Does DHEA help with perimenopause symptoms?

DHEA can genuinely help with certain perimenopause symptoms, but it is not a broad solution for all of them. Your adrenal glands produce DHEA, which your body then converts into estrogen and testosterone. As you enter perimenopause, both ovarian hormone production and adrenal DHEA output begin declining. Supplementing DHEA can partially restore this hormonal raw material, but whether that helps your specific symptoms depends on which ones are bothering you, how low your levels actually are, and how well your body converts DHEA into the downstream hormones it produces.

The strongest evidence for DHEA in perimenopause falls into three areas. First, vaginal DHEA (Intrarosa, prasterone 0.5%) is FDA-approved for pain during sex caused by vulvovaginal atrophy, with robust clinical trial data showing improvement in vaginal tissue health and sexual function. Second, oral DHEA has reasonable evidence for improving libido and sexual satisfaction, particularly in women with documented low DHEAS levels. Third, DHEA supplementation has been shown in multiple studies to modestly improve bone mineral density, a meaningful benefit given that bone loss accelerates in the perimenopausal transition. For other symptoms, including mood, cognition, energy, and vasomotor symptoms, the evidence is more limited, mixed, or indirect.

Why DHEA matters specifically during perimenopause comes down to the convergence of multiple hormonal declines at once. The ovaries reduce estrogen and progesterone production, the adrenals produce less DHEA as a natural part of aging (a process called adrenopause), and the combination leaves the body with less hormonal raw material across the board. Women who enter perimenopause with already low DHEAS levels, which can be measured with a blood test, are more likely to benefit from supplementation. Women with normal DHEAS levels are less likely to see dramatic benefit and face the same risks as everyone else.

For general perimenopause support, oral DHEA studies have commonly used 25 to 50 mg per day. Studies have used 25 mg as a standard starting dose; some research used 50 mg. Talk to your healthcare provider about the right dose for your individual situation, particularly because the right dose depends on your baseline DHEAS level. Vaginal Intrarosa is prescription-only at 6.5 mg per insert nightly and is specifically for GSM symptoms. DHEA creams and sublingual formulations are available but have less standardized dosing. The oral capsule form with third-party testing is the most consistently studied format for systemic symptoms.

Before starting DHEA, get your DHEAS blood level tested. This single step makes the decision clearer and safer. Do not add DHEA to an existing hormone therapy regimen without your prescribing provider knowing. 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 can occur, particularly at higher doses or in women who are more sensitive to androgen effects. OTC availability does not mean DHEA is safe to self-dose or that more is better.

For symptoms where DHEA has good evidence, most women see meaningful changes within 8 to 12 weeks of consistent use. For vaginal symptoms with Intrarosa, tissue changes often begin within 4 to 6 weeks. Hormonal benefits are gradual. Do not expect immediate results, and do not assume no results after two weeks. Give it a full 12-week trial at a stable dose before deciding whether it is working.

See a doctor before starting DHEA, especially for significant perimenopause symptoms. A provider can measure your DHEAS levels, review your history for contraindications, and help you understand whether DHEA is the right tool or whether hormone therapy, other medications, or targeted non-hormonal approaches make more sense for your particular symptom picture. Perimenopause is a medical transition, not just a wellness phase, and you deserve a thoughtful clinical assessment.

Symptom tracking is one of the most valuable things you can do during perimenopause, whether you are using DHEA or not. The PeriPlan app (https://apps.apple.com/app/periplan/id6740066498) lets you track your symptoms day by day across your full cycle, so you can see which symptoms are hormonal, which are consistent, and how they shift with any intervention you try.

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