A systematic review included 55 original trials evaluating impact of the hormonal and nonhormonal approaches to symptoms of sexual dysfunction and vaginal atrophy in postmenopausal women «Sarmento ACA, Costa APF, Lírio J, ym. Efficacy of ...»1. Of these, eight studies evaluated local dehydroepiandrosterone (DHEA, also known as prasterone) in treatment of vaginal atrophy and sexual dysfunction, and seven of these compared it to placebo. Quality assessment of the included original studies was performed by using the Cochrane risk of bias tool. Statistical analyses were not performed because of the large heterogeneity of the measurements. The certainty of evidence was evaluated to be low or very low in six out of seven original studies, and high in one study of seven comparing DHEA with placebo.
Patients: Seven studies evaluating DHEA compared to placebo included 2389 menopausal patients from US or Canada (age range 42-74 years). Several of original studies included the same patients.
Intervention: locally administered DHEA (0,25%, 0,5%, 1,0%). Intervention periods varied between 6 weeks to 12 months.
Control: Placebo.
Outcomes: The review's primary outcomes were vaginal dryness, arousal, desire, orgasm, lubrication, satisfaction, pain, and dyspareunia. The secondary outcomes included side effects, treatment duration, and adhesion. Outcomes were measured by using variety of validated questionnaires (e.g. Menopause Specific Quality of Life (MENQOL), parameters of dyspareunia and vaginal dryness, and symptoms of vaginal atrophy. The results overall favoured DHEA over placebo. This beneficial effect was apparent in all domains of sexual function, not only in those related to dyspareunia and vaginal dryness. Severe side effects were not reported. Three most commonly reported side effects were discharge at the application site, urinary tract infection, and headache.
Comment: The level of evidence is downgraded due to the risk of bias, suspected publication bias, and imprecision of the results.