Systemic and local effects of vaginal dehydroepiandrosterone (DHEA): NCCTG N10C1 (Alliance) Original paper
Researched by:
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Divine Aleru
ID
Divine Aleru
Read MoreI am a biochemist with a deep curiosity for the human microbiome and how it shapes human health, and I enjoy making microbiome science more accessible through research and writing. With 2 years experience in microbiome research, I have curated microbiome studies, analyzed microbial signatures, and now focus on interventions as a Microbiome Signatures and Interventions Research Coordinator.
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Women’s Health
Women’s Health
Women’s health, a vital aspect of medical science, encompasses various conditions unique to women’s physiological makeup. Historically, women were often excluded from clinical research, leading to a gap in understanding the intricacies of women’s health needs. However, recent advancements have highlighted the significant role that the microbiome plays in these conditions, offering new insights and potential therapies. MicrobiomeSignatures.com is at the forefront of exploring the microbiome signature of each of these conditions to unravel the etiology of these diseases and develop targeted microbiome therapies.
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Menopause
Menopause
Menopause impacts many aspects of health, including the gut microbiome, weight management, and hormone balance. Diet, probiotics, intermittent fasting, and HRT offer effective management strategies.
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Divine Aleru
Read More
Researched by:
-
Divine Aleru
ID
Divine Aleru
Read More
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Divine Aleru
What was studied?
This study examined the systemic and local effects of vaginal dehydroepiandrosterone (DHEA) in postmenopausal women, particularly those with a history of breast or gynecologic cancer. It evaluated the impact of vaginal DHEA on hormone concentrations, markers of bone formation, and vaginal cytology, including pH and maturation index. The study aimed to assess the efficacy of two different doses (3.25 mg and 6.5 mg) of vaginal DHEA compared to a plain moisturizer (PM) as a control for women experiencing vaginal dryness or dyspareunia, while considering the effects on systemic hormone levels, vaginal health, and bone biomarkers.
Who was studied?
The study included 345 postmenopausal women with a history of breast or gynecologic cancer, who reported moderate to severe vaginal symptoms. These women were enrolled in a randomized, controlled trial and were either on tamoxifen or aromatase inhibitors (AIs). They were randomly assigned to one of three groups: vaginal DHEA at 3.25 mg, vaginal DHEA at 6.5 mg, or a plain moisturizer (PM) control group. Eligibility criteria included women who had completed curative treatment for their cancer and were not using any oral or transdermal hormonal products except for tamoxifen or AIs.
Most important findings
The study found that vaginal DHEA led to a dose-dependent increase in circulating DHEA-S and testosterone levels. Estradiol levels were significantly higher in the 6.5 mg DHEA group, but not in the 3.25 mg DHEA group, compared to the control group. Despite the increase in estradiol, levels remained in the postmenopausal range. There was no significant effect on estrone or bone biomarkers such as osteocalcin and bone alkaline phosphatase, indicating that vaginal DHEA did not have “off-target” effects on bone health. Regarding vaginal cytology, both DHEA doses led to improvements in the vaginal maturation index, with more women experiencing cell maturation compared to the control group. Vaginal pH also decreased significantly in the DHEA treatment groups, indicating improved vaginal health. Women using DHEA also experienced fewer vaginal symptoms, suggesting that DHEA improved vaginal tissue health without systemic estrogenic effects, particularly beneficial for women on aromatase inhibitors (AIs), who cannot use systemic estrogen.
Key implications
Vaginal DHEA presents a promising treatment for managing vaginal symptoms related to menopause, especially for cancer survivors on aromatase inhibitors, for whom traditional estrogen therapy is contraindicated. The study suggests that DHEA is effective in improving vaginal cytology and reducing vaginal pH, thus alleviating dryness and dyspareunia. These findings support the use of vaginal DHEA as a safe and effective alternative to systemic estrogen therapies for women with hormone-sensitive cancers. Clinicians may consider recommending vaginal DHEA for postmenopausal women with vaginal symptoms, especially those with a history of cancer, as it provides local effects without significantly impacting systemic hormone levels or bone health. Further research is needed to confirm long-term safety, particularly regarding its use in women on AIs.