Hormone replacement therapy for menopause is a proven treatment, but what about DHEA?

Published: January 17, 2025

Menopause is when monthly periods stop completely. The time before menopause is called perimenopause, which is when hormone levels begin to drop. Women who have had certain surgeries or treatments such as chemotherapy or radiation may experience premature menopause. The fluctuation in hormones before, during, and after periods have ceased causes many symptoms, including:

• Hot flashes
• Night sweats
• Vaginal dryness
• Mood swings
• Sleep disturbances
• Fatigue
• Reduced libido

Menopause is a natural process — all women will go through menopause if they are advanced in age, or if they have experienced premature menopause due to a health condition, surgery or related treatment. The body has slowed or stopped producing hormones such as estrogen, testosterone and progesterone. There is no treatment for menopause; however, the symptoms of menopause can be managed with lifestyle changes and medical interventions. 

One such intervention is the use of hormone replacement therapy (HRT). Hormone therapy’s goal is to replace some of the hormones the body is no longer making enough of, or at all. The hormones replaced may include estrogen and progesterone. 

Hormone replacement therapy for menopause

Various hormones can be used in a variety of clinical treatments, such as for cancer, hormone imbalance or other conditions. HRT is the term usually used for replacing hormones lost or decreasing with menopause or perimenopause. 

There are two main types of HRT:

Estrogen replacement therapy involves taking only the hormone estrogen. It can be given in many forms, including pills; a patch that sticks to your skin; creams, gels, or tablets that go in your vagina; or a spray for the skin on your arm.

Combination therapy mixes estrogen and progesterone. Progesterone is also called progestin and includes natural and synthetic hormones that act like progesterone. People who still have a uterus need progestin. 

Benefits and risks of HRT

HRT prescribing practices have evolved in the last decades as more research has been done. There are risks to any hormone therapy, and there are also benefits that may outweigh those risks. 

Risks include:

The recurrence of cancer in some patients. Systemic estrogen is not recommended for women who have or have had breast cancer. You may be at a higher risk of developing a blood clot or for cardiovascular disease. 

Some factors that affect your risks include:

• How old you are when you start HRT
• The type of HRT prescribed
• Your overall health, including history of cancer
• Delivery method of HRT, such as a patch, vaginal cream or pill
• Whether you have had chemotherapy or radiation treatment
• Certain surgeries such as oophorectomy (removing one or both ovaries)

Benefits of HRT include:

• Easing menopause symptoms, such as hot flashes, bone loss, vaginal dryness and some mental health issues 
• Protecting brain health
• Increased sexual function
• Protecting bone health

What about DHEA?

Dehydroepiandrosterone (DHEA) is a naturally occurring hormone in the body, produced by the adrenal glands. DHEA helps the body make other hormones, such as testosterone and estrogen. DHEA declines with age, and with it, overall levels of the hormones it produces. There has been some investigation into DHEA to manage menopause symptoms, since DHEA is a crucial component in the body’s creation of the hormones HRT aims to replace. Researchers also have wondered if DHEA has antiaging properties.

While there is a link between low DHEA levels and symptoms of menopause, there is not enough evidence to support the use of DHEA as a frontline treatment of menopause symptoms. A 2022 meta-analysis of data in the The Journal of Clinical Endocrinology & Metabolism concluded that there are no consistent benefits of taking DHEA. According to the analysis, there may be some minor increases in quality of life or overall mood, but no impact on anxiety, sexual function, brain function or overall well-being in women. The researchers concluded that long-term use of DHEA may increase unwanted side effects in women such as acne and male-patterned hair growth.

More research is needed about the impact of DHEA on aging, menopause symptoms and other conditions. Always talk to your health care provider before taking any new medication or supplement. DHEA can interact negatively with drugs our supplements you are already taking, so it’s best to talk to a doctor before adding something new.

Is HRT right for me?

Your family physician or OB/GYN is the first place to start asking this question. Your health care provider will go over an appropriate course of treatment tailored to you.