Detailed definition
Prasterone is bioidentical dehydroepiandrosterone (DHEA) formulated as a 6.5 mg intravaginal insert (Intrarosa), used once daily at bedtime. The mechanism is intracrine: vaginal epithelial cells contain the enzymes (steroid sulfatase, 3β-HSD, 17β-HSD, aromatase) needed to convert DHEA into small local quantities of estrogen and testosterone, which act on local estrogen and androgen receptors to restore vaginal tissue. Serum estradiol and testosterone do not rise meaningfully above postmenopausal baseline. Prasterone is particularly attractive for women who want to avoid even the very low systemic estrogen exposure of vaginal estrogen — including some breast cancer survivors after consultation with their oncology team.
Why it matters in menopause
Prasterone occupies a useful niche between vaginal estrogen (very effective, very low absorption) and ospemifene (oral, no estrogen but oral-route VTE risk). For women who specifically want to avoid any estrogen exposure but still want an effective GSM treatment, prasterone is the cleanest option.
Related terms
Sources
External references: Wikipedia.