Intrarosa
Intrarosa (prasterone) is a vaginal DHEA insert FDA-approved for menopausal dyspareunia, converting to estradiol and testosterone within vaginal tissue.
How it works
Intrarosa contains prasterone — a synthetic form of DHEA (dehydroepiandrosterone) — which is converted locally within vaginal cells into small amounts of both estradiol and testosterone. This intracrinology approach (local hormone production from a precursor) is mechanistically distinct from vaginal estrogen products, which deliver estrogen directly. The local conversion means that serum estrogen and androgen levels remain very low — within postmenopausal ranges — making Intrarosa an option for women who cannot use estrogen, including some breast cancer survivors (with oncologist guidance). It is FDA-approved specifically for dyspareunia.
Intrarosa is inserted vaginally once daily at bedtime. Clinical trial data from the AMETHYST trials showed statistically significant improvements in vaginal cell maturation, vaginal pH, and dyspareunia severity. Like all vaginal treatments for GSM, improvements in dryness and tissue condition develop gradually over four to twelve weeks. Intrarosa does not require a progestogen.
How to track Intrarosa
- Dyspareunia (painful intercourse) — the FDA-labeled primary indication; rate severity before starting and track weekly.
- Vaginal dryness and discomfort — broader daily quality-of-life symptom that complements dyspareunia tracking.
- Application consistency — nightly insertion is required; logging missed applications correlates with symptom variability.
- Vaginal discharge — a common initial side effect as vaginal tissue responds; should be logged and distinguished from pathological causes.
- Urinary urgency or UTI frequency — secondary benefits of restoring vaginal tissue environment.
- Rate dyspareunia severity from week one — tissue response is gradual, and a weekly log shows the improvement curve that the AMETHYST trials used as their primary endpoint.
- Track general vaginal dryness and discomfort separately from dyspareunia — they are related but distinct, and may improve on different timelines.
- Log any vaginal discharge with description and timing — some discharge is expected in early weeks as tissue responds, but a log helps distinguish normal from concerning.
- Note missed insertions with dates — nightly consistency is required for stable DHEA delivery; missed nights correlate with slower tissue response.
- If you are a breast cancer survivor using Intrarosa, log that your oncologist approved this treatment and the date of that conversation — the safety discussion should be documented.
Questions to ask your physician
- My dyspareunia severity rating before starting Intrarosa was [X]. At [N] weeks, my current rating is [Y]. Is that consistent with the AMETHYST trial response timeline?
- I've been logging vaginal dryness at [rating] — it has [improved/partially improved] alongside dyspareunia. Are they expected to respond at the same pace?
- I've logged vaginal discharge [frequency, description] since starting — is that within the expected range for early tissue response?
- My application log shows [X] missed insertions over [N] weeks. Could those gaps meaningfully affect tissue response?