Facts to Know

Adequate vitamin D levels are essential for multiple physiological functions. Vitamin D insufficiency has been linked to insulin resistance, inflammation, poor psychological health, obesity, type 2 diabetes, and cardiovascular disease - these are also commonly found in women with Polycystic Ovary Syndrome (PCOS). Vitamin D insufficiency contributes to insulin resistance, inflammation, and psychological distress in women with PCOS. These adverse effects may ultimately increase the risk of serious long-term complications in PCOS, including type 2 diabetes and cardiovascular disease. PCOS affects up to 22.5 % of adolescent women of reproductive age in India. The prevalence of Vitamin D deficiency in women with PCOS is about 67%–85%.

Understanding PCOS

Polycystic ovarian syndrome (PCOS) is an extremely common disorder affecting up to 22.5% of Indian women of child-bearing age. PCOS results from a hormonal imbalance affecting women and girls of childbearing age. Women with PCOS usually have at least two of the following three conditions

  • Absence of ovulation, leading to irregular menstrual periods or no periods at all
  • High levels of androgens (a type of hormone) or signs of high androgens, such as having an excess body or facial hair
  • Cysts (fluid-filled sacs) on one or both ovaries "polycystic" literally means "having many cysts"

PCOS is a hormonal disorder with the potential to lead to various diseases. It also continues to be a common cause of infertility among women. Although signs and symptoms vary, problems with ovulation and elevated androgen levels occur in the majority of women with PCOS.

Signs and Symptoms to Watch Out

  • Irregular menstrual cycles
  • Weight gain, especially around the waist. If a woman of this age group is overweight, the chances of developing PCOS are higher
  • Extra hair growth on face and body (Hirsutism) or thinning hair
  • Pelvic pain and depression may be a possible symptom
  • Gradual hair loss (Alopecia)
  • Acne, skin tags or dark patches (Acanthosis nigricans)
  • In some cases inheritance also plays a role in PCOS.

With any of these symptoms, consulting a doctor would be the first right thing to do.

Understanding Vitamin D Deficiency

Vitamin D is a fat-soluble vitamin and its synthesis in the body is dependent on multiple factors like latitude, atmospheric pollution, clothing, skin pigmentation and duration and time of exposure to sunlight. Vitamin D is a part of the “Calcium – Vitamin D – Parathyroid hormone” endocrine axis, meaning all these are hormonally connected and problems with any one of them, may lead to problems with others.

In the kidney, inactive Vitamin D changes into an active form of the vitamin. The active form of Vitamin D helps control calcium and phosphate levels in the body, important for calcium metabolism and balance in the body.

Symptoms Which May Indicate Vitamin D Deficiency

  • Bone Pain/Joint Pain
  • Noticeable and unexpected muscle weakness
  • Tiredness, fatigue and forehead sweating
  • Feeling depressed

Adequate calcium intake along with Vitamin D is necessary to maintain the bone mass of an individual. Vitamin D adequacy during adolescence helps reduce the risk of osteoporosis later in life. Vitamin D deficiency and low calcium intake are important risk factors for osteoporosis. Vitamin D deficiency causes low bone mass, muscle weakness, and therefore the increased risk of fractures.

As per WHO, 30 minutes of exposure of the skin over the arms and face to sunlight, without application of sunscreen, preferably between 10 am to 2 pm daily is adequate to prevent Vitamin D deficiency.

Factors Associated With Vitamin D Deficiency

1.The latitude where you live: At higher latitudes, the amount of vitamin D–producing UVB light reaching the earth's surface goes down in the winter because of the low angle of the sun.

2. The air pollution where you live: Carbon particulates in the air from the burning of fossil fuels, wood, and other materials scatter and absorb UVB rays.

3. The color of your skin: Melanin is the substance in the skin that makes it dark. It "competes" for UVB with the substance in the skin that kick-starts the body's vitamin D production. As a result, dark-skinned people tend to require more UVB exposure than light-skinned people to generate the same amount of vitamin D.

4. The temperature of your skin: Warm skin is a more efficient producer of vitamin D than cool skin. So, on a sunny, hot summer day, you'll make more vitamin D than on a cool one.

5. Your age: Compared with younger people, older people have lower levels of the substance in the skin that UVB light converts into the vitamin D precursor, and there's experimental evidence that older people are less efficient vitamin D producers than younger people.

6. The health of your gut: The vitamin D that is consumed in food or as a supplement is absorbed in the part of the small intestine immediately downstream from the stomach. Stomach juices, pancreatic secretions, bile from the liver, the integrity of the wall of the intestine — they all have some influence on how much of the vitamin is absorbed. Therefore, conditions that affect the gut and digestion, like celiac disease, chronic pancreatitis, Crohn's disease, and cystic fibrosis, can reduce vitamin D absorption.

7. The health of your liver and kidneys: Some types of liver disease can reduce the absorption of vitamin D because the ailing liver isn't producing normal amounts of bile. With other types, steps essential to vitamin D metabolism can't occur — or occur incompletely. Levels of the bioactive form of vitamin D tend to track with the health of the kidneys, so in someone with kidney disease, bioactive vitamin D levels decrease as the disease gets worse, and in end-stage kidney disease, the level is undetectable.

Vitamin D and PCOS Connection

  • Some studies have shown that Vitamin D status influences female reproductive and pregnancy outcomes. Vitamin D deficiency is common among women affected by PCOS. Vitamin D plays a physiologic role in reproduction, including the development of ovarian follicles and its processing. Women with PCOS may also be at elevated risk of Vitamin D deficiency. It has also been suggested that the metabolic problems associated with PCOS are mainly due to a deficiency of Vitamin D.
  • Prevalence of Vitamin D deficiency in women with PCOS is about 67 % – 85 %
  • The prevalence of Vitamin D deficiency is 67%– 85% in women with PCOS. If Vitamin D deficiency were causally related to PCOS and the subsequent development of metabolic and hormonal dysfunction in PCOS, Vitamin D supplementation would be a promising alternative for the prevention and treatment of PCOS. Vitamin D deficiency is common in women with and without polycystic ovary syndrome (PCOS) and may be associated with metabolic and endocrine disorders in PCOS.
  • Vitamin D supplementation can lower the abnormally elevated serum anti-mullerian hormone levels and increase serum anti-inflammatory soluble receptor for advanced glycation end-products in vitamin D-deficient women with PCOS. Consulting a doctor for further education is a better option.

Consult your doctor before starting any type of supplementation.

Disclaimer: For further information, contact your treating physician/doctor. The information provided here is not a recommendation for the treatment of disease. Please consult your doctor before starting any remedies.

References:

1. Krul-Poel, Y., Koenders, P., Steegers-Theunissen, R., Boekel, E. t., Wee, M., Louwers, Y., . . . Simsek, S. (2018). Vitamin D and metabolic disturbances in polycystic ovary syndrome (PCOS): A crosssectional study. PLoS ONE, 13(12), e0204748.

2. Sur, D., & Chakravorty, R. (2015). The Relationship between Vitamin D, Insulin Resistance and Infertility in PCOS Women. Gynecology & Obstetrics (Sunnyvale), 5(5), 294-298.