A study on effect of vitamin d supplementation in vitamin D deficient females with polycystic ovarian syndrome

Sakshi Garg; Nishi Makhija

doi:10.18203/2320-1770.ijrcog20222300

Authors

Sakshi Garg Department of Obstetrics and Gynecology, Tirath Ram Shah Charitable Hospital, Civil Lines, New Delhi, India
Nishi Makhija Department of Obstetrics and Gynecology, Tirath Ram Shah Charitable Hospital, Civil Lines, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20222300

Keywords:

PCOS, Polycystic ovarian syndrome, Vitamin D deficiency

Abstract

Background: Polycystic ovarian syndrome is one of the most common metabolic and endocrine disorders among women, whereas vitamin D is a steroid with hormone like activity and also considered as a missing link between insulin resistance and PCOS due to its underlying mechanism of action in reducing insulin resistance thereby altering pathogenesis behind PCOS symptoms.

Methods: A prospective cohort comparative observational study was carried out from July 2019 to December 2020 in 96 vitamin D deficient females with PCOS (polycystic ovarian-syndrome). All females were randomly recruited under group A and B with equal proportion of 1:1, where group A were given metformin (500 mg twice daily) only and group B were given metformin (500 mg twice daily) plus vitamin D 60000 IU weekly for 24 weeks. Baseline clinical, hormonal, metabolic, sonographic parameters were compared before and after treatment.

Results: Significant improvement was seen in various parameters in both the groups, like oligomenorrhoea improved in 41.67% individuals. FG score improved from mean of 10.28±2.02 in group B to 8.44±2.23 with p<0.0001. Acne improved in both groups equally in 22.92%. Polycystic ovary pattern improved in 14.58% individuals of group B with p<0.0001. Serum total testosterone improved in 16.71% in group A and in 22.92% in group B. HOMA-IR was also reduced in both groups effectively and was statistically significant with p=0.017 in group A and p=0.001 in group B.

Conclusions: Remarkable improvement was seen in clinical, hormonal, metabolic and sonographic parameters in group B and noteworthy reduction in HOMA-IR, BP and triglyceride values was also seen. Hence, supplementation of vitamin D is highly effective in improving PCOS and preventing future consequences as well.

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Author Biographies

Sakshi Garg, Department of Obstetrics and Gynecology, Tirath Ram Shah Charitable Hospital, Civil Lines, New Delhi, India

Post graduation student(dnb) in obstetrics and gynecology

Nishi Makhija, Department of Obstetrics and Gynecology, Tirath Ram Shah Charitable Hospital, Civil Lines, New Delhi, India

head of department in obstetrics and gynecology

References

Goodarzi MO, Dumesic DA, Chazenbalk G, Azziz R. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nat Rev Endocrinol. 2011;7(4):219-31

Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-sponsored 3rd PCOS consensus workshop group. Fertil Steril. 2012;97(1):28-38

Barry JA, Azizia MM, Hardiman PJ. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2014;20(5):748-58.

Legro RS, Kunselman AR, Dunaif A. Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am J Med. 2001;111:607-13.

Schleicher RL, Sternberg MR, Looker AC, Yetley EA, Lacher DA, Sempos CT, et al. National estimates of serum total 25-hydroxyvitamin D and metabolite concentrations measured by liquid chromatography- tandem mass spectrometry in the US population during 2007–2010. J Nutr. 2016;146:1051-61.

Sarafin K, Durazo-Arvizu R, Tian L, Phinney KW, Tai S, Camara JE, et al. Standardizing 25-hydroxyvitamin D values from the Canadian Health Measures Survey. Am J Clin Nutr. 2015;102:1044-50.

Cashman KD, Dowling KG, Škrabáková Z, Gonzalez-Gross M, Valtueña J, De Henauw S, et al. Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr. 2016;103:1033-44.

Cashman KD. Vitamin D deficiency: defining, prevalence, causes, and strategies of addressing. Calcif Tissue Int. 2020;106(1):14-29.

Suryanarayana P, Arlappa N, Sai Santhosh V, Balakrishna N, Lakshmi Rajkumar P, Prasad U, et al. Prevalence of vitamin D deficiency and its associated factors among the urban elderly population in Hyderabad metropolitan city, South India. Ann Hum Biol. 2018;45(2):133-9.

Kapil U, Pandey RM, Goswami R, Sharma B, Sharma N, Ramakrishnan L, et al. Prevalence of vitamin D deficiency and associated risk factors among children residing at high altitude in Shimla district, Himachal Pradesh, India. Indian J Endocrinol Metab. 2017;21:178-83.

Chowdhury R, Taneja S, Bhandari N, Sinha B, Upadhyay RP, Bhan MK, et al. Vitamin-D deficiency predicts infections in young North Indian children: a secondary data analysis. PLoS One. 2017;12:e0170509.

Srimani S, Saha I, Chaudhuri D. Prevalence and association of metabolic syndrome and vitamin D deficiency among postmenopausal women in a rural block of West Bengal, India. PLoS One. 2017;12:e0188331.

Misra P, Srivastava R, Misra A, Kant S, Kardam P, Vikram NK, et al. Vitamin D status of adult females residing in Ballabgarh health and demographic surveillance system: a community-based study. Indian J Public Health. 2017;61:194-8.

Rattan R, Sahoo D, Mahapatra S. Prevalence of vitamin D deficiency in adults in the coastal regions of Odisha, India. IOSR J Pharm Biol Sci. 2016;11:49-52.

Gunjaliya A, Patil R, Vaza J, Patel H, Maniyar A. Prevalence of vitamin D deficiency in higher socioeconomical class of Ahemdabad, Gujarat, India. Int J Med Sci Public Health. 2015;4:617-20.

Bachhel R, Singh NR, Sidhu JS. Prevalence of vitamin D deficiency in North-West Punjab population: a cross-sectional study. Int J Appl Basic Med Res. 2015;5:7-11.

Mogili KD, Karuppusami R, Thomas S, Chandy A, Kamath MS, Tk A. Prevalence of vitamin D deficiency in infertile women with polycystic ovarian syndrome and its association with metabolic syndrome - a prospective observational study. Eur J Obstet Gynecol Reprod Biol. 2018;229:15-9.

Bouillon R, Carmeliet G, Verlinden L, Etten van E, Vertuyf A, Luderer HF, et al. Vitamin D and human health: lessons from vitamin D receptor null mice. Endocr Rev. 2008;29(6):726-76.

El-Fakhri N, McDevitt H, Shaikh MG, Halsey C, Ahmed SF. Vitamin D and its effects on glucose homeostasis, cardiovascular function and immune function. Horm Res Paediatr. 2014;81(6):363-78.

Gill H, Tiwari P, Dabadghao P. Prevalence of polycystic ovary syndrome in young women from North India: a community based study. Indian J Endocrinol Metab. 2012;16(Suppl 2):S389-92.

Joshi B, Mukherjee S, Patil A, Purandare A, Chauhan S, Vaidya R. A cross-sectional study of polycystic ovarian syndrome among adolescent and young girls in Mumbai, India. Indian J Endocrinol Metab. 2014;18(3):317-24.

Kadoura S, Alhalabi M, Nattouf AH. Effect of calcium and vitamin D supplements as an adjuvant therapy to metformin on menstrual cycle abnormalities, hormonal profile, and IGF-1 system in polycystic ovary syndrome patients: a randomized, placebo-controlled clinical trial. Adv Pharmacol Sci. 2019;2019:9680390.

Al-Bayyari N, Al-Domi H, Zayed F, Hailat R, Eaton A. Androgens and hirsutism score of overweight women with polycystic ovary syndrome improved after vitamin D treatment: A randomized placebo controlled clinical trial. Clin Nutr. 2021;40(3):870-8.

Lim SK, Ha JM, Lee YH, Lee Y, Seo YJ, Kim CD, et al. Comparison of vitamin D levels in patients with and without acne: a case-control study combined with a randomized controlled trial. PLoS One. 2016;11(8):e0161162.

Firouzabadi RD, Aflatoonian A, Modarresi S, Sekhavat L, Taheri MS. Therapeutic effects of calcium and vitamin D supplementation in women with PCOS. Complement Ther Clin Pract. 2012;18(2):85-8.

Pal L, Berry A, Coraluzzi L, Kustan E, Danton C, Shaw J, et al. Therapeutic implications of vitamin D and calcium in overweight women with polycystic ovary syndrome. Gynecol Endocrinol. 2012;28(12):965-8.

Asemi Z, Foroozanfard F, Hashemi T, Bahmani F, Jamilian M, Esmaillzadeh A. Calcium plus vitamin D supplementation affects glucose metabolism and lipid concentrations in overweight and obese vitamin D deficient women with polycystic ovary syndrome. Clin Nutr. 2015;34(4):586-92.

Abootorabi SM, Ayremlou P, Behroozi-Lak T, Nourisaeidlou S. The effect of vitamin D supplementation on insulin resistance, visceral fat and adiponectin in vitamin D deficient women with polycystic ovary syndrome: a randomized placebo-controlled trial. Gynecol Endocrinol. 2018;34(6):489-94.

Trummer C, Schwetz V, Kollmann M, Wölfler M, Münzker J, Pieber TR, et al. Effects of vitamin D supplementation on metabolic and endocrine parameters in PCOS: a randomized-controlled trial. Eur J Nutr. 2019;58(5):2019-2028.

Karadağ C, Yoldemir T, Yavuz DG. Effects of vitamin D supplementation on insulin sensitivity and androgen levels in vitamin-D-deficient polycystic ovary syndrome patients. J Obstet Gynaecol Res. 2018;44(2):270-7.

Abootorabi SM, Ayremlou P, Behroozi-Lak T, Nourisaeidlou S. The effect of vitamin D supplementation on insulin resistance, visceral fat and adiponectin in vitamin D deficient women with polycystic ovary syndrome: a randomized placebo-controlled trial. Gynecol Endocrinol. 2018;34(6):489-94.

Wehr E, Pieber TR, Obermayer-Pietsch B. Effect of vitamin D3 treatment on glucose metabolism and menstrual frequency in polycystic ovary syndrome women: a pilot study. J Endocrinol Invest. 2011;34(10):757-63.

Asemi Z, Foroozanfard F, Hashemi T, Bahmani F, Jamilian M, Esmaillzadeh A. Calcium plus vitamin D supplementation affects glucose metabolism and lipid concentrations in overweight and obese vitamin D deficient women with polycystic ovary syndrome. Clin Nutr. 2015;34(4):586-92.