臨床婦人科産科77巻6号

2023年06月発行

今月の臨床 更年期症状への補完代替医療の最新知見―科学的根拠を踏まえて

補完代替医療それぞれの作用機序と効果

―【サプリメント】―DHEA

著者： 満岡孝雄¹

所属機関： ¹満岡内科・循環器クリニック

ページ範囲：P.602 - P.611

文献概要

●米国ではDHEAは栄養補助食品と考えられているため，スーパーやドラッグストアなどで買うことができる．しかし，日本をはじめ多くの国では医薬品として取り扱われている．

●更年期の血管運動神経症状と閉経関連泌尿生殖器症候群（GSM）に対する第一選択はホルモン補充療法であるが，難治性GSMに対してはDHEA腟剤も推奨される．

●閉経後女性の性的欲求低下障害（HSDD）に対してDHEA経口補充の効果を示すエビデンスもあるが，最近のグローバル・コンセンサスはテストステロン補充を推奨している．

参考文献

1）Parasrampuria J, et al : Quality control of dehydroepiandrosterone dietary supplement products. JAMA 280 : 1565, 1998

2）Thompson RD, et al : Liquid chromatographic determination of dehydroepiandrosterone（DHEA） in dietary supplement products. J AOAC Int 83 : 847-857, 2000

3）Rutkowski K, et al : Dehydroepiandrosterone（DHEA） : hypes and hopes. Drugs 74 : 1195-1207, 2014

4）色本　涼，他 : 心身ストレスの検査と評価．日本抗加齢医学会専門医・指導士認定委員会（編）：アンチエイジング医学の基礎と臨床，第3版．pp189-190，メジカルビュー社，2015

5）Rabijewski M, et al : Supplementation of dehydroepiandrosterone（DHEA）in pre- and postmenopausal women ― position statement of expert panel of Polish Menopause and Andropause Society. Ginekologia Pol 91 : 554-562, 2020

6）Klinge CM, et al : Dehydroepiandrosterone research. Past, current, and future. Vitam Horm 108 : 1-28, 2018

7）Longcope C : Adrenal and gonadal androgen secretion in normal females. Clin Endocrinol Metab 15 : 213-228, 1986

8）柳瀬敏彦 : 副腎ホルモン．日本抗加齢医学会専門医・指導士認定委員会（編）：アンチエイジング医学の基礎と臨床，第3版．pp108-109，メジカルビュー社，2015

9）柳瀬敏彦 : 女性におけるテストステロンの意義．日女性医学誌27 : 548-551, 2020

10）Morales AJ, et al : Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. J Clin Endocrinol Metab 78 : 1360-1367, 1994

11）Labrie F, et al : Effect of 12-month dehydroepiandrosterone replacement therapy on bone, vagina, and endometrium in postmenopausal women. J Clin Endocrinol Metab 82 : 3498-3505, 1997

12）Morales AJ, et al : The effect of six months treatment with a 100mg daily dose of dehydroepiandrosterone（DHEA）on circulating sex steroids, body composition and muscle strength in age-advanced men and women. Clin Endocrinol（Oxf）49 : 421-432, 1998

13）Flynn MA, et al : Dehydroepiandrosterone replacement in aging humans. J Clin Endocrinol Metab 84 : 1527-1533, 1999

14）Arlt W, et al : Dehydroepiandrosterone supplementation in healthy men with an age-related decline of dehydroepiandrosterone secretion. J Clin Endocrinol Metab 86 : 4686-4692, 2001

15）Nair KS, et al : DHEA in elderly women and DHEA or testosterone in elderly men. N Engl J Med 355 : 1647-1659, 2006

16）Baulieu EE, et al : Dehydroepiandrosterone（DHEA）, DHEA sulfate, and aging : contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci U S A 97 : 4279-4284,2000

17） Kroboth P, et al : DHEA and DHEA-S : a review. J Clin Pharmacol 39 : 327-348, 1999

18）Panjari M, et al : DHEA for postmenopausal women : a review of the evidence. Maturitas 66 : 172-179, 2010

19）The 2022 hormone therapy position statement of The North American Menopause Society. Menopause 29 : 767-794, 2022

20）Portman DJ, et al ; Vulvovaginal Atrophy Terminology Consensus Conference Panel : Genitourinary syndrome of menopause : new terminology for vulvovaginal atrophy from the international society for the study of women's sexual health and the North American Menopause Society. Menopause 21 : 1063-1068, 2014

21）Kim HK, et al : The recent review of the genitourinary syndrome of menopause. J Menopausal Med 21 : 65-71, 2015

22）The 2020 genitourinary syndrome of menopause position statement of the North American Menopause Society. Menopause 27 : 976-992, 2020

23）Nappi RE, et al : Women's voices in the menopause : results from an international survey on vaginal atrophy. Maturitas 67 : 233-238, 2010

24）Moyneur E, et al : Prevalence of depression and anxiety in women newly diagnosed with vulvovaginal atrophy and dyspareunia. Menopause 27 : 134-142, 2020

25）Rabijewski M, et al : Supplementation of dehydroepiandrosterone（DHEA） in pre- and postmenopausal women―position statement of expert panel of Polish Menopause and Andropause Society. Ginekologia Pol 91 : 554-562, 2020

26）Stute P, et al : Swiss consensus on the role of DHEA in the management of genitourinary syndrome of menopause. Climacteric 25 : 246-256, 2022

27）Lobo RA : Androgens in postmenopausal women : production, possible role, and replacement options. Obstet Gynecol Surv 56 : 361-376, 2001

28）Labrie F : Intracrinology and menopause : the science describing the cell-specific intracellular formation of estrogens and androgens from DHEA and their strictly local action and inactivation in peripheral tissues. Menopause 26 : 220-224, 2019

29）Ke Y, et al : Serum steroids remain within the same normal postmenopausal values during 12-month intravaginal 0.50％DHEA. Horm Mol Biol Clin Investig 24 : 117-129, 2015

30）Martel C, et al : Serum steroid concentrations remain within normal postmenopausal values in women receiving daily 6.5mg intravaginal prasterone for 12 weeks. J Steroid Biochem Mol Biol 159 : 142-153, 2016

31）Portman DJ, et al : Lack of effect of intravaginal dehydroepiandrosterone（DHEA, prasterone）on the endometrium in postmenopausal women. Menopause 22 : 1289-1295, 2015

32）Labrie F, 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 25 : 1339-1353, 2018

33）Labrie F, et al : Prasterone has parallel beneficial effects on the main symptoms of vulvovaginal atrophy : 52-week open-label study. Maturitas 81 : 46-56, 2015

34）Labrie F, et al : Effect of intravaginal prasterone on sexual dysfunction in postmenopausal women with vulvovaginal atrophy. J Sex Med 12 : 2401-2412, 2015

35）Pelletier G, et al : Effects of ovariectomy and dehydroepiandrosterone（DHEA）on vaginal wall thickness and innervation. J Sex Med 9 : 2525-2533, 2012

36）Carter J, et al : Interventions to address sexual problems in people with cancer : American society of clinical oncology clinical practice guideline adaptation of cancer care Ontario guideline. J Clin Oncol 36 : 492-511, 2018

37）Moyneur E, et al : Absence of increase in the incidence or recurrence of breast cancer in women diagnosed with vulvovaginal atrophy（VVA）treated with intravaginal prasterone（DHEA）on the risk of breast cancer : a retrospective matched cohort study. 19th world congress of Gynaecological Endocrinology, 2020

38）Dury A, et al : Serum estrogen levels do not increase following intravaginal administration of prasterone（DHEA）in women treated with an aromatase inhibitor for breast cancer―results from a pilot study. 19th world congress of Gynaecological Endocrinology, 2020

39）Davison SL, et al : Androgen levels in adult females : changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab 90 : 3847-3853, 2005

40）Davis SR : Circulating androgen levels and self-reported sexual function in women. JAMA 294 : 91-96, 2005

41）Genazzani AR, et al : DHEA therapy in postmenopausal women : the need to move forward beyond the lack of evidence. Climacteric 13 : 314-316, 2010

42）Genazzani AR, et al : Effect of 1-year, low-dose DHEA therapy on climacteric symptoms and female sexuality. Climacteric 14 : 661-668, 2011

43）Kushnir VA, et al : Effects of dehydroepiandrosterone（DHEA）supplementation on sexual function in premenopausal infertile women. Endocrine 63 : 632-638, 2019

44）Davis SR, et al : Global consensus position statement on the use of testosterone therapy for women. J Clin Endocrinol Metab 104 : 4660-466, 2019

45）満岡孝雄 : 誌上DEBATE「DHEA補充」「Yesの立場から」．アンチ・エイジ医18 : 36-41, 2022

46）満岡孝雄 : 「老い対策」としてのアンチエイジング医療〜高齢者に対するホルモン補充療法を考える〜．アンチ・エイジ医14 : 26-34, 2019