Prasterone (Vaginal DHEA): How It Helps
SavePrasterone (Intrarosa) is a nightly vaginal insert of DHEA that local cells convert into estrogen and androgen, rebuilding tissue thinned by menopause. Trials show it eases moderate-to-severe painful sex better than placebo, with little change in blood hormone levels — an option for those avoiding direct estrogen.
Last updated: July 2026
What is prasterone and how does it work?
Prasterone is a synthetic form of DHEA, a hormone the body normally makes and then converts into estrogens and androgens. Placed in the vagina each night, the insert lets local cells carry out that conversion right where tissue has thinned 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.The North American Menopause Society 2020 genitourinary syndrome of menopause position statement describes prasterone (vaginal DHEA) as an FDA-approved therapy for moderate-to-severe dyspareunia, converted locally to estrogens and androgens with minimal systemic change, and improving pain with intercourse versus placebo in trials.. The result is more estrogen and androgen acting on vaginal and vulvar tissue, with only small changes in the bloodstream 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.The North American Menopause Society 2020 genitourinary syndrome of menopause position statement describes prasterone (vaginal DHEA) as an FDA-approved therapy for moderate-to-severe dyspareunia, converted locally to estrogens and androgens with minimal systemic change, and improving pain with intercourse versus placebo in trials.. Prasterone is approved for moderate-to-severe painful sex linked to the genitourinary syndrome of menopause, which affects up to 1 in 2 postmenopausal women 2Ref 2American College of Obstetricians and Gynecologists (2019).Female Sexual Dysfunction: ACOG Practice Bulletin, Number 213.ACOG Practice Bulletin 213 identifies genitourinary syndrome of menopause as a common, treatable cause of painful sex and distinguishes sexual pain from low desire.. Its dual estrogen-and-androgen action is what sets it apart from vaginal estrogen, which supplies estrogen alone. Both aim to reverse the same underlying tissue change rather than mask it.
How well does prasterone work for painful sex?
Prasterone improved pain with intercourse more than a placebo insert in the trials that led to its approval, according to menopause society guidance 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.The North American Menopause Society 2020 genitourinary syndrome of menopause position statement describes prasterone (vaginal DHEA) as an FDA-approved therapy for moderate-to-severe dyspareunia, converted locally to estrogens and androgens with minimal systemic change, and improving pain with intercourse versus placebo in trials.. Alongside less pain, studies reported healthier vaginal tissue on examination and better moisture over roughly 12 weeks of nightly use 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.The North American Menopause Society 2020 genitourinary syndrome of menopause position statement describes prasterone (vaginal DHEA) as an FDA-approved therapy for moderate-to-severe dyspareunia, converted locally to estrogens and androgens with minimal systemic change, and improving pain with intercourse versus placebo in trials.. The Endocrine Society and menopause specialists list it among evidence-based treatments for genitourinary symptoms, alongside low-dose vaginal estrogen 3Ref 3Stuenkel CA, et al. (Endocrine Society) (2015).Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline.The Endocrine Society clinical practice guideline lists evidence-based local treatments for genitourinary symptoms of menopause alongside low-dose vaginal estrogen.. Benefits build gradually rather than overnight, since the tissue needs time to rebuild. For women whose main problem is sexual pain rather than low desire, a local tissue treatment addresses the physical cause directly 2Ref 2American College of Obstetricians and Gynecologists (2019).Female Sexual Dysfunction: ACOG Practice Bulletin, Number 213.ACOG Practice Bulletin 213 identifies genitourinary syndrome of menopause as a common, treatable cause of painful sex and distinguishes sexual pain from low desire.. It does not treat hot flashes or other whole-body symptoms of menopause.
How does prasterone compare with other options?
Prasterone is one of several proven treatments for painful sex after menopause, not the only one. Low-dose vaginal estrogen, reviewed in Cochrane analyses, relieves dryness and painful sex effectively and remains a first-line choice 4Ref 4Lethaby A, Ayeleke RO, Roberts H (2016).Local oestrogen for vaginal atrophy in postmenopausal women.This Cochrane review found low-dose vaginal estrogen relieves vaginal atrophy symptoms, including dryness and painful sex, more effectively than placebo, supporting it as a first-line comparator.. Prasterone appeals to women who prefer a single nightly insert or want the added androgen effect, while vaginal estrogen comes in creams, tablets, and rings 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.The North American Menopause Society 2020 genitourinary syndrome of menopause position statement describes prasterone (vaginal DHEA) as an FDA-approved therapy for moderate-to-severe dyspareunia, converted locally to estrogens and androgens with minimal systemic change, and improving pain with intercourse versus placebo in trials.. Non-hormonal moisturizers and lubricants help milder symptoms and can be combined with either. Cost, insurance coverage, and personal preference often decide between them. Because prasterone produces local hormones, women with a history of hormone-sensitive cancer weigh it carefully with their oncology team, just as they would any vaginal hormonal therapy 5Ref 5American College of Obstetricians and Gynecologists (2016).The Use of Vaginal Estrogen in Women With a History of Estrogen-Dependent Breast Cancer.ACOG Committee Opinion 659 frames use of vaginal hormonal therapy in women with a history of estrogen-dependent breast cancer as a shared decision coordinated with oncology..
Who might prasterone suit, and at what life stage?
Prasterone is intended for postmenopausal women, the group in whom low estrogen drives genitourinary symptoms. Menopause typically arrives between ages 45 and 55, and these tissue changes often begin during the perimenopausal transition and deepen afterward 6Ref 6World Health Organization (2024).Menopause (fact sheet).The WHO menopause fact sheet states menopause typically occurs between ages 45 and 55, with symptoms often beginning in the perimenopausal transition.. Younger women with low-estrogen states — for example during breastfeeding or after some cancer therapies — occasionally experience similar dryness, though prasterone's role there is less established and decided case by case 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.The North American Menopause Society 2020 genitourinary syndrome of menopause position statement describes prasterone (vaginal DHEA) as an FDA-approved therapy for moderate-to-severe dyspareunia, converted locally to estrogens and androgens with minimal systemic change, and improving pain with intercourse versus placebo in trials.. Common side effects are mild, mainly vaginal discharge from the melted insert or light spotting, according to menopause guidance 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.The North American Menopause Society 2020 genitourinary syndrome of menopause position statement describes prasterone (vaginal DHEA) as an FDA-approved therapy for moderate-to-severe dyspareunia, converted locally to estrogens and androgens with minimal systemic change, and improving pain with intercourse versus placebo in trials.. It is a nightly commitment rather than an as-needed product, so fit depends partly on routine and preference. Symptoms usually return within about 3 months of stopping, since the underlying estrogen loss remains.
When painful sex needs a clinician
A clinician can confirm that menopause-related tissue change, not another cause such as infection or pelvic pain, is behind painful sex before choosing a treatment. New bleeding after sex or after menopause, a vaginal lump, or pain that keeps worsening despite treatment is a reason to seek clinician review rather than to wait 2Ref 2American College of Obstetricians and Gynecologists (2019).Female Sexual Dysfunction: ACOG Practice Bulletin, Number 213.ACOG Practice Bulletin 213 identifies genitourinary syndrome of menopause as a common, treatable cause of painful sex and distinguishes sexual pain from low desire.. A gynecologist or menopause-focused clinician can compare prasterone with vaginal estrogen and non-hormonal options and tailor the choice to your history, including any cancer concerns 5Ref 5American College of Obstetricians and Gynecologists (2016).The Use of Vaginal Estrogen in Women With a History of Estrogen-Dependent Breast Cancer.ACOG Committee Opinion 659 frames use of vaginal hormonal therapy in women with a history of estrogen-dependent breast cancer as a shared decision coordinated with oncology.. Because roughly 50% of postmenopausal women have these symptoms yet few bring them up, simply raising the topic opens the door to effective care 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.The North American Menopause Society 2020 genitourinary syndrome of menopause position statement describes prasterone (vaginal DHEA) as an FDA-approved therapy for moderate-to-severe dyspareunia, converted locally to estrogens and androgens with minimal systemic change, and improving pain with intercourse versus placebo in trials.. Gale can help you prepare for that conversation.
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Painful-sex signs worth a clinician visit
- —Bleeding after sex or any bleeding after menopause is a reason to seek prompt clinician evaluation
- —A vaginal or vulvar lump, sore, or growth is a reason to arrange clinician review
- —Pain with sex that keeps worsening despite treatment is a reason to seek clinician review
- —A personal history of hormone-sensitive cancer is a reason to review any vaginal hormonal therapy with a specialist first
This article is general health education, not medical advice. Whether prasterone is right for you is a decision to make with a gynecologist or menopause-focused clinician 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 ✓The North American Menopause Society 2020 genitourinary syndrome of menopause position statement describes prasterone (vaginal DHEA) as an FDA-approved therapy for moderate-to-severe dyspareunia, converted locally to estrogens and androgens with minimal systemic change, and improving pain with intercourse versus placebo in trials.
- 2.American College of Obstetricians and Gynecologists (2019). Female Sexual Dysfunction: ACOG Practice Bulletin, Number 213. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000003324 ✓ACOG Practice Bulletin 213 identifies genitourinary syndrome of menopause as a common, treatable cause of painful sex and distinguishes sexual pain from low desire.
- 3.Stuenkel CA, et al. (Endocrine Society) (2015). Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism. doi:10.1210/jc.2015-2236 ✓The Endocrine Society clinical practice guideline lists evidence-based local treatments for genitourinary symptoms of menopause alongside low-dose vaginal estrogen.
- 4.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 ✓This Cochrane review found low-dose vaginal estrogen relieves vaginal atrophy symptoms, including dryness and painful sex, more effectively than placebo, supporting it as a first-line comparator.
- 5.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 ✓ACOG Committee Opinion 659 frames use of vaginal hormonal therapy in women with a history of estrogen-dependent breast cancer as a shared decision coordinated with oncology.
- 6.World Health Organization (2024). Menopause (fact sheet). World Health Organization (WHO). link ✓The WHO menopause fact sheet states menopause typically occurs between ages 45 and 55, with symptoms often beginning in the perimenopausal transition.
6 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy