Long-Term Administration of Intravaginal Dehydroepiandrosterone on Regression of Low-Grade Cervical Dysplasia – A Pilot Study

Abstract

Although many dysplastic cervical lesions regress spontaneously, treatment is common due to concern for progression. Lesions persist or progress in women whose immune systems are unable to clear infection by human papillomavirus (HPV). Dehydroepiandrosterone (DHEA) is an adrenal steroid that has both immune modulatory and tumor inhibitory activity. A pilot study was conducted to examine the feasibility, safety and potential efficacy of intravaginal DHEA in women with low-grade cervical dysplasia. Twelve women with low-grade dysplasia, confirmed by colposcopic exam, were given 150 mg of intravaginal micronized DHEA daily for up to 6 months. Follow-up evaluations of the cervix were done at 3 and 6 months of use. DHEA, DHEA-S, androstenedione and testosterone levels were also measured. By the end of the study period, 10 of the 12 women (83%) had no evidence of dysplasia; the remaining 2 had normal colposcopic exams but cytology showing atypical cells of undetermined significance. There were no serious side effects. Androstenedione levels were elevated at 3 months, whereas testosterone levels were unchanged over the course of treatment. The results suggest that intravaginal DHEA is safe and well tolerated and may promote regression of low-grade cervical lesions. Further study is needed to establish efficacy.

Female-to-Male Patients Have High Prevalence of Unsatisfactory Paps Compared to Non-Transgender Females: Implications for Cervical Cancer Screening

“…It is conceivable that FTM patients are at reduced risk of cervical abnormalities, as there is some indication that the testosteronized cervix is a less hospitable environment for persistent human papillomavirus (HPV) infection due to decreased turnover of cervical cells or changes to cellular receptors. [23][24][25] Alternatively, data show that non-transgender women with inadequate tests are more likely to later have abnormal Pap tests 15 , so FTMs may actually be at increased risk of abnormalities. We therefore caution against drawing any conclusions from the results of the evaluable tests, as the high prevalence of inadequate tests essentially constitutes "missing data" that differentially affects our ability to determine the true proportion of abnormal Pap tests among FTMs.…”

Effects of intravaginal dehydroepiandrosterone on vaginal histomorphology, sex steroid receptor expression and cell proliferation in the rat

“…Also, in a long-term pilot study, 150 mg DHEA was given intravaginally to premenopausal women once daily for up to 6 months; in that study, when compared with baseline values, only androstenedione (4-DIONE) was significantly elevated, while DHEA, DHEA-S and TESTO values did not increase [35].…”

“…In two clinical studies, either a single dose or 6-month intravaginal daily treatment with 150 mg DHEA were used to evaluate pharmacokinetic parameters and/or to obtain regression of lowgrade cervical dysplasia, in premenopausal women [34,35]. None of the two studies documented any significant adverse effect of such high dose of DHEA on vaginal tissue or at the systemic level.…”

New perspectives of the treatment of urogenital atrophy in women: intravaginal DHEA therapy

“…W badanej surowicy pacjentek wykazano zwiększone stężenie androstendionu przy niezmienionym stężeniu testosteronu [15].…”