Does DHEA help with night sweats during perimenopause?

DHEA is unlikely to be a direct or reliable treatment for night sweats during perimenopause, though it may help indirectly in some women. Night sweats are vasomotor symptoms driven primarily by the decline of estrogen, which disrupts the hypothalamic thermostat. DHEA can convert to estrogen in peripheral tissues, and theoretically some of that conversion could partially dampen vasomotor activity. But the evidence for DHEA specifically reducing hot flashes and night sweats is weak and inconsistent compared to estrogen therapy or even some non-hormonal options.

Clinical trials looking at DHEA and vasomotor symptoms have produced mostly disappointing results. A 2006 randomized controlled trial published in the Annals of the New York Academy of Sciences found no significant reduction in hot flash frequency with DHEA compared to placebo. Some researchers have noted that DHEA's conversion to estrogen happens mainly in peripheral tissues like skin and fat, not at the central thermoregulatory level where vasomotor symptoms originate. A small number of women in various studies have reported subjective improvement in night sweats, but those reports are difficult to separate from placebo effects and general hormonal improvements in wellbeing.

Perimenopause night sweats are particularly disruptive because they fragment sleep, which then worsens every other symptom, including mood, cognition, and energy. The estrogen decline responsible for night sweats is the same hormonal shift that DHEA might partially compensate for through peripheral conversion. However, the conversion rate from DHEA to estrogen is highly variable between individuals and is influenced by body composition, genetics, and overall hormonal environment. Women with more adipose tissue tend to convert more DHEA to estrogen peripherally, which may explain why some women report benefit while others notice nothing.

For oral DHEA in the context of vasomotor symptoms, studies have used doses ranging from 25 to 50 mg per day. Studies have used 25 mg as a commonly tested starting dose. Talk to your healthcare provider about whether DHEA makes sense for your vasomotor symptoms specifically or whether a better-supported treatment might be more appropriate. Vaginal DHEA (Intrarosa) is not the right format for addressing night sweats, as its action is primarily local. If estrogen conversion is the hoped-for mechanism, oral DHEA is the relevant route.

If night sweats are your primary symptom, DHEA is probably not your best first option. Clinically, the most effective non-pharmaceutical approaches include cooling sleep environment strategies, avoiding triggers (alcohol, spicy food, caffeine near bedtime), and stress reduction. For supplements, black cohosh has more direct vasomotor evidence. For significant night sweats, low-dose hormone therapy has the strongest evidence of all. Do not add DHEA to an existing hormone therapy regimen without your provider's knowledge. 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. Get a DHEAS blood level tested before starting so you and your provider know whether your levels are actually low. Androgenic side effects including acne, oily skin, facial hair growth, scalp hair thinning, and voice changes can occur. OTC availability does not make DHEA safe to self-dose.

If DHEA is going to influence night sweats at all, you would likely notice changes within 8 to 12 weeks. Given the weak evidence, it is worth being honest with yourself about whether you are seeing a real change or hoping for one. Rating the severity and frequency of night sweats on a simple daily scale before starting and throughout your trial period gives you the clearest read on whether it is doing anything.

See a doctor if your night sweats are drenching (soaking your sheets or pajamas), if they are accompanied by fever, weight loss, or swollen glands (which can signal conditions unrelated to perimenopause), or if they are severe enough to significantly disrupt your sleep most nights. Severe vasomotor symptoms are one of the clearest indications for hormone therapy, which is far better supported by evidence than any supplement for this specific symptom.

Tracking the frequency and intensity of night sweats alongside sleep quality gives you data your doctor can use. The PeriPlan app (https://apps.apple.com/app/periplan/id6740066498) lets you log night sweats, sleep disruption, and other symptoms daily so you can see whether patterns improve with any intervention and share that record with your provider.

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