Compounded DHEA Offers Women Relief from Urogenital Atrophy and Menopause Symptoms
It’s difficult for many patients to talk to their pharmacists about sex related issues. For post-menopausal women experiencing sexual dysfunction related to vulvovaginal atrophy, it can be particularly hard to broach the topic. While the airwaves abound with ads for medication directed at men with erectile dysfunction, women with postmenopausal sexual dysfunction often feel abnormal and are unaware of potential treatments for their condition.
As compounding pharmacists with knowledge about many physiological treatment options for postmenopausal dysfunction, it’s important that we take the time to support women who might be unaware of options or looking for answers. From including an optional area for sexual health and function questions in a patient intake questionnaire to tasteful informational brochures in a prominent location, if your pharmacy works directly with patients and provides hormone-related therapies, make sure women know their potential choices.
Postmenopausal, women are at much higher risk for vulvovaginal or urogenital atrophy, dystrophy and a host of other menopause-related symptoms. Intravaginal dehydroepiandrosterone (DHEA), often compounded into a cream or “cube,” offers women an option for managing vulvovaginal conditions and potential stability in the face of worsening symptoms.
Treating Vulvovaginal Atrophy and Genitourinary Syndrome with Compounded DHEA
Naturally occurring adrenal DHEA is necessary for biosynthesis of estrone and testosterone. Research has shown that DHEA can often decline in women following menopause, so much so that women in their mid-70s can have 77% lower DHEA than women in their 30s. This depletion can lead to various post-menopausal symptoms such as epithelial thinning, disrupted pH, and vulvovaginal or urogenital atrophy. The latter can lead to pain, dryness, itchiness, irritation, infection and dyspareunia.1
While no unique DHEA receptor has been isolated, it works primarily by metabolizing estrogen or androgen. When delivered locally via a compounded cream or suppository, vaginal tissues convert DHEA to localized estrogen without raising overall systemic hormone levels, making it a safer and more effective choice than oral treatment.2
Compounding pharmacists play a major role in helping patients treat post-menopausal issues with DHEA, since the hormone-based therapy is primarily available only through compounding pharmacies. Easily compounded into daily creams or intravaginal cube-shaped suppositories, the hypoallergenic formulations assist with absorption while preventing systemic adverse effects.
Compounded DHEA is proven to improve secretions, epithelial integrity and thickness, dryness and dyspareunia. These symptoms improved in more than 84 percent of women in a very recent clinical study by the VVA Prasterone Research Group published in the North American Menopause Society’s journal, Menopause.3
The naturally occurring adrenal gland and ovarian hormone has also been shown to have some effects on clinical characteristics beyond sexual function, including cognition, insulin resistance and level of risk for cardiovascular disease, though all of these would require more study to be conclusive. As a treatment, compound DHEA should be a primary option for women looking to treat symptoms of postmenopausal vulvovaginal atrophy or sexual dysfunction, rather than seeking for any of the former effects.4
What to Discuss with Post-Menopausal Women Who Might be Interested in DHEA Treatments
Since women interested in DHEA treatments will almost always come to a compounding pharmacy if they’ve done their research, it’s important for compounding pharmacists to be prepared to take on a clinician’s role when advising patients about their options to treat vulvovaginal atrophy.
- Ask patients about other lifestyle factors. This can include smoking habits, alcohol consumption, BMI, exercise levels and overall age. All of these things can cause lowered levels of DHEA and may be major factors in the patient’s vulvovaginal atrophy symptoms. It’s important to evaluate whether adjusting one or several of the patient’s lifestyle factors might also ameliorate their symptoms.
- Recognize potential vasomotor or psychological symptoms. DHEA has also not been proven to improve physical or psychological conditions of sexual dysfunction. Patients who present potential vasomotor or psychological symptoms should be directed to other therapies.5
- Involve other members of a patient’s healthcare team. Many OB/GYNs will be willing to discuss DHEA with your patient as part of a combined effort to treat her symptoms. This can be particularly useful if you feel that a patient should get an adrenal workup to see estradiol, estrogen, progesterone and DHEA levels during the menstrual cycle and also the luteal phase. Coordination with other healthcare professionals can also make sense if the patient has other diagnoses related to postmenopausal or age. This can help you and the patient’s other specialists determine whether DHEA therapy makes sense for the patient’s situation.6
Most importantly, as compounding pharmacists we must make our offices a welcoming place for women seeking help with postmenopausal sexual dysfunction issues. Many women may not know that there are treatments to help them with what they’re going through. Always keep an eye out for an opportunity to educate patients about their options, make it easy for potential patients to find information, and remember that satisfied patients are a pharmacy’s best referral source.
Pharmaceutica North America is a premier provider of high-quality active pharmaceutical ingredients and compounding kits. Contact us to find out more about how our products can help you provide the best possible care for postmenopausal patients.
- “DHEA vaginal suppository good alternative to estrogen creams,” Jan. 5, 2016, http://www.reuters.com/article/us-health-menopause-dhea-idUSKBN0UJ0B720160105 ↩
- “DHEA for Urogenital Atrophy and Sexual Function,” Jan. 15, 2015, http://www.medscape.com/viewarticle/838010 ↩
- “Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and the genitourinary syndrome of menopause,” Dec. 28, 2015, http://www.ncbi.nlm.nih.gov/pubmed/26731686 ↩
- “DHEA for Urogenital Atrophy and Sexual Function,” ibid. ↩
- “DHEA Replacement for Postmenopausal Women,” March 16, 2011, http://press.endocrine.org/doi/10.1210/jc.2010-2888?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed ↩
- “DHEA and Adrenal Imbalance,” accessed Feb. 21, 2016, https://www.womentowomen.com/adrenal-health-2/dhea-and-adrenal-imbalance/4/ ↩