Vitamin D supplementation for primary dysmenorrhea: a double-blind, randomized, placebo-controlled trial

Vitamin D for primary dysmenorrhea and endometriosis-related pain - A systematic review of registered RCTs

OBJECTIVE

This systematic review investigates the potential role of vitamin D supplement in alleviating pain associated with primary dysmenorrhea or endometriosis by analysing registered randomised controlled trials (RCTs).

METHODS

We comprehensively searched the WHO International Clinical Trials Registry Platform to identify registered RCTs that assessed the effects of vitamin D supplement on pain outcomes in people with primary dysmenorrhea or endometriosis. The primary outcomes of interest were pain severity/intensity, pain duration, pain medication usage and pain-related outcome measurements.

RESULTS

Seven registered RCTs were included in this systematic review. These RCTs had diverse doses and treatment durations of vitamin D supplement used as intervention. They also had either high or some concerns of risk of bias, according to Cochrane risk of bias version 2 assessment. Substantial heterogeneities were generally observed across the seven RCTs. When measured using a validated tool visual analogue scale (VAS), pain severity was significantly lower at the end of treatment when compared with placebo (mean difference MD -1.12, 95% confidence interval [-2.16, -0.07], I2=81%, 5 studies, n = 308). This significant difference was observed in the primary dysmenorrhea RCTs, but not the endometriosis RCTs.

CONCLUSION

This systematic review identified vitamin D may reduce pain associated with primary dysmenorrhea, though a low certainty of evidence was available. Future studies that use standardised doses and treatment duration in accordance with the latest clinical practice guidelines are needed to explore any potential benefits vitamin D may have for people with these conditions.

Vitamin D Supplementation for Patients with Dysmenorrhoea: A Meta-Analysis with Trial Sequential Analysis of Randomised Controlled Trials

Vitamin D reduces prostaglandin levels and inflammation, making it a promising treatment option for dysmenorrhoea. However, its effects on pain intensity in different types of dysmenorrhoea remain unclear. We examined whether vitamin D supplementation decreases pain intensity in patients with dysmenorrhoea. The Cochrane Library, Embase, Google Scholar, Medline, and Scopus databases were searched from inception to 30 December 2023. Randomised controlled trials (RCTs) evaluating vitamin D supplementation effects on such patients were included. The primary and secondary outcomes were measured by the changes in pain intensity and rescue analgesic use, respectively. Pooled mean differences and rate ratios were calculated using a random-effect model; trial sequential analysis (TSA) was also performed. Overall, 11 studies involving 687 participants were included. Vitamin D supplementation significantly decreased pain intensity in patients with dysmenorrhoea compared with controls (pooled mean difference, -1.64; 95% confidence interval, -2.27 to -1.00; p < 0.001; CoE, moderate; I2 statistic, 79.43%) and indicated substantial heterogeneity among the included studies. TSA revealed that the current RCTs provide sufficient information. In subgroup analyses, vitamin D supplement reduced primary dysmenorrhoea pain but not secondary dysmenorrhoea pain. In conclusion, although substantial heterogeneity persists, vitamin D supplementation decreased pain intensity in patients with dysmenorrhea, especially in those with primary dysmenorrhoea.

The effects of vitamin D and calcium on primary dysmenorrhea: a systematic review

Dysmenorrhea, affecting approximately 80% of adolescents, significantly impairs quality of life, disrupts sleep patterns, and induces mood changes. Furthermore, its economic impact is substantial, accounting for an estimated $200 billion in the United States and $4.2 million in Japan annually. This review aimed to identify the effects of vitamin D and calcium on primary dysmenorrhea. We conducted a comprehensive literature search across Web of Science, PubMed, Scopus, and Science Direct, focusing on studies published from 2010 to 2020. Keywords included 'primary dysmenorrhea', 'vitamin D', '25-OH vitamin D3', 'cholecalciferol', and 'calcium'. The quality assessment of the articles was done using the Consolidated Standards of Reporting Trials (CONSORT) and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklists, and the risk bias was assessed using the Cochrane assessment tool. Abnormal low Vit. D levels increased the severity of primary dysmenorrhea through increased prostaglandins and decreased calcium absorption. Vitamin D and calcium supplements could reduce the severity of primary dysmenorrhea and the need for analgesics. This systematic review found an inverse relation between the severity of dysmenorrhea and low serum Vit. D and calcium.. Vitamin D and calcium supplements could reduce the severity of primary dysmenorrhea and the need for analgesics.

The effect of vitamin D on adolescents' primary dysmenorrhea

Vitamin D receptor (VDR) expression in the female reproductive tract explains the regulatory role of vitamin D on inflammatory cytokine and prostaglandin (PGD) synthesis. This study aimed to evaluate the effect of vitamin D on adolescents' primary dysmenorrhea and the relationship between Vit. D and adolescents' primary dysmenorrhea. Eighty-five adolescents were included in the current study. After a detailed evaluation, pelvic sonography was performed for all participants to rule out any pelvic pathology. Blood samples were collected to measure thyroid stimulating hormone (TSH), prolactin, glycosylated hemoglobin (HbA1C), and 25-hydroxyvitamin D (25[OH]D). Participants were administered vitamin D (50,000 IU weekly for five months), and their dysmenorrhea symptoms were evaluated before and after this period using the Visual Analog Scale (VAS) and the Verbal Multidimensional Scoring (VMS). The mean VAS and VMS scores of dysmenorrhea statistically decreased from 8.7±0.91 and 2.65±0.93 to 4.8±0.75 and 0.80±0.75, respectively, after vitamin D intake (p=0.03 and 0.025, respectively). Significant negative associations between 25(OH)D and VAS (R = -0.886; p<0.00001) and VMS of dysmenorrhea (R = -0.885; p<0.00001) were detected in this study. Vit. D could be a useful therapeutic option to reduce the severity of primary dysmenorrhea and could limit the use of non-steroidal anti-inflammatory drugs.

The impact of primary dysmenorrhea on adolescents' activities and school attendance

Primary dysmenorrhea is the most commonly encountered menstrual issue among adolescents, often leading to significant school absenteeism. This study aimed to detect the impact of primary dysmenorrhea on adolescents' activities and school attendance. We conducted a cross-sectional comparative study involving 180 adolescents aged 12 to 18 who experienced primary dysmenorrhea. A comprehensive trans-abdominal pelvic sonography was performed to rule out any underlying pelvic conditions. The severity of dysmenorrhea was evaluated using the visual analog scale (VAS), categorizing adolescents into groups with mild dysmenorrhea (VAS ≥1 to ≤3), moderate dysmenorrhea (VAS >3 to ≤7), and severe dysmenorrhea (VAS >7 to ≤10). Adolescents were surveyed to determine whether the severity of dysmenorrhea had an adverse effect on their physical and social activities as well as their school attendance. We used one-way ANOVA to compare the groups. There was a significant positive relation between the severity of dysmenorrhea and its negative impact on adolescents' physical activities (r=0.395; p<0.00001) and social activities (r=0.658; p<0.00001). Additionally, there was a significant positive relation between the severity of dysmenorrhea and its negative impact on adolescents' school attendance (r=0.416; p<0.00001). The odds of a negative impact on adolescents' physical and social activities and school attendance were significantly higher in adolescents experiencing moderate and severe dysmenorrhea than in adolescents with mild dysmenorrhea.

The relation between primary dysmenorrhea in adolescents and body mass index

INTRODUCTION

The aim was to assess the relation between primary dysmenorrhea in adolescents and body mass index (BMI).

MATERIAL AND METHODS

Two-hundred and ten adolescents were recruited for this cross-sectional research. After detailed evaluation, pelvic sonography was performed for the studied adolescents to rule out any pelvic abnormalities and/or lesion(s). The severity of the studied adolescents' dysmenorrhea was assessed by the visual analogue scale (VAS). The studied adolescents were divided into underweight, normal-weight, overweight, and obese adolescent groups based on their BMI (kg/m2). Collected data were analyzed using the ANOVA test, and correlation analysis (Pearson's correlation) to assess the relation between primary dysmenorrhea in adolescents and BMI.

RESULTS

The visual analogue scale of dysmenorrhea was statistically higher in the underweight adolescent group (8.7 ±0.8) compared to normal-weight (6.5 ±0.5) (p = 0.000001), and overweight (6.3 ±0.6) (p = 0.000001) adolescent groups. The visual analogue scale of dysmenorrhea was also statistically higher in the obese adolescent group (9.4 ±0.6) compared to underweight (8.7 ±0.8) (p = 0.000001), normal-weight (6.5 ±0.5) (p = 0.000001), and overweight (6.3 ±0.6) (p = 0.000001) adolescent groups.

CONCLUSIONS

The visual analogue scale of dysmenorrhea was statistically higher in the underweight adolescent group compared to normal-weight, and overweight adolescent groups, and there was a strong negative relation between the VAS and BMI in the underweight adolescent group. In addition, the VAS of dysmenorrhea was statistically higher when the obese adolescent group was compared with the overweight, normal-weight and underweight adolescent groups, and there was a moderate positive relation between the VAS and BMI in the obese adolescent group.

High prevalence of hypovitaminosis D3 among pregnant women in central Iran: correlation with newborn vitamin D3 levels and negative association with gestational age

OBJECTIVE

Hypovitaminosis D3 is a significant concern among pregnant women and their newborns because vitamin D3 (Vit-D3) plays a crucial role in embryonic growth, development, and health. This study aimed to evaluate the Vit-D3 status of a group of pregnant Iranian women and its association with newborn Vit-D3 levels, medical and clinical indices after delivery.

METHODS

A total of 206 pregnant women and their newborns were assessed for Vit-D3 levels and their correlation with gestational age. Mean±standard deviation (SD) or the orders (non-parametric tests) of variables were compared, and correlation estimations were performed to elucidate any differences or associations between groups, with a confidence interval of at least 0.95.

RESULTS

The mean±SD of mothers' age and gestational age were 29.65±6.18 years and 35.59±1.6 weeks, respectively. Neonatal Vit-D3 levels were associated with maternal age. Using a 30 ng/mL cutoff point for serum Vit-D3 levels, 83.5% of pregnant women and 84.7% of newborns had hypovitaminosis D3. The average Vit-D3 levels of mothers and newborns at delivery time were 23.5±8.07 ng/mL and 20.76±9.14 ng/mL, respectively. Newborn Vit-D3 levels were positively correlated with maternal Vit-D3 serum levels (R=0.744; P<0.001) and gestational age (R=0.161; P=0.022). In newborns, head circumference was inversely correlated with bilirubin level (R=-0.302; P<0.001) but directly associated with weight (R=0.640; P<0.001).

CONCLUSION

Hypovitaminosis D3 remains a significant challenge for pregnant Iranian women. Maternal Vit-D3 levels provide for the newborn's needs, particularly in the late stages of pregnancy. Therefore, Vit-D3 supplementation and regular monitoring are essential for pregnant women and their newborns.

Effect of Vitamin D Supplementation on Primary Dysmenorrhea: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Dysmenorrhea causes pain and inconvenience during menstruation. In addition to medication, natural compounds are widely used to relieve various types of pain. In this study, we aimed to assess the effects of vitamin D (vit. D) supplementation in relieving the symptoms of primary dysmenorrhea. A comprehensive systematic database search of randomized controlled trials (RCTs) was performed. Oral forms of vit. D supplementation were included and compared with a placebo or standard care. The degree of dysmenorrhea pain was measured with a visual analogue scale or numerical rating scale. Outcomes were compared using the standardized mean difference (SMD) and 95% confidence intervals (CIs) in a meta-analysis. RCTs were assessed using the Cochrane risk-of-bias v2 (RoB 2) tool. The meta-analysis included 8 randomized controlled trials involving 695 participants. The results of the quantitative analysis showed a significantly lower degree of pain in the vit. D versus placebo in those with dysmenorrhea (SMD: -1.404, 95% CI: -2.078 to -0.731). The results of subgroup analysis revealed that pain lessened when the average weekly dose of vit. D was over 50,000 IU, in which dysmenorrhea was relieved regardless of whether vit. D was administered for more or less than 70 days and in any dose interval. The results revealed that vit. D treatment substantially reduced the pain level in the primary dysmenorrhea population. We concluded that vit. D supplementation is an alternative treatment for relieving the pain symptoms of dysmenorrhea.

Effect of vitamin D vaginal suppository on sexual functioning among postmenopausal women: A three-arm randomized controlled clinical trial

OBJECTIVE

Vaginal atrophy, the second most common complication of menopause, can lead to sexual dysfunction. This study evaluated the effect of a vitamin D vaginal suppository on sexual functioning in postmenopausal women.

METHODS

This three-arm randomized controlled trial was conducted between August 2019 and August 2020. The sample comprised 105 postmenopausal women who were referred to comprehensive health service centers to receive postmenopausal care. The inclusion criteria were as follows: (i) being menopausal for at least 1 year, (ii) being married, (iii) being sexually active, and (iv) having sexual desire. Participants were randomly assigned to three groups for 8 weeks of treatment: intervention (vaginal suppository containing 1,000 units of vitamin D3), placebo (vaginal suppository placebo), or control (no treatment). The main outcome measure was sexual functioning, which was assessed using the Female Sexual Function Scale (FSFI) 4 times during the study (i.e., 1 month before the intervention, immediately after the intervention, 1 month after the intervention, and 2 months after the intervention).

RESULTS

Immediately and 1 month after the trial, the intervention group had the highest FSFI score, followed by the placebo group, both of which were significantly higher than those of the control group (P<0.05). At the 2-month follow-up, the intervention and placebo groups had similar FSFI scores (P=0.08), both of which were significantly higher than those in the control group (P=0.001 and P=0.03, respectively).

CONCLUSION

Vitamin D vaginal suppositories were more effective at improving sexual functioning among postmenopausal women in the short-term and appeared to prevent aging-related sexual functioning decline in the long term.

Severity of Menstrual Pain Is Associated with Nutritional Intake and Lifestyle Habits

Recently, the employment rate of women in Japan has steadily increased. Approximately 80% of women experience menstrual pain and premenstrual syndrome (PMS). These symptoms decrease a woman's quality of life and her work productivity, leading to an economic loss. This cross-sectional study of 321 healthy Japanese women aged 20-39 years aimed to clarify the lifestyle-related factors or nutrient intake that might cause menstrual pain. The participants underwent body composition measurements and completed meal survey sheets and lifestyle questionnaires, including menstrual status, exercise, sleep and breakfast consumption. Based on the questionnaire results, participants were divided into two groups according to the severity of menstrual pain, namely, heavy and light. Chi-square and Wilcoxon signed-rank sum tests were used to compare the severity of menstrual pain in the two groups. In the heavy group, the intake of animal proteins, including fish, vitamin D and vitamin B12, was significantly lower (p < 0.05), as was the frequency of breakfast consumption and bathing (p < 0.05). The rate of PMS symptoms was significantly higher in the heavy group (p < 0.05). This study suggests that a lack of animal protein, the accompanying vitamins and fatty acids, and the frequency of breakfast or bathing are associated with the severity of menstrual pain.

Disease Burden of Dysmenorrhea: Impact on Life Course Potential

Dysmenorrhea is the most common gynecologic condition among the female population and has a significant impact on life course potential. It has a widespread impact on a female's mental and physical well-being, with longstanding impairments on quality of life, personal relationships, and education and career attainment. Furthermore, untreated dysmenorrhea can lead to hyperalgesic priming, which predisposes to chronic pelvic pain. Primary dysmenorrhea is pain in the lower abdomen that occurs before or during menses and in the absence of pelvic pathology. One possible mechanism is endometrial inflammation and increased prostaglandin release, resulting in painful uterine contractions. Dysmenorrhea may also occur secondary to pelvic pathology, such as endometriosis, adenomyosis or due to cyclic exacerbation of non-gynecologic pain conditions. A thorough patient evaluation is essential to differentiate between potential causes and guide management. Treatment must be tailored to individual patient symptoms. Pharmacologic management with non-steroidal anti-inflammatory medications and/or combined hormonal contraceptives is most common. Heat therapy, exercise, vitamins and dietary supplements have limited evidence and can be offered for patients seeking non-pharmacologic adjunctive or alternative options. Greater awareness for both health-care providers and patients allows for early intervention to reduce impact on quality of life and life course potential.

The effect of vitamin D on the severity of dysmenorrhea and menstrual blood loss: a randomized clinical trial

BACKGROUND

Primary dysmenorrhea is considered as one of the women's main problems during reproductive age. The present study aimed to investigate the effect of vitamin D on the severity of dysmenorrhea and menstrual blood loss.

METHODS

This double-blind, randomized, placebo-controlled trial, was performed on 84 single female college students between 18 and 25 years old who living in dormitories. Students with primary dysmenorrhea and vitamin D deficiency were divided into experimental (n = 42) and control (n = 42) groups. Five days before the putative beginning of their next menstrual cycle, the experimental group received 300,000 IU vitamin D (50,000 IU, two tablets every 8 h), and the control group received a placebo (oral paraffin). The effects of the supplement on the severity of dysmenorrhea and menstrual blood loss were evaluated one cycle before and during two successive cycles. Using the visual analog scale (VAS), verbal multidimensional scoring system (VMS), and pictorial blood assessment chart (PBLAC) questionnaires. Fisher's exact, Chi-square, independent sample t-test and repeated measurements were used.

RESULTS

In total, 78 of the 84 students completed the study (39 students per group). The intervention resulted in a significant reduction in the mean scores of both the VAS and VMS in the experimental group, in the first and second menstrual cycles (p < 0.001, p < 0.001, respectively), but not in the means score of PBLAC. Mefenamic acid consumption at the first and second menstruation period, in the experimental group was lower than the control group (p = 0.009, p < 0.001, respectively).

CONCLUSIONS

The results indicate that vitamin D supplementation could decrease the severity of primary dysmenorrhea and the need to consume pain-relief medications. Contrariwise vitamin D supplementation had no significant effect on menstrual blood loss.

TRIAL REGISTRATION

This trial was registered in the Iranian Registry of Clinical Trials with code IRCT201305212324N on 18/1/2014. URL of registry: https://en.irct.ir/trial/1964 .

High Vitamin D Level in Female Mice Increases the Number of Live Fetuses

Little is known about the impact of high-normal range of 25-hydroxyvitamin D [25(OH)D] on reproductive function. The aim of this study was to investigate the effect of different dose vitamin D supplementation in female mice on the pregnancy outcomes. Three groups of female mice were fed with fodder containing different dose of vitamin D at both pre-gestational and gestational stages. Serum 25(OH)D and calcium concentrations were monitored. The expression levels of vitamin D receptor (VDR) mRNA and protein in placenta were determined by real-time RT-PCR and western blot. Pregnancy outcomes were evaluated and compared among the three groups. Compared with the medium and low dose groups, serum 25(OH)D concentration was significantly increased and approximated to high-normal range in the high dose group (pre-gestational: 81.3±5.75 vs 52.8±6.24 and 25.0±3.99 ng/mL; gestational: 86.8±5.99 vs 52.6±9.29 and 27.9±4.96 ng/mL, respectively; all p<0.001). Interestingly, the average number of live fetuses per litter was much larger in the high dose group than in other two groups (19.8±5.31 vs 13.8±1.30 and 12.8±3.55 respectively, both p<0.05). However, no significant differences of the expression levels of VDR mRNA and protein in placenta were identified among the three groups. Supplementation of high dose vitamin D can enhance the female mice reproductive function. Further study is warranted to explore the mechanism by which high level of 25(OH)D in female mice increases the number of fetuses.

Effects of vitamin D supplementation in endometriosis: a systematic review

BACKGROUND

There is a growing body of human, animal and in vitro studies on vitamin D (vit D) substitution in endometriosis. The aim of this systematic review is to critically appraise and qualitatively synthesize the results of the available studies that examine the supplementation of vit D for endometriosis treatment.

METHODS

A systematic search of the literature was conducted in four electronic databases (Medline, Cochrane, Scopus, Embase) and grey literature for original research articles on humans, animals and in vitro models published in any language.

RESULTS

Four human studies, four animal studies and four in vitro studies were included. Quantitative synthesis of human studies showed no significant effect of vit D intake for dysmenorrhea (2 studies, 44 vit D vs 44 placebo, mean -0.71, 95% CI -1.94, 0.51) and non-cyclic pelvic pain (2 studies, 42 vit D vs 38 placebo, mean 0.34, 95% CI -0.02, 0.71). Regarding reproductive outcomes in women with endometriosis after in vitro fertilization, the only available study showed no differences between women taking vit D and women taking placebo. Three of the four included animal studies showed regression of endometriotic implants when treated with vit D. The in vitro studies demonstrated that vit D decreases invasion and proliferation of endometriotic lesions without affecting apoptosis.

CONCLUSIONS

Although in vitro and animal studies suggest regression of the endometriotic implants and decrease of invasion and proliferation after vit D supplementation, this was not reflected in the results of the meta-analysis, which showed no benefit of vit D supplementation in patients with endometriosis and dysmenorrhea or non-cyclic pelvic pain as well as on the outcome of IVF treatment. However, given the heterogeneity and the diversity of the available studies, more research is required to shed light on the role of vit D supplementation in women with endometriosis.

Effects of curcumin supplementation on vitamin D levels in women with premenstrual syndrome and dysmenorrhea: a randomized controlled study

Background

Vitamin D has an established role in female reproduction. There is also evidence for an association between vitamin D levels and menstrual problems such as premenstrual syndrome (PMS) and dysmenorrhea. Curcumin, is a bioactive polyphenol constituent of turmeric, that can potentially interact with vitamin D receptors and its molecular targets. This study evaluated the effects of curcumin on vitamin D levels in young women with PMS and dysmenorrhea.

Methods

In this randomized, triple-blind, placebo-controlled trial, women with PMS and dysmenorrhea were divided randomly into experimental and control groups to receive one capsule (500 mg of curcuminoid+ 5 mg piperine, or placebo) daily, from approximately 7 days before until 3 days after menstruation for three consecutive menstrual cycles. Serum vitamin D levels, renal function, and liver enzymes were also measured before and after intervention.

Results

A total of 76 subjects (38 in each group) were recruited into the trial. Curcumin significantly increased the median (IQR) serum levels of vitamin D [from 12.8 ng/ml (7.0–24.6) to 16.2 ng/ml (6.4–28.8); P = 0.045], compared with placebo [from 18.6 ng/ml (2.2–26.8) to 21.3 ng/ml (5.2–27.1); P = 0.17]. Serum levels of aspartate aminotransferase and direct bilirubin were reduced by the end of trial in the curcumin group (p < 0.05), but did not change significantly in the control group (p > 0.05). Finally, no significant differences in levels of fasting blood glucose were detected between curcumin and placebo groups.

Conclusion

Curcumin supplementation in women with PMS and dysmenorrhea led to a significant improvement of vitamin D, liver function enzyme test, but did not affect blood glucose.

Trial registration

The trial was registered on Iranian Registry of Clinical Trials registry (Trial ID: IRCT20191112045424N1 on 23 January 2020; available at https://www.irct.ir).