Vitamin D and Menopause

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It’s no secret that healthy lifestyle habits, including adequate exercise and a nutritious diet, are important for all phases of life. This includes making sure you get enough vitamins and minerals, especially ones that might take a little more conscious effort to obtain. Vitamin D is one nutrient that we hear about the most, and it’s particularly important during the midlife season.

The Role of Vitamin D for Women

Vitamin D has many roles in the body:

-       It promotes calcium absorption

-       It maintains healthy bones

-       It supports your immune system

-       It reduces inflammation

-       It carries messages between your brain and body parts

Getting enough vitamin D is, of course, essential throughout life to support these functions, but can be especially important during menopause. Due to the natural, progressive loss of skeletal integrity after menopause, it is important to avoid additional skeletal deterioration associated with vitamin D deficiency. Furthermore, an epidemiological study suggests that higher vitamin D intake, and maintaining adequate vitamin D levels, are associated with a lower risk for early menopause.

Vitamin D has been studied for its potential relationship with certain menopausal symptoms. It’s been suggested that, because calcium absorption and retention (which requires sufficient vitamin D levels) decline after reaching menopause, vitamin D levels might affect other hormone-related symptoms of this stage of life.

Interestingly, research actually shows no meaningful link between the two. A 2016 study on 530 postmenopausal women found no significant correlation between vitamin D levels and sleep disturbance, emotional well-being, and energy levels, among other individual menopausal symptoms. That being said, vitamin D is still essential during midlife for many other reasons.

Vitamin D Deficiency 

In middle-aged and older adults, untreated vitamin D deficiency can lead to osteomalacia, or bone softening. This condition causes bone pain and weakens your muscles.

Other symptoms of vitamin D deficiency can include:

-       Feeling fatigued and getting sick often

-       Noticing that your wounds take longer to heal than normal

-       A depressed mood

-       Hair loss

-       Pain in your muscles, back, and bones

For those at risk for low vitamin D acquisition and/or skeletal fragility, it can be a good idea to have your serum vitamin D levels checked around the menopause transition. Your physician can evaluate this at a regular wellness visit. This will tell you whether you’re getting enough vitamin D or if an intervention is needed.

Factors That Influence Your Vitamin D Level

There are two primary sources of vitamin D: food and sunlight. Some people rely on both sources to achieve adequate vitamin D levels.

That means that your vitamin D level can be influenced by how much you consume through food, and how much produce through sunlight exposure. It’s not that simple, though. Many factors can influence how much vitamin D you absorb and how much your body maintains.

 
 

For example:

-       Where you live

Living in regions of higher latitudes means that you’re exposed to less direct sunlight. In these areas, the sun hits you at more of an angle, especially during the fall and winter when there are often fewer sunny days to begin with. Additionally, cloud cover and pollution can interfere with sunlight exposure, and vitamin D production, on any given day. 

-       Your skin pigmentation

Darker skin pigmentation is associated less production of vitamin D after sunlight exposure.

-       How old you are

As you get older, your body produces less of the substance (7-dehydrocholesterol) that your skin uses to produce vitamin D from sunlight.

-       The temperature of your skin

Your skin does a better job at producing vitamin D from sunlight when it’s warm. That means more vitamin D will be made when you’re outside on a spring or summer day than during a cool fall or winter day. 

-       Your diet

People with a milk allergy or lactose intolerance, or who are on a vegetarian or vegan diet may have a Vitamin D deficiency.

-       The health of your digestive system

If you have a digestive condition, like Crohn’s disease, ulcerative colitis, or Celiac disease, this can impair how well the vitamin D you eat is absorbed. Additionally, people who have undergone bariatric surgery, like gastric bypass, can have a reduced ability to absorb vitamin D.

-       The health of your liver and kidneys

Liver disease can reduce the amount of bile your body produces, which is necessary for vitamin D absorption. Research also shows that people with kidney disease tend to have lower levels of vitamin D, especially as the severity of the disease worsens. This because impaired kidneys don’t convert vitamin D to its active form as well as healthy kidneys do.

-       How much you weigh

Vitamin D is a fat-soluble vitamin, which means it’s stored in your body’s fat tissue. Research shows that there are instances when this may or may not be helpful. It could mean that your body maintains vitamin D stores for later, when your production may be less. There’s also evidence that obesity is linked to a higher risk for vitamin D deficiency.

3 Ways to Boost Your Vitamin D Level

1.    Eat vitamin D rich foods regularly

Incorporating some of the foods below into your regular routine can help you maintain healthy vitamin D levels.

-       Fatty fish (e.g., tuna, mackerel, salmon)

-       Fortified orange juice

-       Fortified milk and dairy products

-       Fortified plant-based non-dairy milks (e.g., soy, almond, cashew)

-       UV-enriched mushrooms

-       Egg yolks

-       Fortified cereals

 
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2.    Get outside regularly

Spending time outdoors and in the sun may have multiple health benefits beyond the generation of vitamin D.

Given ideal weather conditions (warm with no cloud cover), your body can produce all of the vitamin D it needs that day with 10-15 minutes of direct sunlight exposure. That means no sunscreen and no protective clothing that covers the arms, legs, face, or hands for those 10-15 minutes. We spend most of our time indoors and have been taught to slather on sunscreen anytime we head outside, so making direct sun exposure a part of your routine might take some effort. Sunshine exposure through a window does not produce Vitamin D. 

In general, you need to strike a balance between too little and too much direct exposure to sunlight as everyone has a different tolerance based on skin pigmentation and family history of skin cancer.

3.    Consider a vitamin D supplement if deemed necessary

Low levels of vitamin D may be easily correctable through certain lifestyle changes. However, your physician or registered dietitian can make recommendations for an appropriate vitamin D supplement based on your serum levels. It is possible to get vitamin D toxicity through too much supplementation, creating health risks from vascular calcification to kidney stones. That’s why it’s important to work with a healthcare professional.

For more information on building strong bones and the importance of vitamin D and other nutrients during your menopausal journey, join the conversation over at Lisa Health!

Dr. Aimee Shu, MD, is a medical endocrinologist with particular interests in reproductive and bone health.  She enjoys treating patients with menstrual disorders, menopause, fractures, osteoporosis, parathyroid imbalance, and calcium imbalance.  As a Clinical Associate Professor of Medicine at Stanford University, she is active in teaching students and physicians-in-training. She is a certified clinical densitometrist (International Society for Clinical Densitometry) and a certified menopause practitioner (North American Menopause Society). Aimee is also a member of the Medical & Scientific Advisory Board for American Bone Health, a national non-profit. Dr. Shu completed her undergraduate studies at Princeton University, medical degree at Harvard University, internal medicine residency at Brigham and Women’s Hospital in Boston, and endocrinology fellowship at Columbia University Medical Center in New York.