Vaginal DHEA and Oral Ospemifene

Other Options for Genitourinary Syndrome of Menopause

Vaginal estrogen products are considered the first-line medical therapy for genitourinary syndrome of menopause (GSM), but they are not the only pharmaceuticals available. For a refresher on genitourinary syndrome of menopause, click here, and for a deeper dive into the different vaginal estrogen products, click here. Today’s post will focus on the two non-estrogen products for GSM: vaginal DHEA and oral ospemifene.

While most people will start with vaginal estrogen, there are definitely situations where vaginal DHEA or oral ospemifene (especially the latter) might be the preferred option. Vaginal estrogen is considered the gold standard because we have more data, more experience, and there are more formulations. There is no head-to-head data comparing vaginal DHEA or oral ospemifene with vaginal estrogen, so it’s not possible to say one product is more or less effective, just that they are different options. Like every medication, there are pros and cons, and so we’ll review those here and how they stack up to the pros and cons of vaginal estrogen. 

Vaginal DHEA or Dehydroepiandrosterone 

Let’s back up just a little and review DHEA. This will come in handy when, in a future post, I write about using DHEA for other reasons or, to present that post more precisely, why we don’t recommend using DHEA for other reasons.

Estradiol, estrone, and testosterone are made from cholesterol. This is a multi-step process that requires the conversion of cholesterol to a few other hormones. DHEA is one of the hormones produced along the way. For adult women, DHEA is largely believed to function only as a prohormone, meaning it exists only as a necessary step