What is Prasterone (Vaginal Route): Uses, Dosage, Side Effects and More

Prasterone is a hormone medication that you insert directly into your vagina to help restore comfort and function. It's a synthetic form of DHEA (dehydroepiandrosterone), a hormone your body naturally produces that decreases as you age, especially after menopause.

This medication specifically targets vaginal tissues that have become dry, thin, or uncomfortable due to hormonal changes. Many women find it helpful for addressing intimate concerns that can significantly impact their quality of life and relationships.

What is Prasterone Used For?

Prasterone vaginal inserts are primarily prescribed to treat moderate to severe painful intercourse caused by vaginal changes after menopause. This condition, called dyspareunia, affects many women and can make intimate relationships challenging.

The medication works by restoring the natural thickness and moisture of vaginal tissues. When estrogen levels drop during menopause, the vaginal walls become thinner, drier, and less elastic. This can lead to discomfort, burning sensations, and pain during sexual activity.

Beyond painful intercourse, prasterone may also help with other symptoms of vaginal atrophy. These include vaginal dryness, irritation, and a feeling of tightness or burning in the vaginal area.

How Does Prasterone Work?

Prasterone is considered a moderate-strength hormone therapy that works locally in vaginal tissues. Unlike oral hormone treatments that affect your entire body, this medication acts primarily where you apply it.

Once inserted, prasterone converts into both estrogen and testosterone within your vaginal tissues. This dual action helps restore the natural balance of hormones that support healthy vaginal function.

The medication gradually rebuilds the vaginal lining, increasing its thickness and improving blood flow to the area. This process typically takes several weeks to show full effects, so patience is important as your body responds to treatment.

How Should I Take Prasterone?

You'll insert one prasterone suppository into your vagina once daily, preferably at bedtime. The medication comes as a small, bullet-shaped insert that dissolves naturally inside your body.

Before insertion, wash your hands thoroughly and remove the suppository from its wrapper. You can insert it while lying down or standing with one foot elevated. Gently push the suppository as far into your vagina as comfortable, similar to inserting a tampon.

You don't need to take this medication with food or water since it's applied locally. However, it's best to use it at the same time each day to maintain consistent hormone levels in your vaginal tissues.

Some women find it helpful to use a panty liner after insertion, as a small amount of the suppository base may leak out. This is completely normal and doesn't affect the medication's effectiveness.

How Long Should I Take Prasterone For?

Most women need to use prasterone for at least 12 weeks to see significant improvement in their symptoms. Your doctor will likely recommend starting with this timeframe and then evaluating how well the treatment is working.

Many women continue using prasterone long-term to maintain the benefits. Since vaginal atrophy is an ongoing condition related to menopause, stopping treatment may cause symptoms to return gradually.

Your healthcare provider will monitor your progress and may adjust the treatment plan based on your response. Some women find they can eventually use the medication less frequently while still maintaining comfort.

What Are the Side Effects of Prasterone?

Most women tolerate prasterone well, but like any medication, it can cause side effects. The good news is that serious side effects are uncommon because the medication works locally rather than throughout your entire body.

Common side effects you might experience include:

• Vaginal discharge that may appear different from usual
• Mild vaginal burning or irritation when you first start treatment
• Temporary increase in vaginal moisture
• Slight spotting or light bleeding

These mild effects often improve as your body adjusts to the medication over the first few weeks of treatment.

Less common but more concerning side effects include:

• Persistent vaginal bleeding or unusual discharge
• Severe vaginal burning or itching
• Pelvic pain or pressure
• Signs of infection such as fever or foul-smelling discharge

Contact your healthcare provider if you experience any of these more serious symptoms, as they may indicate a need to adjust your treatment.

Very rare but serious side effects can include allergic reactions. Seek immediate medical attention if you develop difficulty breathing, severe swelling, or widespread rash after using prasterone.

Who Should Not Take Prasterone?

Prasterone isn't suitable for everyone, and certain health conditions make it unsafe to use. Your doctor will carefully review your medical history before prescribing this medication.

You should not use prasterone if you have:

• Known or suspected breast cancer
• Known or suspected estrogen-dependent cancer
• Unexplained vaginal bleeding
• Active blood clots or history of blood clotting disorders
• Active liver disease or liver problems
• Pregnancy or breastfeeding

These conditions can be worsened by hormone therapy, even when applied locally, so alternative treatments would be safer for you.

Your doctor will also use extra caution if you have a history of heart disease, stroke, or high blood pressure. While prasterone has less systemic absorption than oral hormones, monitoring is still important with these conditions.

Prasterone Brand Names

Prasterone vaginal inserts are available under the brand name Intrarosa in the United States. This is currently the only FDA-approved vaginal DHEA product available by prescription.

Some compounding pharmacies may prepare custom DHEA vaginal preparations, but these haven't undergone the same rigorous testing as the FDA-approved version. It's generally safer to use the standardized commercial product.

Prasterone Alternatives

If prasterone isn't right for you, several other treatments can help with vaginal atrophy and painful intercourse. Your doctor can help you explore these options based on your specific situation.

Hormone-based alternatives include:

• Vaginal estrogen creams, rings, or tablets
• Low-dose systemic hormone therapy
• Ospemifene (Osphena), an oral medication that acts like estrogen in vaginal tissues

Non-hormonal options include:

• Vaginal moisturizers for daily use
• Personal lubricants for intimate moments
• Laser therapy or other energy-based treatments
• Pelvic floor physical therapy

Each approach has its own benefits and considerations, so discussing your preferences and medical history with your healthcare provider is essential.

Is Prasterone Better Than Vaginal Estrogen?

Prasterone and vaginal estrogen are both effective treatments for vaginal atrophy, but they work slightly differently. The choice between them depends on your individual needs and medical history.

Prasterone may be preferred if you want to avoid estrogen-only treatments or have concerns about estrogen exposure. Since it converts to both estrogen and testosterone locally, some women find it more effective for certain symptoms.

Vaginal estrogen has been used longer and has more extensive research supporting its safety and effectiveness. It's often considered the first-line treatment for vaginal atrophy and may be more readily available.

Both medications have similar safety profiles when used vaginally, with minimal absorption into your bloodstream. Your doctor can help you weigh the pros and cons based on your specific situation and preferences.