Clinical Efficacy of Single-Dose Intravaginal Prasterone versus Topical Estrogen Cream for Moderate-to-Severe Vulvovaginal Atrophy

International Journal of Obstetrics and Gynecology | Vol. 14, No. 7, July 2026 | pp. 85–96

DOI: 10.46882/2026/IJOG/000484

Original Research Article

Title: Clinical Efficacy of Single-Dose Intravaginal Prasterone versus Topical Estrogen Cream for Moderate-to-Severe Vulvovaginal Atrophy

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:
Vulvovaginal Atrophy (VVA) is a frequent manifestation of genitourinary syndrome of menopause that significantly impairs sexual health and quality of life. This randomized, open-label, active-controlled trial compared the clinical efficacy, local safety, and impact on vaginal pH of once-daily intravaginal prasterone (dehydroepiandrosterone, 6.5 mg) against topical conjugated equine estrogen cream (0.5 mg) in postmenopausal women. One hundred and eighty participants presenting with moderate-to-severe VVA symptoms (dyspareunia or vaginal dryness) were randomized in a 1:1 ratio for a treatment period of 12 weeks. The primary outcomes evaluated were changes in vaginal pH, percentage of superficial and parabasal cells, and severity scores of the most bothersome symptom. At week 12, both groups demonstrated a significant decrease in mean vaginal pH from baseline (prasterone: 6.4 ± 0.5 to 4.6 ± 0.3, p < 0.001; estrogen: 6.3 ± 0.4 to 4.5 ± 0.4, p < 0.001). The maturation index of the vaginal epithelium improved equivalently, with superficial cells increasing significantly in both cohorts (p < 0.001). Prasterone demonstrated a comparable reduction in dyspareunia severity scores compared to estrogen cream (mean reduction of 1.8 ± 0.4 vs. 1.9 ± 0.5 points, p = 0.42). However, systemic absorption parameters remained significantly lower in the prasterone arm, with serum estradiol levels remaining well within normal postmenopausal thresholds (< 10 pg/mL) compared to the estrogen cream cohort (p < 0.001). Daily intravaginal prasterone provides excellent local tissue restoration and symptom relief for postmenopausal vulvovaginal atrophy, presenting a highly efficient alternative with negligible systemic estrogen exposure.

Keywords: Vulvovaginal Atrophy; Prasterone; Estrogen Cream; Dyspareunia; Postmenopausal Health; Vaginal Maturation Index.

Manuscript Timeline: Received: March 20, 2026; Revised: May 11, 2026; Accepted: June 10, 2026; Published: July 15, 2026.

Citation: Bello MT, Effiong GE. Clinical Efficacy of Single-Dose Intravaginal Prasterone versus Topical Estrogen Cream for Moderate-to-Severe Vulvovaginal Atrophy. International Journal of Obstetrics and Gynecology. 2026; 14(7): 85–96.

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