Supplementation of dehydroepiandrosterone (DHEA) in pre- and postmenopausal women  - position statement of expert panel of Polish Menopause and Andropause Society

Michal Rabijewski; Lucyna Papierska; Malgorzata Binkowska; Radoslaw Maksym; Katarzyna Jankowska; Wioletta Skrzypulec-Plinta; Wojciech Zgliczyński

doi:10.5603/GP.2020.0091

Clinical Guidelines and Standards · Guidelines by Issuing Body

Supplementation of dehydroepiandrosterone (DHEA) in pre- and postmenopausal women - position statement of expert panel of Polish Menopause and Andropause Society

Rabijewski M, Papierska L, Binkowska M, Maksym R, Jankowska K, Skrzypulec-Plinta W, Zgliczyński W

Published October 9, 2020 Ginekologia Polska, 91(9), 554-562

DOI 10.5603/GP.2020.0091 PMID 33030737

RRM Academy Synopsis

DHEA is effective in four groups of women, a Polish panel states

A Polish expert panel judged DHEA supplementation effective in four groups of women. The 2020 position statement reviews trials in pre- and postmenopausal women. It rates four more uses probably effective. The panel states that serious adverse effects have not been reported.

Key Findings

The panel rates DHEA effective in adrenal insufficiency and long-term glucocorticoid treatment, postmenopausal low bone density or osteoporosis, premenopausal sexual disorders and low libido, and menopausal vulvovaginal atrophy treated vaginally.
In a 12-week randomized, double-blind, placebo-controlled trial of vaginal DHEA, pain during sexual activity fell by 1.42 severity score units from baseline.
A 12-month randomized trial of 70 women with low DHEAS, aged 60-88 years, found DHEA trended toward higher bone density than placebo: trochanter 1.2%, lumbar spine 2.2%, shaft 1.2%, total hip 1.0%.
An observational study of premenopausal women (mean age 41 years) found the Female Sexual Function Index score rose 7%, desire 17% and arousal 12%, with no difference in orgasm or satisfaction.
In a case series of five women with premature ovarian insufficiency, all conceived spontaneously within 1-6 months of starting DHEA.

Interpretation

The paper is a review article that presents an expert-panel position statement. The panel describes no search method. The panel rates evidence in two tiers, effective and probably effective. Several studies cited are small, observational or open-label, and the 12-month bone trial reported trends. For postmenopausal low sexual desire, the panel cites a global consensus that does not support DHEA in women with proper adrenal function. A Cochrane review of DHEA supplementation in peri- and postmenopausal women questioned effectiveness. The studies in that review were of moderate to low quality, and their outcomes could not be pooled. The authors state that more adequately powered double-blind randomized trials are required.

RRM Context

Restorative reproductive medicine asks why ovarian reserve is low. In premature ovarian insufficiency, the paper links thyroid antibodies to a bigger drop in DHEAS. Such links suggest causes to look for. Unexplained infertility is undiagnosed infertility.

Our editorial summary of this paper, not the article's abstract.

Abstract

Dehydroepiandrosterone (DHEA) concentration decreases with age, therefore, DHEA has been considered a hormone that reduces the symptoms associated with aging, so the usefulness of DHEA in premenopausal and postmenopausal women, and the options of hormone therapy have received a large amount of attention. The effectiveness of DHEA in the premenopausal women remains unclear, while in postmenopausal women with coexisting estrogens deficiency is controversial. Despite many years of study, the use of DHEA is still controversial, especially regarding its effectiveness. The aim of present article was to evaluate DHEA specific effects on metabolic parameters, bone mineral density, insulin resistance as well as the therapeutic potential of DHEA in pre- and postmenopausal women using measures of sexual activity, cognition and well-being. The summary of this article is the position statement of expert group of the Polish Menopause and Andropause Society regarding the efficacy and safety of DHEA supplementation in women. We concluded, that currently available clinical trials and meta-analyses indicate that DHEA supplementation is effective in women with adrenal insufficiency and chronically treated with exogenous glucocorticoids, postmenopausal women with low bone mineral density and/or osteoporosis, premenopausal women with sexual disorders and low libido, and in women with vulvovaginal atrophy due to menopause or genitourinary syndrome of menopause. Currently available clinical trials also suggest that DHEA supplementation is probably effective in postmenopausal women with hypoactive sexual disorders, infertile women with diminished ovarian reserve, women suffering from depression and anxiety, and women with obesity and insulin resistance. No serious adverse effects have been reported.

Topics

Clinical Guidelines and Standards › Guidelines by Issuing Body › Specialty and Consensus Panels · Therapeutics › Hormonal Agents › Androgens and DHEA · Perimenopause and Menopause › Hormone Therapy › Benefits and Risks

Michal Rabijewski, Lucyna Papierska, Malgorzata Binkowska, Radoslaw Maksym, Katarzyna Jankowska, Wioletta Skrzypulec-Plinta, Wojciech Zgliczyński

M Rabijewski, L Papierska, M Binkowska, R Maksym, K Jankowska, W Skrzypulec-Plinta, W Zgliczyński

PMID 33030737 33030737 DOI 10.5603/GP.2020.0091 10.5603/GP.2020.0091 Rabijewski et al. 2020, Rabijewski 2020

Keywords

Dehydroepiandrosterone