Progesterone, Testosterone & DHEA: The Supporting Cast (Part 3 of 3)

Progesterone recap

Progesterone receptors are found in many tissues (including the uterus and brain). In menopause hormone therapy (MHT), progesterone (or another progestogen) is primarily used to protect the lining of the uterus (endometrium) when oestrogen is prescribed and you still have a uterus.

Some women also report improvements in sleep or mood with certain progestogens, but responses vary and this isn’t the main reason progesterone is prescribed in MHT.

Body-identical option:

• Micronised progesterone (e.g., Utrogestan) is the body-identical progesterone option used in MHT.

Common TGA-approved progesterone options in Australia

• Micronised progesterone capsules (e.g., Utrogestan): used orally for MHT and also used vaginally in some contexts (follow prescriber advice and product information).

• Other progestogens may be used for endometrial protection depending on the regimen and individual factors (your clinician will guide this).

Key safety point: If you have a uterus and are using systemic oestrogen for MHT, a progestogen is usually required to reduce the risk of endometrial hyperplasia/cancer.

Testosterone recap

Women produce testosterone across the lifespan, and it plays a role in sexual function among other physiological processes. However, when it comes to menopause care, international consensus is clear:

The only evidence-based indication for systemic testosterone therapy in women is: Hypoactive Sexual Desire Disorder (HSDD) in postmenopausal women, after a biopsychosocial assessment and after other contributing factors are addressed.

There is insufficient evidence to recommend testosterone for problems such as fatigue, “brain fog”, mood, or disease prevention.

TGA-approved option in Australia

• AndroFeme 1 (testosterone cream) is TGA-registered for HSDD in postmenopausal women.

PBS note (important correction):

• As of December 2025, AndroFeme 1 is not PBS-listed, following a PBAC decision not to recommend listing.

Monitoring matters: If testosterone is prescribed, guidelines recommend using the lowest effective dose, aiming for physiological female ranges, and monitoring for side effects (e.g., acne, hair changes) and blood levels.

DHEA recap (prasterone)

DHEA is an adrenal precursor hormone that declines with age. In menopause care, the most established role is local vaginal DHEA (prasterone) for symptoms of genitourinary syndrome of menopause (GSM) such as dryness and painful sex.

TGA-approved option in Australia

• Intrarosa (prasterone) vaginal pessaries are TGA-approved for moderate–severe vulvar and vaginal atrophy in postmenopausal women. Therapeutic Goods Administration (TGA)+1

Important safety note (correction):

• Australian prescribing information and Australian Prescriber reporting indicate contraindications, including a history of breast cancer or thromboembolism. This is a situation where personalised specialist advice is essential. Australian Prescriber+1

Oral DHEA supplements:

• Evidence for broad menopause symptom relief is limited and inconsistent, and they’re not routinely recommended in major menopause guidance. menopause.org.au+1

What symptom changes are realistic?

Guidelines support the following, when therapy is clinically indicated:

• Progesterone (as part of MHT if you have a uterus): endometrial protection; some women notice sleep benefits, but this varies.

• Testosterone (for diagnosed HSDD): can improve sexual desire and related distress in postmenopausal women; effects are typically moderate.

• Vaginal DHEA (prasterone): can improve vaginal tissue symptoms and painful sex related to GSM.

Individual responses vary, and treatment choice depends on your overall health and preferences.

Your helpful 3-step plan

1. Reflect on symptoms

   • Uterus + systemic oestrogen? You’ll usually need a progestogen for uterine protection. menopause.org.au+1

   • Distressing low desire? Ask whether assessment for HSDD is appropriate. International Menopause Society+1

   • Vaginal dryness/pain? Ask about local GSM treatments (vaginal oestrogen, prasterone, other options). Dutch Menopause Society+1

2. Book with a menopause-trained health professional

3. Ask: “Are progesterone, testosterone or vaginal DHEA options for my needs—and what monitoring would be required?”

Non-hormonal supports that still matter

• Resistance training 2–3 times/week supports strength, function, and bone health across midlife. Monash University+1

• Sleep and stress supports (routine, light exposure, limiting alcohol, addressing sleep disorders) can improve wellbeing alongside medical care. Monash University+1

• Protein-rich meals and adequate overall nutrition support muscle and energy. Monash University+1

If you’ve missed the first two newsletters in this series, you can find them — along with all previous newsletters — at menopauseandme.com.au/blog.If you’d like support or a personalised plan, you can reach me at: hello@menopauseandme.com.au menopauseandme.com.au/booking

Warmly,JennaNurse Practitioner & Menopause Educator

Sources

Australasian Menopause Society (AMS) – Treatment options & MHT dosing resourcesThe Menopause Society (NAMS) – 2022 Hormone Therapy Position StatementInternational Menopause Society (IMS) – Global Consensus on Testosterone Therapy for Women (2019)Jean Hailes for Women’s Health – Menopausal hormone therapy & testosterone guidanceMonash University – Practitioner’s Toolkit for Managing Menopause (updated 2025)TGA (Australia) – Intrarosa (prasterone) + ARTG listingNPS MedicineWise – AndroFeme 1 (indication and consumer information)Australian Prescriber – Prasterone overview and contraindications

Important Disclaimer: The information in this blog/newsletter is general in nature and intended for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your Nurse Practitioner, doctor, or another qualified health practitioner with any questions you may have regarding a medical condition or before commencing any new treatment, exercise program, changing your diet, or taking supplements – particularly if you have existing health conditions, are on medication, or have had fractures or falls in the past. Individual needs and responses vary.