaginal insert studied for painful sex after menopause [4]. Oral DHEA sold as a supplement is not FDA-approved [5]; ask how any DHEA cream you are offered is made and regulated.
Is DHEA safe after breast cancer?
The Intrarosa label notes that estrogen is a metabolite of prasterone, that estrogen is contraindicated with a history of breast cancer, and that it was not studied in women with breast cancer [4]. Ask your oncology team.
More in Women's Libido & Hormones
References
- [1]Clinical review: The benefits and harms of systemic dehydroepiandrosterone (DHEA) in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab, 2014.
- [2]Dehydroepiandrosterone for women in the peri- or postmenopausal phase. Cochrane Database Syst Rev, 2015.
- [3]Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 2014.
- [4]Intrarosa (prasterone) vaginal inserts prescribing information. DailyMed, U.S. National Library of Medicine, 2026.
- [5]Questions and answers on dietary supplements. U.S. Food and Drug Administration, 2026.
- [6]The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 2022.
- [7]Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab, 2019.