Vitamin D Administration Reduces Pain Severity in Subjects with Dysmenorrhea

by | Jul 25, 2023 | 2023, Vitamin D - General, Women's Health

Written by Taylor Woosley, Staff Writer. Results of a systematic review and meta-analysis of 9 RCTs shows that weekly high dose vitamin D3 intervention (50,000 IU or over) significantly reduced pain severity in subjects with primary dysmenorrhea. 

vitamin D capsulesDysmenorrhea is a menstrual disorder defined by the occurrence of severe lower abdominal pain which may radiate to the thighs or lower spine1. It is one of the most common causes of pelvic pain and short-term absenteeism from school or work, among young and adult women2. The mechanism of dysmenorrhea has not been fully understood, however, potential mechanisms that can explain dysmenorrhea’s etiology involve vasopressin levels, cytokine gene expression profiles, prolactin levels in the luteal phase, and morning estrogen concentrations3.

Metabolism and absorption of vitamins and minerals can play a major role in the treatment and severity of dysmenorrhea4. Vitamin D plays a crucial role in female reproduction; the vitamin D receptor is expressed in ovarian tissue, endometrium, and fallopian tube endothelial cells5. The active form of vitamin D exerts anti-inflammatory effects through various pathways and can reduce prostaglandin production and limit its biological activity by affecting prostaglandin receptors6.

Chen et al. conducted a systematic review and meta-analysis to analyze the efficacy of vitamin D for the relief of primary dysmenorrheal pain as a treatment option instead of nonsteroidal anti-inflammatory drugs (NSAIDs) or oral contraceptive pills (OCPs). Study inclusion consisted of randomized controlled trials (RCTs) conducted within the last 10 years, with subjects experiencing a menstrual cycle occurring every 21 to 35 days, with a menstrual period lasting between 3 and 7 days. Participants included women with menstrual pain with no underlying cause (primary dysmenorrhea) and no history of uterine or ovarian diseases.

9 studies were included in the final analysis. Risk of bias shows that seven articles had a low risk, and two articles were rated as unknown. The studies included young women aged 13-40 years, with a total sample size of 695 at baseline. A visual analogue scale (VAS) was utilized in 8 studies to assess pain severity and a numerical rating scale (NRS) was used in one study to examine pain levels. Study length ranged from 2 to 4 months and 6 studies were double-blind RCTS, two were single-blind RCTs, and one study was an open-label trial.

7 studies analyzed the baseline serum 23(OH)D level, and most participants were deficient. 4 studies evaluated postintervention serum 25(OH)D level, which was higher compared to the normal concentration. Vitamin D3 (cholecalciferol) was used in every study and the dosage ranged from 5000 IU daily and 50,000 IU weekly to 300,000 IU monthly. Significant findings of the study are as follows:

  • Subgroup analysis shows that the average and total vitamin D doses were over 50,000 IU and over 400,000 IU, respectively. These specific doses significantly reduced pain severity in subjects (SMD: -1.056; 95% CI: -1.619 to -0.493). Furthermore, pain was also reduced with an average weekly vitamin D consumption of under 50,000 IU (SMD: -1.709; 95% CI: -2.947 to -0.472).
  • High-dose vitamin D intervention of over 50,000 IU reduced pain severity regardless of intervention duration (over 70 days: SMD: -2.856; 95% CI: -9.324 to 3.612; under 70 days SMD: -1.122; 95% CI: -1.578 to -0.666).

Results of the systematic review and meta-analysis show that weekly doses of 50,000 IU or over significantly alleviated pain relating to primary dysmenorrhea. Weekly doses lower than 50,000 IU also reported pain-lowering effects, however, they were not deemed statistically significant. Study limitations include the possible uncertainty of primary dysmenorrhea diagnosis because ultrasound analysis was not performed on all subjects and the potential for publication bias.

Source: Chen, Yi-Chun, Yi-Fen Chiang, Ying-Jiun Lin, Ko-Chieh Huang, Hsin-Yuan Chen, Nadia M. Hamdy, Tsui-Chin Huang et al. “Effect of Vitamin D Supplementation on Primary Dysmenorrhea: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.” Nutrients 15, no. 13 (2023): 2830.

© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

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Posted July 25, 2023.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

  1. Barcikowska Z, Rajkowska-Labon E, Grzybowska ME, Hansdorfer-Korzon R, Zorena K. Inflammatory Markers in Dysmenorrhea and Therapeutic Options. Int J Environ Res Public Health. Feb 13 2020;17(4)doi:10.3390/ijerph17041191
  2. López-Liria R, Torres-Álamo L, Vega-Ramírez FA, et al. Efficacy of Physiotherapy Treatment in Primary Dysmenorrhea: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. Jul 23 2021;18(15)doi:10.3390/ijerph18157832
  3. Szmidt MK, Granda D, Sicinska E, Kaluza J. Primary Dysmenorrhea in Relation to Oxidative Stress and Antioxidant Status: A Systematic Review of Case-Control Studies. Antioxidants (Basel, Switzerland). Oct 15 2020;9(10)doi:10.3390/antiox9100994
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  5. Bahrami A, Avan A, Sadeghnia HR, et al. High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology. Aug 2018;34(8):659-663. doi:10.1080/09513590.2017.1423466
  6. Amzajerdi A, Keshavarz M, Ghorbali E, Pezaro S, Sarvi F. The effect of vitamin D on the severity of dysmenorrhea and menstrual blood loss: a randomized clinical trial. BMC Womens Health. Mar 27 2023;23(1):138. doi:10.1186/s12905-023-02284-5