DHEA and Perimenopause: A Guide to the Precursor Hormone That Often Gets Overlooked

What Is DHEA and Why Does It Matter in Perimenopause?

DHEA stands for dehydroepiandrosterone. It is a hormone produced primarily by your adrenal glands, with smaller amounts from the ovaries. DHEA is a precursor hormone, meaning it does not act strongly on its own but instead converts into other hormones, primarily estrogen and testosterone, in various tissues throughout your body. This conversion process happens inside cells in places like the skin, fat tissue, vaginal tissue, and bone, not just centrally.

DHEA levels peak in your mid-twenties and then decline steadily and significantly with age. By the time women are in their forties and fifties, DHEA levels can be 50 to 70 percent lower than peak levels. That decline happens independently of the ovarian hormone changes of perimenopause, though both processes are happening simultaneously, which compounds the hormonal shifts you are experiencing.

Because DHEA is a building block for both estrogen and testosterone, declining DHEA contributes to the broader hormonal decline of perimenopause. But it is worth understanding that DHEA's role is tissue-specific. The conversion of DHEA into active hormones happens locally within cells, which is different from systemic hormone therapy where a hormone circulates throughout the body. This local action is one of the reasons vaginal DHEA has become a clinically interesting option for genitourinary symptoms.

Vaginal DHEA (Intrarosa): What the Evidence Shows

The most well-supported use of DHEA in menopause care is a prescription vaginal product called prasterone, sold under the brand name Intrarosa. It was FDA-approved in 2016 specifically for moderate to severe dyspareunia, which is pain with sexual activity, related to vulvovaginal atrophy (VVA) in menopause.

Intrarosa is an ovule (a small suppository) inserted vaginally each night. The DHEA in it converts locally in vaginal tissues into both estrogen and testosterone. Clinical trials showed that women using Intrarosa had significant improvement in vaginal tissue health, lubrication, and pain with sex compared to placebo. In multiple 12-week trials, the drug improved pH, the proportion of superficial vaginal cells, and pain scores at levels comparable to topical vaginal estrogen. Importantly, blood levels of estrogen and testosterone increased only minimally above baseline, which is an appealing feature for women who cannot or do not want systemic hormones.

Because of that low systemic absorption, Intrarosa is considered an option for breast cancer survivors and women with hormone-sensitive cancer histories, though this should always be confirmed with your oncologist. The genitourinary benefits of vaginal DHEA are well-documented and represent a legitimate treatment option that many women and providers are still not fully aware of.

Oral DHEA Supplements: A More Complicated Picture

Walk into any health food store or pharmacy and you will find DHEA supplements on the shelf. They are sold over-the-counter, usually in doses ranging from 25 mg to 100 mg, and marketed with vague claims about aging and energy. The availability of DHEA as an unregulated supplement is a quirk of how the Dietary Supplement Health and Education Act of 1994 classified it, and it means you are buying a product that has not gone through FDA drug approval.

Does oral DHEA work for perimenopause symptoms? The evidence is genuinely mixed. Some studies show modest benefits for sexual function, wellbeing, and energy at doses in the 10 to 50 mg range. Others show little to no benefit over placebo. Part of the problem is that oral DHEA is rapidly metabolized, and how much actually converts to active hormones varies significantly from person to person based on individual enzyme activity. You cannot know your actual conversion rates without testing.

Dosing is also a real concern with over-the-counter DHEA. There is no standardized therapeutic dose for women because the appropriate dose depends on your current DHEA-S levels (the stable storage form measured in blood tests), your age, and your individual metabolic conversion. Taking too much oral DHEA can drive testosterone too high, leading to acne, oily skin, unwanted hair growth, and potentially more serious hormonal imbalances. The variability in supplement quality (potency, purity, and actual content versus label claims) adds another layer of uncertainty.

What "Adrenal Fatigue" Gets Wrong About DHEA

You have probably encountered the term adrenal fatigue in wellness spaces, often linked to DHEA. The concept proposes that chronic stress exhausts the adrenal glands, leading to low DHEA and a cascade of symptoms including fatigue, brain fog, and hormonal imbalance. The solution typically offered is DHEA supplementation combined with various other supplements.

Here is the problem: adrenal fatigue is not a recognized medical diagnosis. Endocrinologists, who are the specialists in adrenal function, do not accept it as a clinical entity. Adrenal insufficiency is a real and serious condition (also known as Addison's disease), but it is distinct from the vague, self-diagnosed adrenal fatigue marketed in wellness circles. True adrenal insufficiency is diagnosed with specific testing and treated under medical supervision, not with over-the-counter DHEA supplements.

That said, the real decline in DHEA with age is well documented and is not wellness mythology. What the evidence does not support is using DHEA supplementation casually without knowing your baseline levels, your conversion rates, or whether your symptoms are attributable to DHEA decline versus the many other hormonal and lifestyle factors in play during perimenopause. If you are interested in DHEA for your symptoms, starting with a lab workup (DHEA-S level at minimum) and a conversation with a knowledgeable provider is a much better approach than self-prescribing from a supplement aisle.

How DHEA Is Used in Medical Practice

In clinical practice, DHEA is used in a few different ways by providers who take it seriously. Some integrative gynecologists, functional medicine physicians, and menopause specialists measure DHEA-S levels as part of a comprehensive hormonal workup. If levels are low and symptoms align, they may recommend low-dose oral DHEA, typically 5 to 25 mg daily for women, with follow-up testing to confirm levels are reaching an appropriate range without going too high.

Some practitioners use DHEA as part of a broader hormone optimization approach alongside estrogen and/or testosterone. Because DHEA converts to both, it can be a gentler way to modestly support testosterone and estrogen levels in women who cannot tolerate or access direct testosterone or estrogen therapy. This is a more nuanced clinical approach than typical supplement use, and it depends heavily on monitoring.

For vaginal symptoms specifically, Intrarosa is increasingly recognized in mainstream menopause medicine as an underused but effective option. It is often not the first thing a provider mentions for dyspareunia or vaginal dryness, but it belongs in the toolkit alongside vaginal estrogen creams and rings. If vaginal discomfort is a significant concern for you, it is worth asking specifically whether vaginal DHEA is appropriate for your situation.

Who Might Benefit and Who Should Be Cautious

Women most likely to benefit from DHEA-focused treatment are those with documented low DHEA-S levels on lab testing, genitourinary symptoms that have not responded to lubrication alone, low libido that has not improved with other interventions, and in some cases women who cannot use systemic estrogen and need an alternative vaginal treatment.

Caution is warranted if you have a history of hormone-sensitive cancers. While the systemic absorption from Intrarosa is low, the question of whether any estrogen or testosterone exposure is safe for breast cancer survivors requires a conversation with your oncologist specifically. Self-prescribing oral DHEA if you are in this category is a significant risk.

Oral DHEA supplementation should also be approached carefully if you have any liver conditions, because DHEA is processed by the liver, and if you are already taking other hormonal medications, because the cumulative hormonal load matters. DHEA interacts with other hormones and medications in ways that a provider familiar with your full picture needs to evaluate.

Getting Tested and Having the Conversation

If you are curious about whether DHEA plays a role in what you are experiencing, the first step is a lab workup. DHEA-S (dehydroepiandrosterone sulfate) is the stable, circulating form measured in blood tests and gives a reliable picture of your DHEA status. This can be ordered by most primary care providers or gynecologists as part of a hormonal panel. Some providers who specialize in menopause or integrative medicine will include it routinely; others will not unless you ask.

When you bring this up, be specific about what you are hoping to address: vaginal symptoms, low libido, energy, or all of the above. Asking whether your DHEA-S level is appropriate for your age and symptoms opens the door to a more targeted conversation than simply asking for a supplement recommendation.

If you are already tracking symptoms with PeriPlan, your pattern data can be helpful in these conversations. Being able to show that low energy and low libido have been persistent for months gives your provider useful context for deciding whether hormonal investigation is warranted.

Medical Disclaimer

This article is for informational purposes only and does not constitute medical advice. DHEA supplementation, including both prescription vaginal DHEA and oral supplements, should be discussed with a qualified healthcare provider before use. DHEA affects hormone levels and interacts with other medications and health conditions. Women with a history of hormone-sensitive cancers should consult their oncologist specifically before using any DHEA product.

Information in this article reflects research and clinical guidance available as of early 2026.