PAD Refills

Prasterone (Intrarosa^®) for the Genitourinary Syndrome of Menopause (GSM)

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The BC Provincial Academic Detailing (PAD) service’s topic Medications for menopause-associated vasomotor and genitourinary symptoms delivers evidence and practical drug information for the most commonly prescribed estrogen and progestogen products (oral, transdermal, vaginal).¹ Visit www.bcpad.ca to book a session with an academic detailing pharmacist in your area.

We received this question during PAD sessions: Does vaginal prasterone offer an additional advantage on measures of sexual dysfunction compared to vaginal estrogen products accessible in the National Pharmacare formulary (Plan NP)?

Basics1-4

Prasterone (also known as dehydroepiandrosterone or DHEA) is an inactive prodrug which is converted intracellularly into estrogens and androgens in vaginal cells It was approved by Health Canada based on two 12-week trials which demonstrated improvements in dyspareunia and vaginal dryness associated with GSM in postmenopausal women The Society of Obstetricians and Gynecologists of Canada’s 2021 guideline states that prasterone also improves sexual dysfunction but does do not quantify the magnitude of the treatment effect

Comparisons5-6

Canada’s Drug Agency’s 2022 review of prasterone did not identify exceptional benefits for prasterone compared to other available treatments but it has not been compared directly to the two vaginal estrogen products currently listed on Plan NP (Premarin®, Imvexxy®). Review the table below for cost comparison It has been compared directly to Vagifem® in a small trial, but methodologic limitations preclude drawing confident conclusions on the results (e.g., open label, single center, non-standardized outcomes)

What is the effect of vaginal prasterone ovules on sexual dysfunction in women with GSM?⁷

In one of the 12-week drug approval trials, the impact of prasterone on sexual dysfunction was assessed as a secondary outcome using the Female Sexual Function Index (FSFI) questionnaire. FSFI includes six domains: desire, arousal, lubrication, orgasm, satisfaction and pain. The total score ranges from 2 to 36 with higher scores indicating better or improved sexual function. Participants were postmenopausal women (mean age 60) with moderate to severe dyspareunia.

Table8-10	Premarin cream	Imvexxy softgel inserts	Intrarosa ovules
Active ingredient	Conjugated equine estrogens	Estradiol	Prasterone
Cost per month	~$10-40	~$30	~$55
PharmaCare coverage	regular benefit (Plan NP)*	regular benefit (Plan NP)*	non-benefit

^*100% coverage (no cost to patient)

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¹BC PAD Service Medications for Menopause-Associated Vasomotor and Genitourinary Symptoms (May 2025); ²Health Canada Drug Product Database Intrarosa; ³Health Canada Clinical Information Intrarosa; ⁴Society of Obstetricians and Gynaecologists of Canada JOGC 2021 (PMID:34649681); ⁵Canada’s Drug Agency Intrarosa; ⁶Strandberg Maturitas (PMID:41903372); ⁷Labrie J Sex Med 2015 (PMID:26597311); ⁸Health Canada Drug Product Database; ⁹Cost: does not include mark-up or professional fee, calculated from McKesson Canada PharmaClik March 1, 2026; ¹⁰BC PharmaCare Formulary Plan NP menopausal hormone therapy