If you follow Liz on Instagram, you may have seen her sharing her own HRT routine – and one product prompted so many questions: Intrarosa. Here, she explains what you need to know…
Unlike the oestrogen gel, progesterone or testosterone we’ve come to know and love, Intrarosa is a little-known vaginal pessary containing prasterone. It deserves more attention because it works in an unusual way, especially when it comes to vaginal and bladder health, painful sex and sexual function after menopause.
What is Intrarosa?
Intrarosa is a waxy pessary made with 6.5mg of prasterone, also known as DHEA, that’s inserted into the vagina once a day, usually at bedtime. DHEA is a hormone our bodies make naturally but levels decline during perimenopause and beyond.
Once prasterone or DHEA enters the vaginal cells, it’s converted into small amounts of oestrogens and androgens (testosterone). This is what makes Intrarosa different from a conventional vaginal oestrogen. The official product information describes DHEA as an ‘inactive precursor’ as its effects come from conversion into other hormones – testosterone and oestradiol. It’s licensed in the UK for moderate-to-severe vulval and vaginal atrophy after menopause, increasingly referred to as genitourinary syndrome of menopause, or GSM.
Vaginal tissues change after menopause
The vagina, vulva, bladder and urethra are all hormone-sensitive tissues. As oestrogen levels decline, vaginal tissue becomes thinner, drier and less elastic. Blood flow and lubrication decrease and the vaginal microbiome and pH can change. The result isn’t “just a little dryness” and GSM can be extremely debilitating. Symptoms can include:
- vaginal or vulval dryness, burning and irritation
- pain or discomfort during sex
- reduced lubrication
- urinary urgency or frequency
- discomfort when passing urine
- recurrent urinary infections (UTIs)
Unlike hot flushes, which can lessen over time, GSM frequently persists – and usually worsens with age if it isn’t treated.
Intrarosa versus Vagifem: what’s the difference?
Vagifem or Vagirux are low-dose vaginal treatments containing body-identical oestradiol, delivering oestrogen directly to the vaginal tissues. Intrarosa takes a different route. It supplies DHEA, which the vaginal cells then convert locally into both oestrogenic and androgenic hormones. That’s the important distinction.
Both approaches improve the vaginal environment and vaginal oestrogen remains the first-line hormonal treatment in current NICE guidance. However, vaginal prasterone can be considered if vaginal oestrogen hasn’t worked well enough. An NHS doctor is likely to ask you to try Vagifem or similar first, before prescribing Intrarosa.
Vaginal Viagra?
This is an added bonus! Although Intrarosa isn’t licensed as a libido treatment, studies suggest benefits beyond simply reducing dryness. In one randomised placebo-controlled study of 482 postmenopausal women with vulvovaginal atrophy, daily 6.5mg vaginal prasterone for 12 weeks resulted in statistically significant improvements across all six areas measured by the Female Sexual Function Index.
Compared with placebo, women reported improvements in desire, arousal, lubrication, orgasm, sexual satisfaction and pain during sex.
Painful sex after menopause is incredibly common, yet many older women still put up with it or assume it is simply an unavoidable part of getting older. It isn’t.
There’s even evidence that these improvements aren’t purely because sex becomes less painful. Women reported better sexual function even if they didn’t have painful sex. That raises the thought that locally produced androgens within the vagina have a role in sexual sensation and response regardless.
Help for recurrent UTIs
Another key benefit is that prasterone improves the vaginal lining and lowers vaginal pH towards its healthier, pre-menopausal levels. This helps maintain normal vaginal bacterial flora in the pelvic region, including the urethra. Although vaginal oestrogen has been more studied (so has stronger evidence) many women find Intrarosa even more effective.
How do you use Intrarosa?
The licensed dose is one 6.5mg pessary inserted into the vagina every night at bedtime. This is another difference from many vaginal oestrogen products, which have an initial daily loading phase followed by useage two or three times a week. Intrarosa is used daily.
Is Intrarosa available on the NHS?
Yes – but access varies. NICE now recommends that vaginal prasterone should be considered for genitourinary symptoms when vaginal oestrogen or non-hormonal moisturisers and lubricants have been ineffective or aren’t tolerated. However, individual Integrated Care Boards and local formularies make their own prescribing decisions, so in some areas Intrarosa can be prescribed relatively readily, while others restrict it to second-line treatment or specialist recommendation. The good news is that your GP can prescribe it, Intrarosa is covered by the NHS HRT annual pre-payment scheme. And as with all prescriptions, it is free for the over-60’s.
If your NHS GP says it isn’t available, it’s worth asking them to check your area’s current formulary from time to time, as prescribing guidance does change. Many private clinicians are also happy to prescribe Intrarosa and it’s also available from online pharmacies after a short consultation. It costs around £50-£55 per month.
My honest opinion
One of the things I’ve learnt from talking to so many women about menopause is just how overlooked our vaginal and urinary health still is. We readily talk about hot flushes, brain fog and sleep – yet vaginal dryness, painful sex, urinary symptoms, incontinence and changes in sexual sensation are still affecting our quality of life. And there is absolutely no medal for putting up with them.
I’ve used both vaginal oestrogen and Intrarosa, and what interests me about Intrarosa is that it isn’t simply delivering another dose of oestrogen. The clinical evidence showing a wide range of benefits to our vaginal tissues when locally applied DHEA is converted into oestrogens and androgens is compelling. That’s something I think more midlife women deserve to know about.
Vaginal oestrogen remains extremely useful, inexpensive and well supported by evidence, particularly when recurrent UTIs are part of the picture. But Intrarosa gives us another tool in the menopause toolkit. When it comes to our intimate health, more well-evidenced options – as well as more open conversations about them – can only be a good thing.
Always speak to your GP, pharmacist or menopause healthcare professional about the treatment that’s appropriate for you. Never ignore unexplained vaginal bleeding, persistent pain or recurrent urinary symptoms.
References
- Labrie F, Archer DF, Koltun W, et al. Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause. Menopause. 2016;23(3):243–256.
- Archer DF, Labrie F, Bouchard C, et al. Treatment of pain at sexual activity (dyspareunia) with intravaginal dehydroepiandrosterone (prasterone). Menopause. 2015;22(9):950–963. doi:10.1097/GME.0000000000000428.
- Labrie F, Derogatis L, Archer DF, et al. Effect of intravaginal prasterone on sexual dysfunction in postmenopausal women with vulvovaginal atrophy. Journal of Sexual Medicine. 2015;12(12):2401–2412. doi:10.1111/jsm.13045.
- Labrie F, Archer D, Bouchard C, et al. Lack of influence of dyspareunia on the beneficial effect of intravaginal prasterone (dehydroepiandrosterone, DHEA) on sexual dysfunction in postmenopausal women. Journal of Sexual Medicine. 2014;11(7):1766–1781. doi:10.1111/jsm.12517.
- Rubin R, Sanaee M, Yee A, et al. Prevalence of urinary tract infections in women with vulvovaginal atrophy and the impact of vaginal prasterone on the rate of urinary tract infections. Menopause. 2025;32(3):217–227. doi:10.1097/GME.0000000000002485.
- National Institute for Health and Care Excellence (NICE). Menopause: identification and management (NG23).Recommendation 1.5.10: consider vaginal prasterone for genitourinary symptoms if vaginal oestrogen, or non-hormonal moisturisers or lubricants, have been ineffective or are not tolerated. Updated 2024; guideline last updated April 2026.
Further information: Intrarosa 6.5 mg pessary. Summary of Product Characteristics. Electronic Medicines Compendium.
