Vitamin D’s important roles after menopause

Most cells in the human body need vitamin D. The nutrient also has an important role in preventing symptoms and diseases that may occur after menopause – including osteoporosis, muscle weakness, dry mucosa, mood swings, cardiovascular disease, type 2 diabetes, and cancer. In an article that is published in Frontiers in Physiology, the authors address the widespread vitamin D deficiency that is an overlooked problem in post-menopausal women, and they suggest striving to have optimal vitamin D levels in the blood throughout life.

Menopause sets in after a woman’s last menstrual period. It is derived from the Latin words “meno” (month) and “pausa” (cessation). After menopause, the ovaries stop producing estradiol, testosterone, and progesterone because there are no longer eggs in need of maturation and fertilization. The adrenal glands, liver, and fatty tissues continue to produce small amounts of estradiol and other estrogen forms (estrone and estriol), testosterone, and progesterone because these hormones are important for our mucous membranes, bones, etc. Still, the hormone balance is often disrupted after menopause and this may result in problems like transitory menstrual disturbances, hot flushes, sleep disturbances, dry mucosa, and loss of libido. In the longer run there is an increased risk of osteoporosis and cardiovascular disease. Many women receive hormone replacement therapy and are treated with estradiol, but prolonged use of the hormone increases the risk of breast cancer, uterus cancer, and cardiovascular disease. This has created a growing interest for other types of therapy, including the use of vitamin D, especially because 50-80 percent of postmenopausal women are believed to lack this vitamin. This can be a result of getting too little sunlight combined with the fact that age decreases our ability to synthesize vitamin D in the skin and to convert the nutrient into its active steroid form, a process that is handled by the kidneys and various other tissues.

Vitamin D’s functions and the widespread deficiency problems

Vitamin D is synthesized from cholesterol just like the other steroid hormones (estrogens, testosterone, progesterone, and cortisol). It is commonly known that vitamin D is important for the uptake of calcium and bone health in general. In addition, vitamin D regulates different genes that are important for cell division, immune defense, inflammation, blood sugar levels, mood, and the prevention of oxidative stress that can damage cells and tissues.
In fat tissue, vitamin D regulates the production of adipokines, which are cell-signaling proteins with different functions. Some promote low-grade chronic inflammation and the development of metabolic syndrome, an early stage of type 2 diabetes.
It is believed that one billion people worldwide lack vitamin D. Menopausal women are particularly vulnerable, and that is why the authors behind the new review study have looked closer at vitamin D’s role in connection with osteoporosis, muscle weakness, dry mucosa, mood swings, cardiovascular disease, type 2 diabetes, and cancer. The study is published in Frontiers in Physiology.

Osteoporosis and muscle weakness

The risk of developing osteoporosis increases with age, especially after menopause due to the drop in estrogen levels and the reduced uptake of calcium from the small intestine. Vitamin D has a profound role in promoting the uptake of calcium and phosphorous from the small intestine. Other than that, vitamin D regulates parathyroid hormone that is important for blood levels of calcium and phosphorous. A vitamin D deficiency can result in hyperparathyroidism that can lead to disrupted bone formation and osteoporosis.
Our muscles have vitamin D receptors that are important for muscle strength and muscle function. In the article, the authors mention several studies where it has been seen that women who are vitamin D-deficient during their menopause have reduced muscle mass, lack of muscle strength, poor physical performance, and impaired balance. Weak muscles also increase the risk of bone fractures in connection with falling.
They also refer to studies showing that vitamin D can prevent osteoporosis and weak muscles in menopausal women. Another important thing is the interplay between vitamin D, calcium, and magnesium, which is important for the body’s calcium distribution, strong bones, and other metabolic processes.

Cardiovascular disease and sugar metabolism

Estrogen has a protective effect on the heart. It regulates the liver’s fat metabolism and increases the catabolism of low-density lipoprotein (LDL) by increasing LDL receptor activity. Menopausal women often lack estrogen, which can result in a disrupted lipid metabolism, weight gain, and changes in the body’s fat distribution. The disrupted lipid metabolism can also increase the risk of metabolic syndrome, including cardiovascular disease, type 2 diabetes, and hyperlipidemia (elevated blood levels of cholesterol and triglyceride).
The disturbed hormone balance increases the risk of chronic inflammation and oxidative stress, thereby setting the stage for atherosclerosis. Studies have shown that vitamin D and vitamin D supplements help to regulate the lipid metabolism, insulin sensitivity, sugar metabolism, inflammation, and oxidative stress, all of which can prevent the development of cardiovascular disease, metabolic syndrome, and type 2 diabetes.

Dry mucosa and loss of libido

GMS (genitourinary syndrome of menopause) is a condition that causes dry mucosa in menopausal women. This can lead to vaginal dryness, pain during intercourse, bacterial vaginosis, and bladder infection because of the decreased estrogen levels. The problems are mainly linked to the reduced levels of estriol, a form of estrogen that is universally important for mucous membranes in the body.
Vitamin D also seems to play a role in the growth and development of the vaginal epithelium and epithelial cells in other places. For example, some studies show that vitamin D supplementation can strengthen the epithelial cells in the vagina, strengthen the immune defense, regulate the body’s pH value, and reestablish the physical barrier against bacteria and fungi. Vitamin D supplementation also contributes to the prevention of recurrent bladder infections by strengthening the mucosa and the immune defense.

Cancer

The immune defense is designed to fight infections and tissue damage by using acute inflammation as a weapon. However, chronic inflammation where the immune defense becomes unhinged increases the risk of oxidative stress, cell damage, cancer, and chronic disease. The hormone changes that follow in the wake of menopause increase a woman’s risk of producing too many pro-inflammatory cytokines. Also, there is an increased risk of human papilloma virus (HPV) infections and cervical cancer.
Several studies have shown that vitamin D and its metabolites are important for the immune defense and for regulating inflammation. Vitamin D also helps to reduce tumor cell growth and the formation of new blood vessels (angiogenesis). Studies have linked an increased vitamin D intake to a lower risk of developing cancer in tissues such as the lungs, breasts, and ovaries. Also, vitamin D supplements appear to lower the risk of breast cancer in women receiving hormone replacement therapy with estradiol. Non-prescription hormone pills with estriol are available from the pharmacy, and they are more effective for treating sensitive mucosa but without increasing the risk of cancer.

Mood swings

Most women today live long enough to spend a third of their lives after menopause. The hormone changes and the reduced estrogen levels increase their risk of mood swings, depression, and anxiety. Studies also show that levels of proinflammatory cytokines in the hippocampus are higher in patients with depression. Besides, depressed individuals tend to be less physically active and spend a lot more time indoors, which means they get less sunshine. It becomes a vicious cycle
Studies show that the hippocampus and other parts of the brain that are linked to feelings have vitamin D receptors, and it has been seen that patients suffering from depression often have lower vitamin D levels in their blood. Not surprisingly, vitamin D supplements can improve the mood. Research demonstrates that vitamin D has a profound role in mood control and the cognitive abilities and affects the brain’s synthesis of dopamine and other relevant neurotransmitters.
A large study of 81,189 women (Women’s Health Initiative) shows that vitamin D can reduce the risk of depression.

• We are only able to synthesize vitamin D from sunlight during the summer period. The diet only provides small amounts of vitamin D.
• The ability to synthesize and activate vitamin D decreases with increasing age.
• Many studies have looked at vitamin D supplementation in doses from 50-100 micrograms daily
• The need for vitamin D varies from person to person. The important thing is to have optimal levels of the nutrient in the blood (higher than 75 nmol/L)

Conclusion

The authors conclude that lack of vitamin D is a widespread yet overlooked problem among post-menopausal women. The body’s vitamin D status is related to musculoskeletal and cardiovascular diseases, mood changes, and GMS that is characterized by dry mucosa, bacterial vaginosis, bladder infections, and other symptoms. Vitamin D supplementation is a both inexpensive and relevant intervention with a number of vital roles after menopause. It is essential to have optimal levels of vitamin D in the blood throughout life.

Facts about the three types of estrogen

• Estradiol is the only ”female estrogen” and is primarily produced by the ovaries of women of childbearing age. Estradiol is what gives women their feminine curves and it increases cellular growth. Too much estradiol (also from hormone supplements) increases the risk of inflammation and cancer.
• Estrone is a hormone that is stored in fatty tissue
• Estriol helps keep mucosa moist and healthy and is important for skin, bones, mood, and libido. This form of estrogen is made by everyone but is often overlooked when the discussion is about estrogen.

References:

Zhaojun Mei et al. The role of vitamin D in menopausal women´s health. Frontiers in Physiology. 2023

Andrea Rosanoff et al. Essential Nutrient Interactions: Does Low or Suboptimal Magnesium Interact with Vitamin D and/or Calcium status. Advances in Nutrition 2016

Zhaojun Mei et al. The role of vitamin D in menopausal women´s health. Frontiers in Physiology. 2023

Andrea Rosanoff et al. Essential Nutrient Interactions: Does Low or Suboptimal Magnesium Interact with Vitamin D and/or Calcium status. Advances in Nutrition 2016

Zhaojun Mei et al. The role of vitamin D in menopausal women´s health. Frontiers in Physiology. 2023

Andrea Rosanoff et al. Essential Nutrient Interactions: Does Low or Suboptimal Magnesium Interact with Vitamin D and/or Calcium status. Advances in Nutrition 2016

Anette Paulin og Jens-Ole Paulin. Naturlig hormonterapi – opgør med østrogenmyten. Vingholm