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DHEA for Menopause

Verdict: Oral DHEA does not help menopause

For general menopausal symptoms, oral DHEA supplements show weak-to-null evidence and are not recommended; the only solid evidence belongs to a separate FDA-approved intravaginal prescription drug (prasterone/Intrarosa), not the oral supplement.

D 🔴 D Counter-Evidence Counter-Evidence

🔬Why this grade7-layer evidence engine

The oral-supplement evidence is consistently negative. A 2014 systematic review and meta-analysis of 23 RCTs in 1,188 postmenopausal women (PMID 25279571) found no significant improvement in libido or sexual function (SMD 0.35, P=0.06) and no benefit on lipids, glucose, weight, BMI, or bone density. A 2025 meta-analysis (PMID 40616152) confirmed oral DHEA raises testosterone and estradiol only at doses >=50 mg/day, but the estradiol rise (~7.86 pg/mL) is likely clinically minimal, and a cited Cochrane review found no improvement in quality of life or menopausal symptoms.

The earns-a-D picture is reinforced by route conflation. The genuinely positive trials test a different product: intravaginal prasterone (Intrarosa). A 2018 Phase III RCT (PMID 30358731) and a 2018 systematic review (PMID 30244783) show this drug improves dyspareunia and vaginal dryness of genitourinary syndrome of menopause, but it is an FDA-approved drug, not the oral supplement, and the pivotal trial was industry-funded (EndoCeutics).

Regulators and clinics draw the same line. The FDA approved prasterone only as the intravaginal drug Intrarosa; Mayo Clinic says DHEA helps vaginal atrophy only when given through the vagina; and the UK NHS classes DHEA as a prescription-only medicine and Class C controlled drug, while WADA bans it as an S1 anabolic agent. As a steroid-hormone precursor, oral DHEA also carries hormone-sensitive cancer and androgenic side-effect risks with no proven symptom benefit.

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Scoring transparency

All scores computed by a 7-layer evidence engine — fully auditable
Raw score 0.39
D
C
B
A
S
← counter-evidence / ineffectiveeffective / strong evidence →
Final grade
D · Counter-Evidence
Confidence
79%
Broadly consistent
Evidence level
E2
Multiple high-quality MAs (≥2 independent, consistent)

How strongly each layer supports this effect

lower = less supportive
L1 ExamineGlobal benchmark
0.30
L11 AI re-checkIndependent read
0.30
L5 Clinical bodiesAuthoritative stance
0.40
L2 PubMedPrimary literature
0.45
L3 MechanismPlausibility
0.45
Against Mixed Supports
▸View the full decision path (audit trail)
  1. compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.387
  2. tier_from_score — 依分數區間映射至 tier letter
  3. apply_hec_rules — 高階證據未達主導 (1 positive vs 1 negative)，由 raw_score 決定
  4. tier_strict_requirement_check — Tier 條件達標，未降階
  5. detect_disputes — 偵測到 0 個 hard + 1 個 soft dispute
  6. decide_status — 依 tier + dispute 結果決定 status

📄PubMed studies (4)L2 · primary research & systematic reviews

The Benefits and Harms of Systemic Dehydroepiandrosterone (DHEA) in Postmenopausal Women With Normal Adrenal Function: A Systematic Review and Meta-analysis
PMID: 25279571 2014 統合分析 n = 1,188
Finding: Systemic DHEA was NOT associated with significant improvement in libido or sexual function (SMD 0.35, 95% CI -0.02 to 0.73, P=0.06, I2=62%). No significant effect on serious adverse effects, serum lipids, serum glucose, weight, BMI, or bone mineral density. Authors concluded low-confidence evidence shows systemic DHEA does not significantly impact sexual symptoms or selected metabolic markers in postmenopausal women with normal adrenal function.
Effect size: SMD sexual function 0.35 (95% CI -0.02 to 0.73), non-significant
View on PubMed
Impact of DHEA supplementation on testosterone and estradiol levels in postmenopausal women: a meta-analysis of randomized controlled trials assessing dose and duration effects
PMID: 40616152 2025 統合分析 n = 1,084
Finding: Oral DHEA significantly increased testosterone (WMD 24.31 ng/dL, 95% CI 15.22-33.40, P<=0.001) and estradiol (WMD 7.86 pg/mL, 95% CI 6.33-9.40, P<=0.001). Effect seen only at >=50 mg/day; doses <50 mg/day had no significant effect. Authors cautioned the 7.86 pg/mL estradiol rise may be clinically minimal, and noted a referenced Cochrane review found DHEA did not significantly improve quality of life or menopausal symptoms.
🟠 Limited quality Effect size: WMD testosterone +24.31 ng/dL; estradiol +7.86 pg/mL (hormone levels only, not symptoms)
View on PubMed
Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause
PMID: 30358731 2018 RCT (double-blind) n = 482
Finding: Intravaginal prasterone significantly improved all four FDA co-primary endpoints: dyspareunia decreased 0.36 severity unit over placebo (P=0.0002); vaginal dryness decreased 0.27 unit over placebo (P=0.004); parabasal cells decreased 27.7% vs placebo (P<0.0001); superficial cells increased 8.44% vs placebo (P<0.0001); vaginal pH decreased 0.66 units (P<0.0001). NOTE: this is the FDA-approved intravaginal DRUG (Intrarosa), not the oral supplement.
⚠️ Industry-funded Effect size: Dyspareunia -0.36 severity unit over placebo (P=0.0002)
View on PubMed
Efficacy of intravaginal dehydroepiandrosterone (DHEA) for symptomatic women in the peri- or postmenopausal phase
PMID: 30244783 2018 系統性回顧
Finding: All RCTs of vaginal DHEA in vulvovaginal atrophy showed sexual dysfunction improved with treatment; vaginal DHEA was superior to placebo and at least as efficacious as vaginal estrogens. Concluded intravaginal DHEA appears safe and effective for menopausal vulvovaginal atrophy and dyspareunia. NOTE: applies to the intravaginal drug route, not oral DHEA supplements.
Effect size: Qualitative; consistent improvement vs placebo across included RCTs
View on PubMed

🏛️Regulatory & authoritative positionsL4/L5 · FDA / EMA / NIH ODS / Cochrane / Mayo …

L4a US FDA
Cautious
Intrarosa (prasterone) is the first FDA-approved product containing the active ingredient prasterone, also known as dehydroepiandrosterone (DHEA). source↗
L4b EU EFSA
Against
L4c UK NHS
Against
DHEA is classed as a prescription-only medicine in the UK and is also a Class C controlled drug. source↗
L4d TW TFDA / 衛福部
Against
DHEA（脫氫表雄酮）在台灣屬於藥品列管，不論劑量高低均以藥品管理，須由醫師開立處方；不得作為食品或膳食補充劑販售。 source↗
L4e WHO
Cautious
DHEA is included in the pharmacological class S1 'Anabolic Agents' as an Anabolic Androgenic Steroid, prohibited at all times (in and out of competition) under the World Anti-Doping Code. source↗
L5a NIH Office of Dietary Supplements
Cautious
L5b Mayo Clinic
Cautious
DHEA can help improve symptoms of vaginal atrophy when treatment is given through the vagina. source↗
L5c Cleveland Clinic
Cautious
L5d Harvard Health
Cautious
L5e Specialty Society (condition-mapped)
Cautious
✓PMID 100% verifiedevery citation checked via NCBI Entrez
🔬4 PubMed studiesindependently re-checked by multiple sub-agents
engine_version: v1.0 claim_id: CLM-COND-menopause-INT-dehydroepiandrosterone-001 繁體中文版 →