A New Treatment for Sexual Pain Associated with Menopausal Genital Atrophy

News in Context |
November 29, 2016

A New Treatment for Sexual Pain Associated with Menopausal Genital Atrophy

  1. Andrew M. Kaunitz, MD

Intravaginal dehydroepiandrosterone (prasterone) is now FDA-approved.

  1. Andrew M. Kaunitz, MD

On November 17, 2016, the FDA approved vaginal dehydroepiandrosterone (DHEA, prasterone) for menopausal women with genital atrophy who experienced moderate to severe pain with sexual intercourse (also known as genitourinary syndrome of menopause). The efficacy and safety of daily 0.5% DHEA (6.5 mg vaginal ovules) was established in four 12-week placebo-controlled trials as well as a 1-year open-label trial. Vaginal discharge was the most common adverse effect.

Comment

After menopause, DHEA (produced largely by the adrenals and enzymatically transformed at the intracellular level into estrogens) is a major progenitor of all sex steroids. Because estradiol is inactivated at its site of synthesis, use of prasterone results in little if any rise in serum estradiol levels (J Steroid Biochem Mol Biol 2016; 159:142). This attribute may make prasterone an appealing choice for women with estrogen-sensitive cancers; indeed, a federally supported trial is under way in breast cancer survivors.

Editor Disclosures at Time of Publication

  • Disclosures for Andrew M. Kaunitz, MD at time of publication Consultant / Advisory board Allergan; Bayer AG; Merck; Pfizer Royalties UpToDate Grant / Research support Therapeutics MD; Bayer; Agile; Merck Editorial boards Contraception; Menopause; Contraceptive Technology Update; OBG Management; Medscape OB/GYN & Women’s Health Leadership positions in professional societies North American Menopause Society (Board of Trustees)

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Reader Comments (1)

DEBRA ROME Nurse/NP/PA, Obstetrics/Gynecology

Good news

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