DHEA and Perimenopause: What It Is and What the Research Shows

A Hormone Most People Have Never Heard Of

DHEA (dehydroepiandrosterone) does not get the same attention as estrogen or progesterone, but it is the most abundant circulating steroid hormone in the human body. Your adrenal glands produce most of it, and your ovaries contribute a portion as well.

What makes DHEA different is that it is a precursor hormone. Your body converts it into other hormones, including testosterone and estrogen, in various tissues. This means its effects are broad and somewhat indirect.

Levels of DHEA peak in your mid-twenties and decline steadily from there. By the time you are in your forties and fifties, levels can be less than half of what they were at peak. This decline is one reason DHEA supplements and medications have attracted significant research interest.

What DHEA Does in the Body

Because DHEA converts into both testosterone and estrogen locally within tissues, its effects are wide-ranging. Libido, energy, mood, and vaginal tissue health are among the areas most studied.

In tissues that have the right enzymes, DHEA can be converted into testosterone, supporting sexual desire and physical energy. In other tissues, it converts to estrogen. The conversion varies by tissue type, which means DHEA may have estrogen effects in some areas of the body without producing the same systemic estrogen exposure as a patch or pill.

DHEA also appears to have its own receptors in certain tissues, including the brain, suggesting some effects may not depend entirely on its conversion to other hormones.

Why DHEA Declines During Perimenopause

The decline in DHEA is primarily age-related rather than being caused by perimenopause specifically. Your adrenal glands begin producing less DHEA in your late twenties, and this reduction continues steadily into your fifties and beyond.

During perimenopause, the loss of ovarian DHEA production adds to the adrenal decline. Stress also suppresses adrenal DHEA production, which is worth noting because the perimenopause years are often a high-stress period in many people's lives.

The result is that by mid-perimenopause, you may have significantly lower DHEA than you did a decade earlier. This contributes to a downstream reduction in the testosterone and estrogen that tissues rely on DHEA to produce.

Oral DHEA Supplements: What to Know

DHEA is available over the counter in the United States as a dietary supplement. This is unusual, since most hormones require a prescription. Doses sold in pharmacies and health food stores typically range from 25 mg to 100 mg, though the research on appropriate dosing for perimenopausal women is not settled.

Some studies show that oral DHEA supplementation improves sexual function, sense of wellbeing, and bone density in older women. Others show modest or inconsistent effects. The variation in results likely reflects differences in dosing, the populations studied, and individual variation in how well different people convert DHEA.

Because oral DHEA converts in the liver and elsewhere, it produces systemic testosterone and estrogen. This matters for people with hormone-sensitive conditions or specific health histories. Starting at a low dose, such as 25 mg, and working with a provider to monitor levels and effects is a more informed approach than self-dosing at higher amounts.

Vaginal DHEA: A Different Application

The most rigorously studied use of DHEA specifically for perimenopausal and menopausal women is intravaginal application. Prasterone, the pharmaceutical form of DHEA, is FDA-approved under the brand name Intrarosa for treating dyspareunia, which means pain during sex caused by vaginal tissue changes.

Intravaginal DHEA works because vaginal tissue contains the enzymes needed to convert DHEA locally into both testosterone and estrogen. This local conversion restores tissue health, including lubrication, elasticity, and pH, without producing the same level of systemic hormone exposure as oral or transdermal forms.

Clinical trials show that Intrarosa reduces pain during sex, improves vaginal dryness, and restores tissue integrity. Systemic hormone levels with vaginal DHEA are minimal, which makes it an option for people who have reasons to avoid systemic estrogen or testosterone.

DHEA and Libido: What the Evidence Shows

The connection between DHEA and libido is one of the more studied areas. Both oral DHEA and vaginal DHEA have been shown in clinical trials to improve sexual function, including desire and arousal, though the size of the benefit varies across studies.

For vaginal DHEA specifically, the improvement in libido appears connected both to the physical improvement in vaginal tissue (making sex less uncomfortable) and to direct hormonal effects on desire. The HYDRA trial and other research on prasterone showed significant improvements in sexual desire, arousal, lubrication, and satisfaction compared to placebo.

For oral DHEA, evidence on libido in perimenopausal women is more mixed. Some trials show benefit, others show modest effects. The best evidence tends to be in postmenopausal women rather than those in the transition years specifically.

Safety Considerations and Who Should Be Cautious

DHEA is not without considerations. Because it converts to both testosterone and estrogen, it shares some of the same safety questions associated with those hormones.

For people with a personal history of hormone-sensitive breast cancer or certain other hormone-sensitive conditions, DHEA supplementation is a conversation to have carefully with a provider, not a self-treatment decision. Vaginal DHEA produces minimal systemic hormone levels and has been studied in some women with a history of breast cancer, but guidance in that group is still evolving.

At higher oral doses, side effects can include acne, oily skin, and unwanted hair growth, reflecting its conversion to testosterone. Testing DHEA-S levels (the sulfate form, which is what blood tests measure) before starting and after a few months is a reasonable way to understand your baseline and track effects with your provider's guidance.

How to Talk to Your Provider About DHEA

If vaginal dryness, pain during sex, or libido changes are among your most significant symptoms, vaginal DHEA (prasterone/Intrarosa) is a well-supported, FDA-approved option worth asking about by name. Your gynecologist should be familiar with it. If they are not, that is useful information about whether they are current on perimenopause treatment options.

For oral DHEA, the conversation is more nuanced because it is a supplement and the research is more variable. A menopause specialist or an integrative medicine provider who follows hormone research can help you think through whether it makes sense for your situation and what monitoring would be appropriate.

PeriPlan's symptom tracking can help you arrive at that appointment with a clear record of what has been changing and when, which makes the clinical conversation more productive.

The Bottom Line

DHEA is a real hormone with real effects on libido, energy, vaginal health, and potentially mood and bone density. Its decline with age is a legitimate physiological change, not a niche concern.

The evidence is strongest for vaginal DHEA in addressing vaginal symptoms and pain during sex. For oral DHEA and broader symptom management, the picture is more variable and worth approaching with a provider's guidance rather than solo supplementation at high doses.

You deserve to have these options on the table in a real clinical conversation, not just discovered through late-night research.

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