Does DHEA help with fatigue during perimenopause?

DHEA (dehydroepiandrosterone) is a hormone produced by the adrenal glands that declines steadily with age, reaching roughly half its peak level by your mid-40s. Since it converts into both estrogen and testosterone and has direct neurosteroid activity, declining DHEA can contribute to the low energy and persistent tiredness many women experience during perimenopause. The evidence for DHEA helping with fatigue exists, but its strength depends heavily on the cause of your fatigue and your baseline DHEA-S levels.

The best evidence for DHEA improving fatigue comes from studies in people with adrenal insufficiency, where DHEA levels are clinically low. In these populations, DHEA supplementation consistently improves energy, mood, and sense of wellbeing. The picture is less clear for healthy perimenopausal women with normal-to-low-normal DHEA-S levels. A 2006 randomized trial in healthy older adults found that DHEA supplementation improved quality of life and reduced fatigue in women more than in men. A review published in Menopause found that DHEA had beneficial effects on mood and wellbeing in perimenopausal women, though the studies were heterogeneous and not all focused specifically on fatigue as a primary outcome. Some research suggests the effect is modest in women who still have functional ovarian activity, and larger in those who are fully postmenopausal.

The cortisol-DHEA ratio is an important concept here. Cortisol and DHEA are both produced by the adrenal glands, and they tend to counterbalance each other: cortisol is catabolic and stimulating under stress, while DHEA has more anabolic and mood-stabilizing effects. As DHEA declines with age, while cortisol often stays elevated or rises due to chronic stress, the ratio shifts in a direction that can amplify fatigue, mood changes, and reduced resilience. During perimenopause, sleep disruption further elevates cortisol, compounding the problem. DHEA supplementation may help restore a better cortisol-DHEA balance, though this mechanism has not been confirmed in large trials of perimenopausal fatigue specifically.

Studies examining DHEA for energy and wellbeing in middle-aged and older women have typically used oral doses of 25 to 50 mg daily. Some trials have used 10 to 25 mg in participants with better baseline levels. Vaginal DHEA (Intrarosa, 6.5 mg nightly) is FDA-approved for vaginal symptoms with minimal systemic absorption, making it less relevant for fatigue. Because DHEA is a hormone precursor, the right dose is highly individual. Get your DHEA-S blood level tested before starting. Self-dosing without knowing your baseline risks overshooting and creating androgen excess. Talk to your healthcare provider about whether your levels support a trial and what dose makes sense.

If you have or have had breast cancer, ovarian cancer, uterine cancer, endometriosis, PCOS, or uterine fibroids, do not use DHEA without discussing it with your healthcare provider first. At higher doses, androgenic side effects can develop: acne, oily skin, unwanted facial hair, scalp hair loss, and voice changes. If you are already using hormone therapy, adding DHEA without your provider's knowledge can shift your hormone balance unpredictably. Over-the-counter availability does not mean DHEA is safe to self-dose.

If you trial DHEA, some women notice improved energy and resilience within four to six weeks, particularly if fatigue is tied to low adrenal reserve or a notably low DHEA-S baseline. Others notice little change, especially when fatigue is driven primarily by sleep disruption, thyroid dysfunction, iron deficiency, or depression. Treating fatigue as a single-cause problem is rarely effective. Addressing sleep quality, ruling out thyroid or iron issues, and managing stress alongside any hormonal support tends to produce better results than any single supplement.

See a doctor about fatigue that does not improve with reasonable sleep hygiene, that is severe enough to interfere with daily functioning, or that has come on suddenly. Perimenopause-related fatigue is real, but fatigue can also signal hypothyroidism, anemia, depression, blood sugar dysregulation, autoimmune conditions, or sleep apnea, all of which become more common around this life stage. Blood work is worth it.

Tracking your energy level on a 1 to 10 scale each morning alongside sleep hours, cycle phase, and stress level gives you actionable patterns within two to four weeks. The PeriPlan app lets you log all of these variables together, making it much easier to identify whether your fatigue is consistent or tied to specific triggers. Download it at https://apps.apple.com/app/periplan/id6740066498.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.