A Randomized Controlled Trial of Intravaginal Dehydroepiandrosterone versus Estriol Gel for Genitourinary Syndrome of Menopause in Early Postmenopausal Women

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 735–746

DOI: 10.46882/2026/IJOG/000542

Original Research Article

Title: A Randomized Controlled Trial of Intravaginal Dehydroepiandrosterone versus Estriol Gel for Genitourinary Syndrome of Menopause in Early Postmenopausal Women

Names of Authors: Mariam T. Bello¹, Grace E. Effiong²

Authors’ Affiliations:
¹ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
² Department of Public Health, University of Calabar, Calabar, Nigeria

Abstract:
Genitourinary Syndrome of Menopause (GSM) triggers progressive epithelial thinning and severe local mucosal dyspareunia. This randomized, double-blind active-controlled trial assessed the tissue-restoring efficacy, impact on vaginal pH, and circulating hormonal safety profile of once-daily intravaginal prasterone (dehydroepiandrosterone [DHEA], 6.5 mg) capsules versus local 0.1% estriol gel. One hundred and forty early postmenopausal women presenting with severe GSM symptoms were randomized into two equal cohorts (n = 70 per group) for a treatment course of 12 weeks. Primary outcomes included changes in the Vaginal Health Index (VHI) score, vaginal pH, and subjective symptom severity scores. After 12 weeks of daily application, both arms achieved equivalent, significant improvements in mean VHI scores (p < 0.001) and reduction of vaginal pH below 4.8 (p < 0.001). Subjective dyspareunia intensity dropped substantially in both the prasterone and estriol groups (mean reductions of 1.92 ± 0.45 and 1.88 ± 0.52 points, respectively, p = 0.74). Crucially, sequential blood monitoring confirmed that the prasterone cohort maintained stable, unchanged baseline serum estradiol and testosterone levels, whereas 11.4% of the estriol gel arm demonstrated transient systemic estriol elevations (p = 0.012). Daily intravaginal prasterone capsules offer mucosal tissue rejuvenation and symptomatic dyspareunia relief equivalent to local estriol gel, while avoiding any systemic sex-steroid accumulation.

Keywords: Genitourinary Syndrome of Menopause; Prasterone; Estriol Gel; Dyspareunia; Vaginal Health Index; Intracrinology.

Manuscript Timeline: Received: August 01, 2026; Revised: August 28, 2026; Accepted: September 08, 2026; Published: September 15, 2026.

Citation: Bello MT, Effiong GE. A Randomized Controlled Trial of Intravaginal Dehydroepiandrosterone versus Estriol Gel for Genitourinary Syndrome of Menopause in Early Postmenopausal Women. International Journal of Obstetrics and Gynecology. 2026; 14(9): 735–746.

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