title: Vitamin D levels and menopause-related symptoms Calcium and vitamin D supplementation do not influence menopause-related symptoms: Results of the Women's Health Initiative Trial. The effect of vitamin D on vaginal atrophy in postmenopausal women Hormone replacement therapy and the prevention of postmenopausal osteoporosis Role of Vitamin D in urogenital health of geriatric participants [Changes in maturation index and vaginal dryness in postmenopausal women who use or not calcitriol]. A comparison of raloxifene and calcium plus vitamin D on vaginal atrophy after discontinuation of long-standing postmenopausal hormone therapy in osteoporotic women. A randomized, masked-evaluator, one-year, prospective study. Soy isoflavones, lactobacilli, Magnolia bark extract, vitamin D3 and calcium. Controlled clinical study in menopause. Vitamin D and calcium intake and risk of early menopause. Calcium and vitamin D supplements and health outcomes: a reanalysis of the Women's Health Initiative (WHI) limited-access data set. Non-hormonal treatment of vulvo-vaginal atrophy-related symptoms in post-menopausal women Comparing the effects of continuous hormone replacement therapy and tibolone on the genital tract of menopausal women; a randomized controlled trial.
abstract: Objective This study aims to determine whether vitamin D levels are associated with menopause-related  symptoms  in older women . Methods A r and omly selected subset of 1,407 women , among 26,104 potentially eligible participants of the Women ’s Health Initiative Calcium and Vitamin D trial of postmenopausal women aged 51 to 80 years , had 25-hydroxyvitamin D [ 25(OH)D ] levels measured at the Women ’s Health Initiative Calcium and Vitamin D trial baseline visit .  Information about menopause-related symptoms at baseline was obtained by question naire and included overall number of symptoms and composite measures of sleep disturbance , emotional well-being , and energy/fatigue , as well as individual symptoms . After exclusions for missing data , 530 women ( mean [ SD ] age , 66.2 [ 6.8 ] y ) were included in these analyses . Results Borderline significant associations between 25(OH)D levels and total number of menopausal symptoms were observed ( with P values ranging from 0.05 to 0.06 for fully adjusted models ) ; however , the effect was clinical ly insignificant and disappeared with correction for multiple testing . No associations between 25(OH)D levels and composite measures of sleep disturbance , emotional well-being , or energy/fatigue were observed ( P ’s > 0.10 for fully adjusted models ) . Conclusions There is no evidence for a clinical ly important association between serum 25(OH)D levels and menopause-related symptoms in postmenopausal women BACKGROUND It is unknown whether supplementation with calcium and vitamin D has an impact on menopause-related symptoms . METHODS As part of the Women 's Health Initiative Calcium/Vitamin D Supplementation Trial ( CaD ) , women were r and omized at 40 clinical sites to  elemental calcium carbonate 1000 mg with vitamin D 400 IU daily or placebo . At the CaD baseline visit ( year 1 or year 2 ) and during a mean follow-up of 5.7 years , participants provided data on menopause-related symptoms via question naires . Generalized linear mixed effects techniques were used to address research questions . RESULTS After excluding participants with missing data ( N=2125 ) , we compared menopause-related symptoms at follow-up visits of 17,101 women r and omized to CaD with those of 17,056 women given the placebo .  Women in the CaD arm did not have a different number of symptoms at follow-up compared to women taking the placebo ( p=0.702 ) . Similarly , there was no difference between sleep disturbance , emotional well-being , or energy/fatigue at follow-up in those who were r and omized to CaD supplementation compared to those taking the placebo . CONCLUSIONS Our data suggest that supplementation with 1000 mg of calcium plus 400 IU of vitamin D does not influence menopause-related symptoms over an average of 5.7 years of follow-up among postmenopausal women with an average age of 64 at the WHI baseline visit Background : Most of the women suffer from vaginal atrophy and dryness , and therefore , efficient and safe treatment is needed to improve vaginal lubrication . Vitamin D has several important functions which may be effective in proliferation and repair of the epithelial tissue . This study aim ed to evaluate the effect of vitamin D vaginal suppositories on maturation index , pH , and dryness in postmenopausal women . Material s and Methods : Women were enrolled in this double-blind clinical trial , in whom menopause occurred at least one year ago . Those women who had an abnormal Papanicolaou smear , had undergone hormonal treatment , or have had vaginal infection in the previous year were excluded . Forty-four women who found eligible were r and omized into two equal groups , the treatment and control groups , which received vitamin D and placebo vaginal suppository daily for 8 weeks , respectively . Vaginal pH and maturation value were measured at the beginning and end of the study . Pain , dryness , and paleness were assessed before treatment and at the end of the 2 , 4 , and 8 weeks of treatment . Results : In the treatment group , the number ( Mean ± SD ) of superficial cells increased ( 69.76 ± 12.4 ) and vaginal pH decreased ( 1.42 ± 0.67 ) significantly compared to the control group after 56 days . The mean pain significantly reduced after 8 weeks in the treatment group ( 1.23 ± 0.53 ) compared to the control group 1.95 ± 0.74 ( P < 0.001 ) . The mean of dryness and paleness reduced significantly in the treatment group versus control at 56 days . Conclusions : Vitamin D is effective in improving the maturation index and decreased the pH and dryness of the vaginal atrophy due to menopause Fracture prevention is one of the public health priorities worldwide . Estrogen deficiency is the major factor in the pathogenesis of postmenopausal osteoporosis , the most common metabolic bone disease . Different effective treatments for osteoporosis are available . Hormone replacement therapy ( HRT ) at different doses rapidly normalizes turnover , preserves bone mineral density ( BMD ) at all skeletal sites , leading to a significant , reduction in vertebral and non-vertebral fractures .  Tibolone , a selective tissue estrogenic activity regulator ( STEAR ) , is effective in the treatment of vasomotor symptoms , vaginal atrophy and prevention/treatment of osteoporosis with a clinical efficacy similar to that of conventional HRT . Selective estrogen receptor modulators ( SERMs ) such as raloxifene and bazedoxifene reduce turnover and maintain or increase vertebral and femoral BMD and reduce the risk of osteoporotic fractures . The combination of bazedoxifene and conjugated estrogens , defined as tissue selective estrogen complex ( TSEC ) , is able to reduce climacteric symptoms , reduce bone turnover and preserve BMD . In conclusion , osteoporosis prevention can actually be considered as a major additional benefit in climacteric women who use HRT for treatment of climacteric symptoms . The use of a st and ard dose of HRT for osteoporosis prevention is based on biology , epidemiology , animal and pre clinical data , observational studies and r and omized , clinical trials . The antifracture effect of a lower dose HRT or TSEC is supported by the data on BMD and turnover , with compelling scientific evidence Introduction : Role of Vitamin D is very well known for the functioning of many body organs . However , its role in the postmenopausal women in relation to various genitourinary disorders has been recognized recently . The main objective of this study was to evaluate role of Vitamin D in vaginal health , prolapse , bladder and bowel function , and bacterial vaginosis ( BV ) . Material s and Methods : This was a r and omized controlled study in which 200 geriatric female patients of 65–78 years of age divided into two groups comprising study and control group with 100 participants in each . Detailed obstetrical , gynecological , and clinical history was elicited . Detailed examination regarding the prolapse , urinary and bowel functions , and bacterial infections was done followed by follow-up of 3 and 6 months each . Chi-square and independent t-test used for data analysis . Results : Mean modified vaginal health index ( MVHI ) among patients with pelvic floor diseases was statistically significant with P = 0.0472 . There was a visible increasing trend in Vitamin D deficiency with increase in time since menopause ( P = 0.1193 ) . Patients with pelvic floor disease had mean Vitamin D statistically significant with P = 0.0462 . With increase in  Vitamin D levels , MVHI was found to be better . The association of mean Vitamin D levels among patients with urinary incontinence as compared to controls was significant with P = 0.0460 . Association of mean Vitamin D levels in patients with fecal incontinence and BV as compared to controls was not statistically significant with P = 0.6304 and 0.79 , respectively . Low Vitamin D levels were associated with high mean parathyroid hormone ( PTH ) levels statistically significant with P = 0.034 . MVHI was found to increase significantly with Vitamin D supplementation at 3 and 6 months ' follow-up . There was increase in Vitamin D and calcium levels and fall in serum PTH levels at 3 and 6 months . Conclusions : Vitamin D levels were associated with a decreased risk of pelvic floor disorders , improved MVHI in women in geriatric age group BACKGROUND it is known that vitamin D increases the population of superficial cells , so the objective of the present work was to evaluate the effect in Mexican postmenopausal women who were using or not oral calcitriol .  METHODS postmenopausal women with vaginal dryness that received at r and om : calcium 500 mg orally every 24 h or calcitriol 0.25 μg every 24 h during two months . At the beginning of treatment and at two months a vaginal Pap smear was performed . The maturation index was determined and the estrogenic value was calculated . Vaginal dryness was evaluated using an analog visual scales and vaginal by the moistening of a pH test strip . Student 's t test was used for statistical analysis . RESULTS 23 postmenopausal women were studied and divided as follows : group I ( calcium ) = 11 women and group II ( calcitriol ) = 12 women . In the analyzed parameters only the average of superficial cells was significantly greater at the end of treatment in the calcitriol group . CONCLUSION calcitriol use increased the average of superficial cells in vaginal cytology , but did n't modify vaginal dryness OBJECTIVES We assessed the effects of the discontinuation of long-st and ing transdermal estrogen replacement therapy ( > 4 years ) and substitution of this treatment by calcium or raloxifene on the vaginal epithelium and climateric symptoms in a study population of osteoporotic women . METHODS A total of 136 women ( mean age 55.5 years ) were r and omized to calcium ( 500 mg elemental calcium , 400 IU Vitamin D3 ) ( n=40 ) , raloxifene ( 60 mg/day ) ( n=48 ) , or estrogen patches ( 3.9 mg estradiol ) and progesterone ( 100 mg/day ) ( n=48 ) . Treatment was given for 1 year . The vaginal maturation value ( VMV ) , serum estradiol levels , and climateric symptoms using a 12-item modification of the SF-36 quality of life question naire were evaluated at baseline and at 6 and 12 months . RESULTS At 6 months , mean VMV decreased significantly ( P<0.001 ) in the calcium ( -51.8 % ) and raloxifene ( -18.6 % ) groups compared with baseline and the estrogen/progesterone group . At 12 months , significant decreases of mean VMV in the calcium ( -38.7 % ) and raloxifene groups ( -32 % ) ( P<0.001 ) were also observed . Serum estradiol levels and changes of VMV correlated significantly at 6 months ( rho=0.361 , P<0.01 ) and at 12 months ( rho=0.269 , P<0.035 ) . A significantly higher number of patients complained of hot flushes and palpitations in the calcium and raloxifene groups than in the estrogen/progesterone group . Raloxifene-treated women reported a significantly higher number of adverse events at 6 months compared to the other treatment groups . CONCLUSIONS Withdrawal and change of long-st and ing transdermal hormone replacement therapy by treatment with calcium or raloxifene result ed in worsening of vaginal atrophy assessed by the VMV , although it was not clinical ly perceived by the patients . However , increases in dyspareunia and urinary leaks were reported . Menopausal complaints related to vasomotor symptoms worsened in the calcium- and raloxifene-treated groups and persisted throughout the study period AIM Affective and behavioural disorders possibly concomitant to the vasomotor menopausal symptoms worsen quality of life . A rational formulation containing soy isoflavones ( 60 mg ) , lactobacilli ( 500 millions spores ) , calcium ( 141 mg ) and vitamin D3 ( 5 microg ) was added of Magnolia bark extract ( 60 mg ) and magnesium ( 50 mg ) ( Estromineral serena , ES ) . The Magnolia extract active principles interact with GABA system and exhibit a sedative central action . Magnesium intervenes in enzymatic reactions of the energetic metabolism and protects the bone integrity . Aim of this controlled study was to compare the clinical activity and safety of ES versus calcium+vitamin D3 ( Ca+D ) in menopause . METHODS A controlled , r and omised , multicentre study was carried out in symptomatic menopausal women with sleep or mood alterations . Women received 1 tablet/day of ES or Ca+D for 24 weeks . Symptoms during the treatment and final judgements on efficacy and acceptability were evaluated . RESULTS Eighty-nine women ( 44 ES and 45 Ca+D , mean age 53.8 years , in menopause since 56.6 months ) participated to the study .  Flushing , nocturnal sweating , palpitations , insomnia , asthenia , anxiety , mood depression , irritability , vaginal dryness , dyspareunia , and libido loss , significantly decreased in severity and frequency during ES versus Ca+D treatment even since the fourth week . Woman wellbeing ( good/very good 66.7 % vs 20 % ) judgement on efficacy ( 72.7 % vs 17.1 % ) and acceptability ( 93.9 % vs 31.4 % ) were significantly better for ES . CONCLUSIONS The controlled study showed the efficacy of Magnolia extract and magnesium on psycho-affective and sleep disturbances in menopause , in addition to the effects of isoflavones on vasomotor symptoms . A global natural approach to menopause with ES evidence d its therapeutic usefulness and safety Background : Early menopause , defined as the cessation of ovarian function before the age of 45 y , affects ∼10 % of women and is associated with higher risk of cardiovascular disease , osteoporosis , and other conditions . Few modifiable risk factors for early menopause have been identified , but emerging data suggest that high vitamin D intake may reduce risk . Objective : We evaluated how intakes of vitamin D and calcium are associated with the incidence of early menopause  in the prospect i ve Nurses ' Health Study II ( NHS2 ) . Design : Intakes of vitamin D and calcium from foods and supplements were measured every 4 y with the use of a food-frequency question naire . Cases of incident early menopause were identified from all participants who were premenopausal at baseline in 1991 ; over 1.13 million person-years , 2041 women reported having natural menopause before the age of 45 y. We used Cox proportional hazards regression to evaluate relations between intakes of vitamin D and calcium  and incident early menopause while accounting for potential confounding factors . Results : After adjustment for age , smoking , and other factors , women with the highest intake of dietary vitamin D ( quintile median : 528 IU/d ) had a significant 17 % lower risk of early menopause than women with the lowest intake [ quintile median : 148 IU/d ; HR : 0.83 ( 95 % CI : 0.72 , 0.95 ) ; P-trend = 0.03 ] . Dietary calcium intake in the highest quintile ( median : 1246 mg/d ) compared with the lowest ( median : 556 mg/d ) was associated with a borderline significantly lower risk of early menopause ( HR : 0.87 ; 95 % CI : 0.76 , 1.00 ; P-trend = 0.03 ) . Associations were stronger for vitamin D and calcium from dairy sources than from nondairy dietary sources , whereas high supplement use was not associated with lower risk . Conclusions : Findings suggest that high intakes of dietary vitamin D and calcium may be modestly associated with a lower risk of early menopause . Further studies evaluating 25-hydroxyvitamin D concentrations , other dairy constituents , and early menopause are warranted BACKGROUND Frequent use of personal , non protocol calcium supplements obscured an adverse effect of coadministered calcium and vitamin D ( CaD ) on cardiovascular risk in the Women 's Health Initiative ( WHI ) . OBJECTIVE We investigated the effects of the use of personal calcium or vitamin D supplements on other outcomes in the WHI CaD Study ( WHI CaD ) by using the WHI limited-access clinical trials data set . DESIGN The WHI CaD was a 7-y , r and omized , placebo-controlled trial of CaD ( 1 g Ca/400 IU vitamin D daily ) in 36,282 community-dwelling , postmenopausal women . The incidence of total cancer ( excluding nonmelanoma skin cancers ) , breast and colorectal cancers , hip and total fracture , and mortality was assessed by using Cox proportional hazards models . RESULTS In the WHI CaD , interactions between the use of either personal calcium or vitamin D supplements and CaD were found for total , breast , and colorectal cancers but not for fracture or mortality .  In 15,646 women ( 43 % ) who were not taking personal calcium or vitamin D supplements at r and omization , CaD significantly decreased the risk of total , breast , and invasive breast cancers by 14 - 20 % and nonsignificantly reduced the risk of colorectal cancer by 17 % . In women taking personal calcium or vitamin D supplements , CaD did not alter cancer risk ( HR : 1.06 - 1.26 ) . CONCLUSIONS For women in the WHI CaD who were not taking personal calcium or vitamin D supplements at r and omization , CaD decreased the risk of total , breast , and colorectal cancers and did not change the risk of fractures or total mortality . The nonskeletal effects of CaD may be more important than the skeletal effects and should be considered when evaluating these supplements . The WHI CaD trial is registered at clinical trials.gov as NCT00000611 In post-menopausal period vulvo-vaginal atrophy (VVA)-related symptoms may seriously affect women 's quality of life . Hormonal replacement therapy effectively relieves these symptoms but it is not always safe or accepted , and a non-hormonal treatment is often needed instead . Over a period of 12 weeks , we tested the effect of a twice-a-week vulvo-vaginal application of a hyaluronic acid , AC collagen , isoflavones and vitamins-based cream ( Perilei Pausa ® ) on 35 women in post-menopausal period , reporting VVA-related symptoms . After 12 weeks of treatment with Perilei Pausa ® a significant improvement in vaginal dryness , vulvo-vaginal itching , dyspareunia ( P < 0.001 ) , dysuria ( P = 0.02 ) , nocturia ( P = 0.009 ) and pollakiuria ( P = 0.005 ) was reported by the women . Colposcopical score assessing the intensity of atrophic colpitis , cervico-vaginal paleness and petechiae was also reduced ( P = 0.037 , P = 0.016 and P = 0.032 , respectively ) . No significant difference in terms of maturation value of cervico-vaginal epithelium was observed . In conclusion , Perilei Pausa ® may represent an effective and safe alternative treatment of symptomatic VVA in post-menopausal women INTRODUCTION Many postmenopausal women who are on hormone replacement therapy discontinue medications due to vaginal bleeding .  Tibolone , a synthetic steroid , has minimal stimulatory effect on the endometrium . The aim of this study was to assess the effects of continuous HRT regimen and tibolone on the onset of vaginal bleeding and vaginal maturation value . MATERIAL S AND METHODS A total of 150 healthy women in postmenopausal period were r and omly enrolled in this controlled clinical trial . Patients were r and omly allocated into three groups , and were followed for six months . The first 50 women received 2.5 mg tibolone plus a Cal+D tablet ( 500 mg Calcium and 200 IU vitamin D ) daily , the second 50 women received 0.625 mg conjugated equine estrogen and 2.5 mg medroxyprogesterone acetate ( CEE/MPA ) plus one Cal+D tablet daily , and the remaining 50 received only one Cal+D tablet per day and served as the control group . Symptoms were recorded using a question naire that assessed vaginal bleeding or spotting , vaginal dryness and intention to continue the medications . Vaginal maturation value was assessed by examining vaginal smears before and after the treatment . The results for the three groups were analyzed using statistical methods . RESULTS In comparison with the control group , CEE/MPA and tibolone increased vaginal maturation value and decreased the frequency of vaginal dryness ( p < 0.01 ) . Women in tibolone group were more likely to continue the treatment regimen than those in the CEE/MPA or the control groups ( p < 0.01 ) . CONCLUSION Tibolone can serve as an appropriate choice for HRT as it has low rates of vaginal bleeding/ spotting episodes and high acceptance rate in postmenopausal women
target: Although the level of evidence for the effects of vitamin D on vaginal health is low in our study , we concluded that vitamin D may improve the vaginal health of women , especially during menopause
background: Menopause is associated with the onset of climacteric symptoms due to low estradiol levels , which may cause insufficient maturation of the vaginal mucosa .
  Vitamin D may regulate the growth and differentiation of cells that are adversely affected due to low estradiol levels , thereby restoring vaginal health .
  The objective of this systematic review , the first on this subject , was to investigate the effect of vitamin D on the  vaginal health of menopausal women .