Dehydroepiandrosterone for women in the peri- or postmenopausal phase.

Systematic review of 28 randomized trials in 1273 women in the peri- or postmenopausal phase, predominantly postmenopausal. Trials were conducted in multiple countries and included healthy volunteers as well as women with comorbid conditions; most comparisons were against placebo, with some head-to-head comparisons against hormone therapy.

Dehydroepiandrosterone (DHEA) was evaluated across oral, topical, and intravaginal regimens in randomized trials. Reported doses ranged from 10 mg/day to 1600 mg/day orally, and from 0.25% to 10% for topical or vaginal preparations, typically administered for 4 weeks to 12 months. Most trials compared DHEA with placebo; some compared it with hormone therapy or other active treatments.

DHEA did not improve quality of life. In the main pooled sensitivity analysis, the QoL effect was SMD 0.16, 95% CI -0.03 to 0.34, P = 0.10, across 8 studies and 287 women. Sexual function may improve slightly, but the effect was small and clinically uncertain: pooled SMD 0.19, 95% CI -0.01 to 0.40, P = 0.06, and after excluding one high-risk trial SMD 0.31, 95% CI 0.07 to 0.55, P = 0.01. DHEA was associated with more androgenic side effects, with OR 3.77, 95% CI 1.36 to 10.4, P = 0.01, while evidence for menopausal symptom relief remained inconsistent and there was little evidence it outperformed hormone therapy.

Evidence quality was moderate to low, and pooled results were affected by heterogeneity, especially for quality of life (I2 = 67% in one pooled analysis). Trials varied substantially in dose, route, duration, and outcome measures, and only 16 trials contributed to meta-analysis. Several studies were small, some were crossover designs, and at least one trial was judged high risk of bias, limiting certainty and generalizability.