Comparison of intravaginal 0.5% prasterone, 0.3mg conjugated estrogens and 10μg estradiol on estrogen-related symptoms of vulvovaginal atrophy

Publication date: Available online 18 March 2017
Source:The Journal of Steroid Biochemistry and Molecular Biology
Author(s): David F. Archer, Fernand Labrie, Marlene Montesino, Céline Martel
The objective is to compare the effect of intravaginal dehydroepiandrosterone (DHEA, prasterone), conjugated equine estrogens (CEE) and estradiol (E2) on moderate to severe dyspareunia and/or vaginal dryness.In a review of available data, independent prospective, randomized, double-blind and placebo-controlled Phase III 12-week clinical trials involved daily administration of 6.5mg (0.50%) prasterone, daily (21days on/7days off) 0.3mg CEE, twice weekly 0.3mg CEE or 10 μg E2 daily for 2 weeks followed by twice weekly for 10 weeks. Vulvovaginal atrophy symptoms were evaluated by questionnaires.The total severity score decreased from 1.27 to 1.63 units with prasterone treatment, 1.4 with CEE and 1.23 in one statistically significant study with E2. Decreases over placebo ranged from 0.36 to 1.21 with prasterone, 0.7 to 1.0 with CEE and 0.36 for the E2 study. The total decreases in vaginal dryness severity ranged from 1.44 to 1.63 units for prasterone, 1.1 unit for CEE and 1.23 unit for E2. The decreases over placebo of vaginal dryness intensity ranged from 0.27 to 0.43 unit for prasterone and 0.40 unit for CEE with no statistically significant difference over placebo for E2.Daily 0.50% prasterone appears to be at least as efficacious as 0.3mg CEE or 10 μg E2 for treatment of the VVA symptoms. In summary, the beneficial effects on the VVA symptomatology can be obtained by the addition of a small amount of intravaginal prasterone to compensate for the low serum concentration of prasterone observed in the majority of women after menopause without concerns about systemic effects.



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