Does DHEA help with low libido during perimenopause?

DHEA has some of the strongest evidence among supplements for low libido during perimenopause, particularly when the loss of desire is linked to genitourinary symptoms. Your body converts DHEA into both estrogen and testosterone, and testosterone is a key driver of sexual desire in women. As DHEA and estrogen production from the ovaries decline during perimenopause, desire, arousal, and vaginal comfort can all take a hit at the same time. Restoring DHEA levels may help address several of these threads at once.

The most compelling evidence is for vaginal DHEA. Intrarosa (prasterone 0.5%), a vaginal insert used daily, is FDA-approved specifically for moderate to severe dyspareunia (pain during sex) caused by menopause-related vulvovaginal atrophy. Clinical trials showed it improved vaginal tissue health, reduced pain with intercourse, and significantly improved sexual function scores including desire and arousal. A 2016 study published in the Journal of Sexual Medicine found that women using vaginal prasterone reported meaningful improvements in all four domains of sexual function measured. For oral DHEA, a systematic review published in Menopause (2018) found evidence of modest but real improvements in sexual function in postmenopausal women, particularly those who started with low baseline DHEAS levels.

Perimenopause creates a particular challenge for libido because it attacks desire from multiple angles at once. Falling estrogen thins and dries vaginal tissue, making sex uncomfortable or painful. Falling testosterone reduces the neurological drive for desire. Mood changes, poor sleep, and body image shifts pile on top of the physical changes. DHEA is notable in this context because it can address both the systemic hormonal piece (testosterone conversion supporting desire) and the local vaginal piece (Intrarosa directly restoring vaginal tissue). No other single supplement has FDA approval for any part of this picture.

For oral DHEA aimed at libido, studies have generally used 25 to 50 mg per day. Studies have used 25 mg as a reasonable starting point in perimenopausal women. Talk to your healthcare provider about the right dose for your specific situation. Vaginal Intrarosa is a prescription product dosed at one 6.5 mg insert nightly. It works locally with minimal systemic absorption, which makes it a lower-risk option for women concerned about systemic hormone exposure. Oral DHEA will raise DHEAS, testosterone, and estrogen levels in blood, which requires monitoring. Creams and sublingual formats exist but have less standardization in dosing and absorption.

DHEA pairs well with open communication with your partner and pelvic floor physical therapy if pain during sex is a component. Do not add DHEA to an existing hormone therapy regimen without telling your prescribing provider, since the combination can shift your hormone levels in unpredictable ways. 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. Androgenic side effects including acne, oily skin, facial hair growth, scalp hair thinning, and voice changes are possible, especially with oral forms. Get a DHEAS blood level tested before starting. OTC availability does not make DHEA safe to self-dose.

Women using Intrarosa vaginally often notice vaginal tissue changes within 4 to 6 weeks, with fuller benefits at 12 weeks. Improvements in desire with oral DHEA tend to take longer, often 8 to 12 weeks, because testosterone conversion and its effects on central desire are gradual processes. Be patient with the timeline and track your response. If pain during sex improves but desire does not follow, that is useful information to bring back to your provider.

See a doctor if low libido is causing significant distress in your relationship or your sense of self, if sex has become painful enough that you are avoiding it, or if you notice vaginal bleeding after intercourse (which can indicate atrophy or other issues that need evaluation). A pelvic exam can assess vaginal tissue health directly. Low libido can also have psychological, relational, and thyroid-related contributors that are worth ruling out alongside any DHEA supplementation.

Tracking changes in desire, arousal, and comfort over time helps you see whether an intervention is working. The PeriPlan app (https://apps.apple.com/app/periplan/id6740066498) lets you log daily symptoms and energy levels so you can see patterns across your cycle and across weeks of supplementation. Sharing those logs with your provider makes for a much more productive appointment.

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