Prasterone (DHEA and Intrarosa)

Vaginal prasterone is used for moderate to severe painful intercourse associated with menopausal vulvar and vaginal changes. This is a specific symptom and population, not an approval for energy, whole-body rejuvenation or every cause of low sexual desire. ¹

Unexplained vaginal bleeding and a history of breast cancer require discussion before use. Vaginal discharge can occur. A clinician should evaluate persistent pain, bleeding or irritation rather than assume all symptoms are caused by menopause. ¹

A product’s ingredient name is only one part of its identity. Ask whether the evidence cited is for the vaginal insert, an oral supplement or another formulation. A patient should also know the clinical goal, when it will be reviewed, and what alternatives are relevant if symptoms have another cause.

Intrarosa is a prescription vaginal prasterone insert evaluated for moderate to severe pain with sexual activity due to menopause-related vulvar and vaginal changes. DHEA capsules, creams and products sold as supplements are not the same dosage form and cannot inherit that approval. Systemic hormone levels, ingredients and manufacturing oversight differ. Use the full product name and route when discussing prior use, because the abbreviation DHEA can conceal several unlike products. ¹

Pain with sexual activity can have more than one cause, including infection, skin disease, pelvic-floor problems, trauma, medication effects and conditions requiring examination. A product reference cannot determine the cause. Report unexplained vaginal bleeding, a breast or hormone-sensitive cancer history, pregnancy possibility or new discharge to the clinician. The label notes vaginal discharge and abnormal cervical smear findings among adverse events, so routine screening and evaluation should follow the individual plan rather than be skipped. ¹

Ask when benefit should be reviewed, how to use the supplied applicator and what to do if irritation, discharge or bleeding develops. Keep the insert in its original packaging and follow storage instructions. Do not apply an oral supplement or compounded cream vaginally unless that exact product was prescribed with written directions. If symptoms worsen or new pelvic pain, fever, sores, odor or bleeding appears, seek assessment instead of assuming it is a temporary adjustment effect. ¹

Any bleeding after menopause should be reported for assessment. It should not be assumed to come from tissue irritation or treated by increasing or decreasing prasterone without advice. The clinician may need to evaluate the cervix, vagina, uterus and other medicines. Bring the timing, amount, associated pain and current hormone products to the visit so the symptom can be assessed in context. ¹