How to use Intrarosa
Intrarosa is a nightly vaginal insert containing prasterone — a hormone your body produces naturally — that works locally in the vaginal tissue to treat the changes of menopause that affect comfort and sexual response.
What it is and what it does
Intrarosa (prasterone, also called DHEA) is a small vaginal insert used once a night at bedtime. It works entirely in the local tissue: once inserted, it is converted into small amounts of estrogen and testosterone right in the vaginal and vulvar tissue, where those hormones are needed. Because the conversion happens locally and not systemically, hormone levels in the rest of the body do not meaningfully change.
Intrarosa is FDA-approved for moderate-to-severe pain with sex caused by menopause. It also addresses the broader picture of vaginal dryness, tissue thinning, and the changes in arousal and orgasm that come with the loss of local estrogen and testosterone after menopause.
Why it works on more than dryness
Most local treatments for menopause focus on tissue health alone. Intrarosa does that, and more: because prasterone is the precursor to both estrogen and testosterone, the tissue makes both locally. Testosterone in the vulvar and vaginal tissue is closely tied to nerve density, sensation, arousal, and orgasm response — not only to lubrication and comfort.
In the pivotal randomized controlled trial of nightly intravaginal prasterone, all six measured domains of sexual function — desire, arousal, lubrication, orgasm, satisfaction, and pain — improved significantly compared with placebo at 12 weeks. Arousal improved by 56.8% over placebo (P=0.0022) and orgasm by 33% (P=0.047). A separate phase III trial showed arousal and sensation improved by 64.2% (P=0.01) and orgasm by 75% (P=0.047) over placebo. Notably, those improvements occurred whether or not vaginal pain was present at the start — meaning Intrarosa helps with arousal and orgasm specifically, not only when pain is the main problem.
How to use it
Use one vaginal insert every night at bedtime. Each box contains 28 inserts and 28 single-use applicators.
- Wash your hands with soap and water.
- Tear off one insert from the blister pack along the perforation.
- Peel back the plastic to remove the insert. It is a small, white to off-white, bullet-shaped solid.
- Take one applicator. Place the insert into the open end (the end without the plunger).
- Get into a comfortable position — lying on your back with knees bent, or standing with one foot on a step or chair.
- Gently insert the applicator into your vagina as far as it will comfortably go.
- Push the plunger to release the insert.
- Remove the applicator and throw it away. Each applicator is for one use only — do not reuse.
- Wash your hands.
What to expect
Use it every night. Intrarosa works best with consistent nightly use, and bedtime use lets it dissolve while you are lying down. The benefit depends on continued daily use — do not stop without talking to us.
Discharge is normal. The insert is made of a fat-based material that melts at body temperature. You may notice a watery or oily discharge — this is expected, not a side effect to worry about. A panty liner may be helpful.
It takes time. Most women begin to notice improvement within a few weeks. Full benefit is typically seen after about 12 weeks of daily use.
Pap smear changes. Intrarosa can cause changes on a Pap smear (such as ASCUS). These are usually not concerning. Let your provider know you are using Intrarosa before any Pap test.
Storage. Keep at room temperature (41°F to 86°F / 5°C to 30°C). Refrigeration is also fine if you prefer.
If you miss a dose
Insert it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue your regular schedule. Do not use two inserts at the same time.
When to message us
- Unusual vaginal bleeding
- Severe vaginal irritation or itching that does not improve
- Any new breast lumps or changes
- Any concerns about discharge or side effects
Research
- 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.
- Labrie F, Archer D, Bouchard C, et al. Lack of Influence of Dyspareunia on the Beneficial Effect of Intravaginal Prasterone on Sexual Dysfunction in Postmenopausal Women. Journal of Sexual Medicine. 2014;11(7):1766–1785.
- Labrie F, Archer DF, Koltun W, et al. Efficacy of Intravaginal Dehydroepiandrosterone (Prasterone) 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.