Does DHEA help with hot flashes during perimenopause?

DHEA (dehydroepiandrosterone) is a precursor hormone that converts into estrogen and testosterone in body tissues. Since hot flashes are primarily driven by declining estrogen and its effect on the hypothalamic thermostat, DHEA has been studied as an indirect route to supporting estrogen levels. The evidence for oral DHEA specifically reducing hot flash frequency is limited and inconsistent, though vaginal DHEA has shown more credible benefits and has an important distinction from oral forms.

Several small to medium trials have examined oral DHEA for vasomotor symptoms with mixed results. A 2009 randomized trial found that oral DHEA at 50 mg daily did not significantly reduce hot flash frequency compared to placebo in postmenopausal women. Other research has found modest reductions in hot flash severity rather than frequency with DHEA supplementation. The challenge is that DHEA's conversion to estrogen is variable across individuals and tissues, and the systemic estrogen boost from oral DHEA is typically smaller than what you would get from conventional low-dose estrogen therapy. For women whose hot flashes are severe, oral DHEA is unlikely to be sufficient. For women with milder flashes who also want support for other DHEA-deficiency symptoms, it may be worth discussing with a provider.

Vaginal DHEA (Intrarosa) is a different story when it comes to evidence, though its effects on hot flashes are localized and indirect. Intrarosa is FDA-approved for vaginal dryness and pain with intercourse from genitourinary syndrome of menopause, and trials have shown consistent improvement in these symptoms. Interestingly, some Intrarosa trial participants also reported reductions in vasomotor symptoms, though this was not a primary endpoint and the evidence is not strong enough to use vaginal DHEA as a hot flash treatment specifically. The systemic estrogen absorption from vaginal DHEA is very low, which is why it is approved for use in women with a history of hormone-sensitive cancers in some contexts.

For hot flashes, studies have used oral DHEA at 25 to 50 mg daily, with some researchers using lower doses of 10 to 25 mg in women with better baseline DHEA-S levels. Since DHEA is a precursor rather than a direct estrogen source, its vasomotor effect is contingent on how efficiently your tissues convert it. Get your baseline DHEA-S blood level tested before starting supplementation. Self-dosing without knowing your baseline is risky because overshooting into androgen excess is a real possibility. Talk to your healthcare provider about whether your hormone levels support a DHEA trial and whether other options are more appropriate for your hot flash burden.

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 occur: 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 disrupt your carefully calibrated hormone balance. Over-the-counter availability does not mean DHEA is safe to self-dose.

If you trial oral DHEA for hot flashes, allow eight to twelve weeks before drawing conclusions. The conversion process to estrogen takes time to stabilize, and effects on vasomotor symptoms, if they occur, are typically modest and gradual. Many women find DHEA more useful for improving libido, vaginal dryness, and mood than for directly addressing hot flashes. Other options with stronger vasomotor evidence include low-dose estrogen therapy, certain SSRIs and SNRIs, and fezolinetant (a non-hormonal prescription option), all worth discussing with your provider.

See a doctor if your hot flashes are happening more than seven times per day, significantly disrupting your sleep, or affecting your ability to work or function socially. This level of severity warrants prescription options, not supplement trials. Also see a provider if you have not had a review of your cardiovascular risk and bone density, as these are the most important medical concerns associated with perimenopause beyond symptom management.

Logging your hot flash frequency and intensity alongside cycle phase, sleep quality, alcohol and caffeine intake, and stress level using the PeriPlan app gives you and your provider real data on your patterns and what may be making them better or worse. Download PeriPlan 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.