EP.356/ Low vitamin d levels could be worsening your endo and period pain

Podcast

25 Jul

Finally, about two months later, I am wrapping up my series on certain vitamins and minerals and their association with period/endo pain when low.

Now, just to recap and highlight, the key nutrients we see associated with more severe menstrual or endo pain when low, or shown to improve menstrual/endo pain are:

Vitamin A
Vitamins B1, B6 and B12 (for those of you wondering, folate - otherwise known as B9 - hasn’t been associated with menstrual pain, but does improve ovulation and hormonal health)
Vitamin C
Vitamin E
Calcium
Zinc
Magnesium
Omega 3 fatty acids

So today, we’re focusing on the last one in the series, and that’s vitamin D.

Research has shown a strong association between menstrual disorders, endometriosis, and vitamin D deficiency, including the development endo and its severity, and various studies have shown low levels of vitamin D are associated with more severe menstrual pain.

Vitamin D is anti-inflammatory. One of its anti-inflammatory benefits is that it regulates prostaglandin production. Inflammatory prostaglandins like prostaglandin E2 are the absolute key drivers behind both menstrual pain and endo pain. In fact, studies have shown that those of us with endometriosis and dysmenorrhea (meaning painful periods) have elevated levels of prostaglandins in our menstrual blood.

Having low levels of vitamin D can allow for inflammatory prostaglandin levels to rise, fuelling that pain.

Additionally, prostaglandins are at the heart of endo development and progression, and research has shown that vitamin D also reduces several of the other inflammatory pathways that trigger endo progression, including the regulation of inflammatory cytokines, interleukin-6 and interleukin-8, which are types of proteins that are involved in the immune response.

But endometriosis isn’t the only chronic pain condition linked to low vitamin D levels, in fact, research has shown that 71% of people with a chronic pain condition may suffer from the deficiency. This is in part due to many chronic pain conditions being of an inflammatory nature, and vitamin D is anti-inflammatory, but also because vitamin D is involved in pain signalling.

Now there’s also another mechanism behind why low vitamin D levels can fuel more endo and period pain. In this series, we looked at how calcium regulates uterine contractions, and we saw how low levels of calcium can cause more intense cramps. Well, vitamin D regulates how well our body absorbs and uses calcium, and without enough vitamin D, calcium may not make it to our muscles and bones, where it’s needed. This can result in a worsening of period pain due to the low levels of calcium in our uterus, creating more severe contractions.

Multiple studies have demonstrated the improvement of menstrual pain with the use of vitamin D supplementation and that vitamin D supplementation resulted in a reduced intake of pain relief medication including ibuprofen and mefenamic acid for period pain.

So what about dosing?

Some of the studied doses were particularly high, for example, one study of 897 participants used 50,000 IU of vitamin D a week for nine weeks and saw a significant reduction in dysmenorrhea and PMS. In contrast, another study used just 667 IU once per day, for only the first two days prior to menstruation and the first three days of bleeding. This was enough to reduce period pain levels as much as ibuprofen, and those taking vitamin D required less pain medication.

And what about endo? One study demonstrated that vitamin D supplementation in endo patients reduced pelvic pain, inflammatory markers like c-reactive protein (which can be higher in our population) and resulted in a higher level of antioxidants, which help fight oxidative stress, another contributor to endo development. The study again used 50,000 IU, this time every two weeks, for 12 weeks.

However, a meta-analysis concluded that despite animal and in vitro studies (meaning in a lab, like a petri dish, not studied on humans or animals) showing a regression of endo with vitamin D, the same was not shown in human studies, and nor did they find that vitamin D supplementation could improve pelvic pain. However, they did observe that due to the variation of the results and methods between the studies, more research was needed - so really, at this stage, all we can do is see how we respond personally, especially given that there are so many promising results for period pain in general.

How much should you take personally?

In my training we’re taught that a safe maintenance dose that you can take with normal vitamin D levels is 2000IU a day, though the department of health recommends a minimum of 400IU a day, which is just the lowest dose required and is really only just enough to avoid deficiency, but is not an optimal amount for good health.

If your levels are deficient, then you’ll need to increase your intake. 5000IU daily is the recommendation for low levels of vitamin D but because of the risk of vitamin D toxicity if you take too much, you should work with your doctor to agree on the required dose for you personally and retest between 60 to 90 days after beginning to supplement at these higher levels. Once you’re at a healthy range, you can drop down to a maintenance dose.

Now, of course, I am not working with you directly, so please consult your doctor when supplementing with vitamin D, especially if you’re keen to try the higher doses such as 50,000IU a week.

Show notes

Endo, vit D, inflammatory pathways, menstrual pain research

https://www.sciencedirect.com/science/article/abs/pii/S2666571922000202

https://pmc.ncbi.nlm.nih.gov/articles/PMC4512562/

https://pmc.ncbi.nlm.nih.gov/articles/PMC7834752/#b31-ogs-20205

https://pubmed.ncbi.nlm.nih.gov/6790261/

Vit D and chronic pain

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10260782/

Calcium and vitamin D interaction for period pain

https://pmc.ncbi.nlm.nih.gov/articles/PMC7834752

Supplementation for period pain

https://pubmed.ncbi.nlm.nih.gov/30044160/