Women's Health Research Program, School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Maturitas. 2011 Sep;70(1):22-5. doi: 10.1016/j.maturitas.2011.06.005. Epub 2011 Jul 5.
Vaginal atrophy is a common symptom of postmenopausal estrogen deficiency and can present as dryness, irritation, infection and dyspareunia and can affect sexual function and quality of life. Currently vaginal atrophy is treated with the intravaginal application of preparations containing estradiol or estriol, which are both effective and safe. It has been proposed that intravaginally administered dehydroepiandrosterone (DHEA) can be used to treat vaginal atrophy. DHEA and its sulphate DHEAS are the most abundant circulating sex steroid hormones in women, and provide a large precursor reservoir for the intracellular production of androgens and estrogens in non-reproductive tissues. Levels of DHEA and DHEAS decline with age. Although there is some evidence to support the use of intravaginal DHEA for postmenopausal women with symptoms of vaginal atrophy, independent studies are required to confirm this. In addition studies regarding the effects of vaginal DHEA on sexual function in women without vaginal atrophy are needed. Given that the efficacy and long term safety of low dose vaginal estradiol and estriol therapy is well established and that vaginal estrogen requires application of 2-3 times a week, rather than daily dosing; the benefit of daily vaginal DHEA over estrogen also needs to be considered as women may find it unpalatable to adhere to daily dosing with a cream preparation.
阴道萎缩是绝经后雌激素缺乏的常见症状，可表现为干燥、刺激、感染和性交困难，并会影响性功能和生活质量。目前，阴道萎缩采用含有雌二醇或雌三醇的阴道内制剂治疗，这些制剂既有效又安全。有人提出，可使用阴道内给予脱氢表雄酮（DHEA）来治疗阴道萎缩。DHEA 和其硫酸盐 DHEAS 是女性体内循环中最丰富的性激素，为非生殖组织中雄激素和雌激素的细胞内产生提供了大量前体储备。DHEA 和 DHEAS 的水平随年龄增长而下降。尽管有一些证据支持对有阴道萎缩症状的绝经后妇女使用阴道内 DHEA，但需要独立的研究来证实这一点。此外，还需要研究阴道 DHEA 对无阴道萎缩的女性性功能的影响。鉴于低剂量阴道雌二醇和雌三醇治疗的疗效和长期安全性已得到充分证实，并且阴道雌激素需要每周应用 2-3 次，而不是每天应用；因此，还需要考虑每日阴道 DHEA 相对于雌激素的益处，因为女性可能会发现难以接受每天用乳膏制剂进行阴道给药。
