DHEA intravaginal, una nueva alternativa para el síndrome genitourinario de la menopausia

Introduction: Menopause, a natural stage in a woman's life, causes hormonal changes that can affect health, particularly the genitourinary tract, leading to the genitourinary syndrome of menopause (GSM). This syndrome usually presents genital and urinary symptoms and sexual dysfunction. Despite its high prevalence, many women do not seek appropriate treatment due to a lack of information or the stigma associated with these symptoms. However, therapeutic options such as intravaginal dehydroepiandrosterone (DHEA) or prasterone (prasterone 6.5 mg) have proven effective in treating GSM symptoms. State of the Art: DHEA is locally converted into androgens and estrogens in the vaginal mucosa through intracrinology, improving vaginal health and sexual function. In clinical studies, intravaginal DHEA has been shown to reduce dyspareunia, improve vaginal pH, lubrication, and mucosal integrity. The benefits of intravaginal DHEA were comparable to or even greater than those of other treatments, such as vaginal estrogens. The administration of 0.5% DHEA intravaginally in postmenopausal women significantly improved GSM symptoms, reducing dyspareunia and enhancing quality of life. DHEA has also been shown to improve sexual function in women with low levels dehydroepiandrosterone sulfate (DHEA-S) and testosterone. Regarding safety, it was observed that it does not have significant effects on the endometrium nor does it alter serum steroid levels. Conclusion: Daily vaginal DHEA is as effective as local estrogens. It has beneficial effects on the anatomy and physiology of vulvovaginal atrophy and all associated symptoms and signs without systemic exposure, according to the intracrinology mechanism.