Intrarosa® (prasterone) is an FDA-approved vaginal insert, available by prescription, that treats painful sex caused by menopause. It’s also shown to improve vaginal dryness and vaginal pH.
Takeaways
- Intrarosa doesn’t contain estrogen; it delivers DHEA, which vaginal cells convert into both estrogen and testosterone locally
- Because it works locally, Intrarosa doesn’t raise estrogen above the normal postmenopausal range
- In a 12-week clinical trial, Intrarosa reduced pain during sex and improved vaginal pH and tissue health
- Vaginal discharge is the most common side effect, reported by about 6% of users in clinical trials
- Intrarosa’s label warns against use after breast cancer, but 2021 ACOG guidelines say DHEA may still be considered if vaginal estrogen isn’t an option
- Without insurance, Intrarosa costs about $300/month, though manufacturer coupons can lower it to a $35 copay
If you’re approaching menopause or well beyond it, there are several ways to treat vaginal and urinary symptoms - from over-the-counter lubricants and moisturizers to prescription vaginal estrogen.
Intrarosa is a treatment that’s less well known - and we’re going to cover everything you need to know about its uses, safety, and efficacy.
Intrarosa (prasterone) is a vaginal DHEA insert that’s inserted daily with a vaginal applicator. Intrarosa has been shown to:
- Improve the condition of the vaginal skin
- Balance vaginal pH
- Prevent painful sex
Intrarosa can also be used to treat and prevent other symptoms caused by menopause - including vaginal dryness, frequent UTIs, and urgency.
1. Intrarosa does not contain estrogen
Strictly speaking, Intrarosa inserts do not contain estrogen, but they do contain a different ingredient that your body naturally converts into estrogen.
The active ingredient in Intrarosa is known as prasterone, a steroid that’s a form of the hormone DHEA that your body naturally produces.
Intrarosa works by releasing DHEA directly into your vagina which the vaginal cells then convert into estrogens (including estradiol) and androgens (including testosterone) (1).
The idea behind vaginal DHEA is that instead of releasing estrogen and testosterone directly into your vagina, the vagina can produce these hormones with the help of DHEA. And, since vaginal DHEA is only applied directly to the vagina, estrogen and testosterone are not released throughout the rest of the body.
In summary, Intrarosa is a non-estrogen option that enables the vagina to produce its own estrogen and testosterone.
2. Intrarosa does not significantly increase estrogen levels
Intrarosa does not increase estrogen levels beyond what is considered the normal range for post-menopausal women (2).
Women may take comfort that Intrarosa, like low-dose topical vaginal estrogen treatments, can be safer than systemic hormones like an estrogen pill or patch.
The chart below shows that treatments like Intrarosa, estradiol vaginal cream, and estradiol vaginal suppositories do not significantly increase estrogen levels in the bloodstream (3,4,5).
| Medication | Brand name | Standard dosing | Typical serum estradiol level (pg/mL) | Estrogen blood levels within normal post-menopausal range? |
|---|---|---|---|---|
| Estradiol vaginal cream 0.01% | Estrace | 1 gram of cream (.1mg of estradiol) two times per week | Variable | Yes* |
| Estradiol vaginal suppositories 10mcg | Vagifem | 1 mcg two times per week | 4.6 | Yes |
| Prasterone (DHEA) 6.5mg | Intrarosa | 6.5mg daily | 5 | Yes |
3. Studies show that Intrarosa can improve vaginal and urinary symptoms
Intrarosa is FDA-approved to treat painful sex. And studies have shown that Intrarosa can also be effective in rebuilding the vaginal skin and balancing vaginal pH - which can help prevent vaginal dryness, irritation, burning, and frequent UTIs.
In 2016, the manufacturers of Intrarosa published results from a randomized controlled trial of Intrarosa. After 12 weeks, participants who used Intrarosa showed significant improvements in the overall health of the vaginal environment (5).
- Intrarosa reduced the severity of pain during sex
- Intrarosa improved vaginal pH to healthier ranges
- Intrarosa improved the number of surface layer skin cells in the vaginal walls
4. The most common side effect is vaginal discharge
Like any prescription medication, when taking Intrarosa, there are some side effects to be aware of. In short-term studies of Intrarosa, vaginal discharge was the most common side effect, reported by 6% of study participants. An abnormal pap smear was reported by 2% of study participants (5).
Longer-term studies are reassuring regarding uterine safety. In one study, 422 women received DHEA for 52 weeks, and samples of endometrial tissues showed no changes among any of the participants (3).
Because Intrarosa acts locally and doesn’t raise estrogen beyond the normal postmenopausal range, you don’t need to take progesterone alongside it to protect the uterus. And the same is true for low-dose vaginal estrogen. However, progesterone is needed to protect the uterine lining when estrogen is given systemically (such as a pill or patch) (2).
5. It may be appropriate if you have a history of breast cancer
The Intrarosa boxed information states that women with a history of breast cancer cannot take Intrarosa, since the body converts DHEA into estrogen (5).
However, in 2021, the American College of Obstetricians and Gynecologists released new and updated guidelines for women with a history of breast cancer who suffer from vaginal and urinary symptoms. The guidelines outline a stepwise approach:
- If non-hormonal treatments do not alleviate symptoms, low-dose topical estrogen may be used.
- If low-dose topical estrogen is not an option, DHEA (such as Intrarosa) may be used.
Although DHEA is not an estrogen, it stimulates estrogen production. So some oncologists may not be supportive of it in certain cases.
Remember, you should always consult your oncologist and become informed of the risks and benefits in your particular situation. And, if you’re not comfortable with even a small amount of estrogen, a vaginal DHEA treatment like Intrarosa probably isn’t the right choice for you.
6. Intrarosa is expensive and your insurance may not cover it
The list price for a month’s supply of Intrarosa without insurance is around $300. Some insurance plans may cover Intrarosa. However, because Intrarosa is only FDA-approved to treat painful sex, your insurance may not approve it for other menopause-related symptoms like vaginal dryness, irritation, burning, or frequent UTIs.
Intrarosa coupon
For people with commercial health insurance, the Intrarosa manufacturer website offers a discount program. With the Intrarosa savings program, you may be able to obtain a prescription for as little as a $35 co-pay per 30-day supply. Of course, how much Intrarosa costs you will depend on your insurance, area, local pharmacy prices, and availability.
Does Medicare cover Intrarosa?
For those who have federal insurance like Medicare, the Intrarosa manufacturer website offers a separate coupon program, but terms and conditions apply.
Intrarosa alternatives
There is currently no generic version of Intrarosa on the market. But there are alternatives out there. Our DHEA Vaginal Cream is $49 for a 2-month supply. And vaginal estrogen can effectively treat the same symptoms as Intrarosa treats. We offer a range of vaginal estrogen treatments starting at $39.
Our conclusion
Intrarosa pros and cons
The data is compelling: Vaginal DHEA treatments like Intrarosa are worth considering to help eliminate vaginal and urinary symptoms due to menopause.
Intrarosa pros
- DHEA converts into both estrogen and testosterone, and both can be helpful for vaginal health. Vaginal estrogen only contains estrogen.
- Vaginal DHEA does not contain estrogen, but it stimulates estrogen to be produced inside the vaginal cells. In terms of safety, vaginal DHEA isn’t necessarily better than vaginal estrogen, since vaginal estrogen has not been shown to carry serious risks.
Intrarosa cons
- Intrarosa requires daily insertion, while vaginal estrogen requires twice weekly insertion. Although some people may like the daily dosing, others may find it is inconvenient.
- Once the insert melts, a little medication can leak out. For some people, this isn’t entirely a bad thing since it can help to treat both the inside of the vagina and the opening of the vagina.
- It’s a brand-name medication with no generic, so it can be expensive even with insurance.
Intrarosa vs. vaginal estrogen
- You can use either product to alleviate painful sex, as well as other vaginal and urinary symptoms.
- You can use either product without increasing your risk of serious side effects. Both Intrarosa and vaginal estrogen are great options for women who do not want or cannot take oral estrogen.
- You can use either product for internal and external vaginal symptoms. This is helpful, for example, to prevent pain or soreness at the 6 o’clock area at the entrance to the vagina where pain is common.
FAQ
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Does Intrarosa contain estrogen?
No. Intrarosa’s active ingredient is prasterone (DHEA), which vaginal cells convert locally into estrogen and testosterone. It does not raise estrogen levels beyond the normal postmenopausal range.
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What is the most common side effect of Intrarosa?
Vaginal discharge is the most common side effect, reported by about 6% of participants in clinical trials. An abnormal pap smear was reported by about 2%.
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Can I use Intrarosa if I’ve had breast cancer?
Intrarosa’s label advises against use after a breast cancer diagnosis. However, 2021 ACOG guidelines say DHEA may still be considered for breast cancer survivors if low-dose vaginal estrogen isn’t an option, in consultation with an oncologist.
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How much does Intrarosa cost without insurance?
Intrarosa costs about $300 per month without insurance. A manufacturer savings program can lower the cost to as little as a $35 copay per 30-day supply for those with commercial insurance.
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Are there other alternatives to Intrarosa?
Yes. Our DHEA Vaginal Cream is a custom-compounded vaginal DHEA prescription product that starts at $49 for a 2-month supply. It’s formulated with DHEA and a lightweight botanical cream base.
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Is Intrarosa better than vaginal estrogen?
Neither is proven more effective than the other. Both are safe, FDA-approved treatments for vaginal and urinary symptoms of menopause. Intrarosa is inserted daily and also produces testosterone locally, while vaginal estrogen is typically used twice weekly. The North American Menopause Society’s 2020 GSM guidelines state that both vaginal estrogen and vaginal DHEA (such as Intrarosa) are safe and effective treatments for GSM (2).
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Do I need to take progesterone with Intrarosa?
No. Progesterone is only needed to protect the uterine lining when estrogen is given systemically, such as with a pill or patch. Because Intrarosa works locally and doesn’t raise estrogen beyond the normal postmenopausal range, no added progesterone is needed - the same is true for low-dose vaginal estrogen.
Next steps
Treating vaginal dryness and painful sex can be overwhelming, but it doesn’t have to be. Although Intrarosa may be effective in treating vaginal dryness and pain, it may not be the best treatment for your needs and preferences. Interlude’s licensed medical providers are here to prescribe you FDA-approved and effective treatments like estradiol vaginal cream, estradiol vaginal suppositories, or our DHEA Vaginal Cream. They can also help answer any questions you may have and help figure out what works for you. Shop our solutions, take our quiz, or get a telehealth consult today, and you’ll be one step closer to finding solutions that work for your needs.
