Prasterone (DHEA) Inserts: A GSM Option
SavePrasterone (Intrarosa) is a nightly vaginal insert of DHEA that vaginal tissue converts into small amounts of estrogen and testosterone. It eases the dryness and painful sex of genitourinary syndrome of menopause, working locally with little absorption into the bloodstream — one of several GSM options [1].
Last updated: July 2026
What is prasterone and how does it work?
Prasterone is the drug name for a vaginal insert containing DHEA (dehydroepiandrosterone), a natural hormone precursor. Once placed, vaginal and vulvar cells convert it locally into small amounts of estrogen and androgen, which thicken thinning tissue and restore moisture and acidity 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Prasterone as a low-absorption, locally acting option for genitourinary syndrome of menopause; GSM symptom cluster, its tendency to persist rather than fade, its prevalence in postmenopausal women, and that GSM is treatable at any stage and rarely resolves on its own.. Because the conversion happens inside the tissue, blood hormone levels change very little — a key reason it is grouped with other low-absorption vaginal dryness after menopause treatments rather than with whole-body systemic hormone therapy 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Prasterone as a low-absorption, locally acting option for genitourinary syndrome of menopause; GSM symptom cluster, its tendency to persist rather than fade, its prevalence in postmenopausal women, and that GSM is treatable at any stage and rarely resolves on its own.. It comes as a small insert used once nightly at bedtime, and effects build over roughly 6 to 12 weeks rather than overnight 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Prasterone as a low-absorption, locally acting option for genitourinary syndrome of menopause; GSM symptom cluster, its tendency to persist rather than fade, its prevalence in postmenopausal women, and that GSM is treatable at any stage and rarely resolves on its own..
What does prasterone treat?
Prasterone is approved for moderate to severe pain with sex caused by GSM, the cluster of changes that follow the drop in estrogen after menopause. GSM covers vaginal dryness, burning, itching, painful sex, and urinary urgency, and unlike hot flashes it tends to persist or worsen over time rather than fade 2Ref 2MedlinePlus (National Library of Medicine) (2026).Hormone Replacement Therapy.Consumer-facing overview of genitourinary syndrome of menopause and the local vaginal treatments used for its dryness and painful sex.. According to national estimates, GSM affects up to about 50% of postmenopausal women, yet only a minority raise it with a clinician 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Prasterone as a low-absorption, locally acting option for genitourinary syndrome of menopause; GSM symptom cluster, its tendency to persist rather than fade, its prevalence in postmenopausal women, and that GSM is treatable at any stage and rarely resolves on its own.. Prasterone targets the local tissue changes directly, which is why it helps painful sex and dryness but does nothing for whole-body symptoms like hot flashes. Improvement in comfort and tissue health is usually clear within about 12 weeks 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Prasterone as a low-absorption, locally acting option for genitourinary syndrome of menopause; GSM symptom cluster, its tendency to persist rather than fade, its prevalence in postmenopausal women, and that GSM is treatable at any stage and rarely resolves on its own..
How does prasterone compare with vaginal estrogen?
Vaginal estrogen and prasterone are close cousins: both act locally, both need regular use, and both keep systemic absorption low 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Prasterone as a low-absorption, locally acting option for genitourinary syndrome of menopause; GSM symptom cluster, its tendency to persist rather than fade, its prevalence in postmenopausal women, and that GSM is treatable at any stage and rarely resolves on its own.. A Cochrane review of local estrogen for vaginal atrophy found creams, tablets, and the ring all relieve dryness and painful sex effectively, giving prasterone a well-studied benchmark to sit beside 3Ref 3Lethaby A, Ayeleke RO, Roberts H (2016).Local oestrogen for vaginal atrophy in postmenopausal women.Systematic-review evidence that local vaginal estrogen (creams, tablets, and the ring) effectively relieves vaginal dryness and painful sex, providing the benchmark prasterone sits beside.. The practical differences are format and labeling — prasterone is a DHEA insert rather than an estrogen, which some women prefer, while vaginal estrogen comes in at least 3 forms and has decades of use behind it 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Prasterone as a low-absorption, locally acting option for genitourinary syndrome of menopause; GSM symptom cluster, its tendency to persist rather than fade, its prevalence in postmenopausal women, and that GSM is treatable at any stage and rarely resolves on its own.. Head-to-head data are limited, so choice often comes down to preference, cost, and how a person responds. An oral alternative, ospemifene, suits those who would rather avoid vaginal products altogether 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Prasterone as a low-absorption, locally acting option for genitourinary syndrome of menopause; GSM symptom cluster, its tendency to persist rather than fade, its prevalence in postmenopausal women, and that GSM is treatable at any stage and rarely resolves on its own..
Is prasterone safe if you have had breast cancer?
A history of hormone-sensitive breast cancer makes any vaginal hormone product a more careful decision. For survivors, ACOG advises trying non-hormonal moisturizers used 2 to 3 times a week and lubricants first, and reserving low-dose vaginal estrogen or prasterone for when those fall short — ideally in consultation with the oncology team 4Ref 4American College of Obstetricians and Gynecologists (2016).The Use of Vaginal Estrogen in Women With a History of Estrogen-Dependent Breast Cancer.For women with a history of estrogen-dependent breast cancer, non-hormonal moisturizers and lubricants first-line and reserving low-dose vaginal estrogen or prasterone, decided together with the oncology team.. Because prasterone produces small amounts of both estrogen and androgen in the tissue, long-term cancer-safety data are still limited 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Prasterone as a low-absorption, locally acting option for genitourinary syndrome of menopause; GSM symptom cluster, its tendency to persist rather than fade, its prevalence in postmenopausal women, and that GSM is treatable at any stage and rarely resolves on its own.. Low estrogen is not only a post-menopause story: similar tissue dryness can appear during breastfeeding or with premature ovarian insufficiency years earlier, so GSM-type symptoms are worth naming at any age 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Prasterone as a low-absorption, locally acting option for genitourinary syndrome of menopause; GSM symptom cluster, its tendency to persist rather than fade, its prevalence in postmenopausal women, and that GSM is treatable at any stage and rarely resolves on its own.. Anyone weighing prasterone after cancer benefits from a shared decision with both gynecology and oncology 4Ref 4American College of Obstetricians and Gynecologists (2016).The Use of Vaginal Estrogen in Women With a History of Estrogen-Dependent Breast Cancer.For women with a history of estrogen-dependent breast cancer, non-hormonal moisturizers and lubricants first-line and reserving low-dose vaginal estrogen or prasterone, decided together with the oncology team..
When GSM symptoms need a gynecologist
A gynecologist or a primary care clinician comfortable with menopause can confirm that symptoms are from GSM rather than an infection or skin condition, and match the format — insert, cream, ring, or pill — to your preferences and history. According to the Menopause Society, GSM is treatable at any stage and rarely improves on its own, so raising it is worthwhile even years after menopause 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Prasterone as a low-absorption, locally acting option for genitourinary syndrome of menopause; GSM symptom cluster, its tendency to persist rather than fade, its prevalence in postmenopausal women, and that GSM is treatable at any stage and rarely resolves on its own.. New bleeding, pain, or discharge alongside dryness is a reason to be seen rather than to self-treat. A brief medication review also helps rule out interactions before starting.
Common questions
Related
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Ospemifene: An Oral Option for GSM PainMenopause & midlife
GSM: The Menopause Syndrome Nobody MentionsMenopause & midlife
Painful Sex After Menopause: What Actually Helps
Say it back
How would you explain this to someone you love?
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When to check in about vaginal symptoms
- —Vaginal bleeding after menopause, even light spotting, is a reason to be evaluated before starting or continuing any hormone product.
- —New pelvic or vaginal pain, sores, or unusual discharge is a reason to seek clinician review rather than self-treating.
- —A personal history of breast or other hormone-sensitive cancer is a reason to decide about prasterone together with your gynecology and oncology teams.
- —Symptoms that do not improve after about 12 weeks of consistent use are a reason to revisit the plan with a clinician.
This article is general health education, not medical advice. Whether prasterone fits your situation is a decision to make with a gynecologist or a clinician experienced in menopause who knows your health history.
References
- 1.The North American Menopause Society (Menopause Society) (2020). The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. doi:10.1097/GME.0000000000001609 ✓Prasterone as a low-absorption, locally acting option for genitourinary syndrome of menopause; GSM symptom cluster, its tendency to persist rather than fade, its prevalence in postmenopausal women, and that GSM is treatable at any stage and rarely resolves on its own.
- 2.MedlinePlus (National Library of Medicine) (2026). Hormone Replacement Therapy. MedlinePlus, U.S. National Library of Medicine (NIH). link ✓Consumer-facing overview of genitourinary syndrome of menopause and the local vaginal treatments used for its dryness and painful sex.
- 3.Lethaby A, Ayeleke RO, Roberts H (2016). Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD001500.pub3 ✓Systematic-review evidence that local vaginal estrogen (creams, tablets, and the ring) effectively relieves vaginal dryness and painful sex, providing the benchmark prasterone sits beside.
- 4.American College of Obstetricians and Gynecologists (2016). The Use of Vaginal Estrogen in Women With a History of Estrogen-Dependent Breast Cancer. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000001351 ✓For women with a history of estrogen-dependent breast cancer, non-hormonal moisturizers and lubricants first-line and reserving low-dose vaginal estrogen or prasterone, decided together with the oncology team.
4 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy