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Vitamin D3

Supplement 1: Vitamin D3

What is it?

Vitamin D is a fat-soluble vitamin that is naturally present in a few foods and also available as a dietary supplement. Vitamin D3 (cholecalciferol) is used as a dietary supplement when the amount of vitamin D in the diet is not sufficient.

Good sources of Vitamin D

  • Cod liver oil

  • Trout

  • Salmon

  • Mushrooms

  • Milk

  • Sardines

  • Egg

  • Cheese

  • Brocolli

  • Carrots

  • Almonds

  • Banana

  • Sunflower seeds

Regimen:

  • What: Oral capsule/tablet/sachet

  • How much / Dosage: 60,000 IU (RDA = 600 IU; tolerable upper limit = 4,000 IU)

  • How to use: Take one capsule/tablet/sachet every week for 8 weeks

Recommended Dietary Allowance (RDA): Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97–98%) healthy individuals; often used to plan nutritionally adequate diets for individuals.1

How does it work?

A suggested mechanism causing primary dysmenorrhea is the increasing production of prostaglandins in the endometrium. Vitamin D metabolites reduce the production of prostaglandin in the uterine endometrium and restrict its biological activity by affecting prostaglandin receptors in the endometrium.2

Vitamin D also helps control inflammation by blocking a key pathway (NF-κB) that triggers the release of inflammatory substances like IL-1beta, IL-6, TNF-α, and others. These substances normally increase pain and inflammation in the body.

In menstrual cramps, strong uterine contractions are caused by calcium entering muscle cells, which activates a protein (myosin light-chain kinase). Vitamin D helps relax these muscles by reducing calcium-related contractions through its effect on certain calcium channels.3

What is the efficacy?

Methods: These studies looked at women and girls with primary dysmenorrhea, some of whom had low vitamin D levels, and tested whether vitamin D₃ supplements could help with period pain. Participants were randomly assigned to either get vitamin D₃ (in different doses and schedules) or a placebo. Pain levels, number of painful days, and use of painkillers were tracked over one or more menstrual cycles, and one study combined results from several trials to see the overall effect.3,4,5,6

Results: In most of the studies, women who took vitamin D₃ had less intense period pain, fewer days of pain, and needed fewer painkillers compared to those who took a placebo. The benefits were often stronger in women who had low vitamin D levels before starting. While not every single symptom improved in all studies, the overall pattern showed vitamin D₃ helping to ease menstrual pain.

Conclusion: Overall, vitamin D₃ supplements seem to be a safe and helpful option for reducing period pain, especially for those with low vitamin D levels. While the results are promising, more research is needed to figure out the best dose and who might benefit the most.

Side-effects:

Short-term effects: Nausea, vomiting, constipation

Long-term effects: Fatigue, weakness, unintentional weight loss, bone pain, Neurological symptoms - confusion, apathy, agitation, irritability, kidney damage.

Toxicity is often linked to serum 25(OH)D levels exceeding 250 nmol/L, with levels above 750 nmol/L considered highly dangerous. The condition can lead to severe outcomes such as tissue calcification and heart issues if not managed promptly.

In conclusion, while vitamin D is vital for maintaining bone health and immune function, care must be taken to avoid excessive intake, especially through supplements. Regular monitoring of serum levels is recommended when using high-dose vitamin D for extended periods.

References

  1. Office of Dietary Supplements, National Institutes of Health. Nutrient Recommendations and Databases. [Internet]. Bethesda (MD): National Institutes of Health; [cited 2025 May 20]. Available from: https://ods.od.nih.gov/HealthInformation/nutrientrecommendations.aspx

  2. Thota C, Laknaur A, Farmer T, Ladson G, Al-Hendy A, Ismail N. Vitamin D regulates contractile profile in human uterine myometrial cells via NF-κB pathway. Am J Obstet Gynecol. 2014 Apr;210(4):347.e1–10. doi:10.1016/j.ajog.2013.12.020.

  3. Chen YC, Chiang YF, Lin YJ, Huang KC, Chen HY, Hamdy NM, Huang TC, Chang HY, Shieh TM, Huang YJ, Hsia SM. Effect of vitamin D supplementation on primary dysmenorrhea: A systematic review and meta-analysis of randomized clinical trials. Nutrients. 2023 Jun 21;15(13):2830.

  1. Rahnemaei FA, Gholamrezaei A, Afrakhteh M, Zayeri F, Vafa MR, Rashidi A, Ozgoli G. Vitamin D supplementation for primary dysmenorrhea: a double-blind, randomized, placebo-controlled trial. Obstet Gynecol Sci. 2021;64(4):353–63. doi:10.5468/ogs.20316.

  2. Moini A, Ebrahimi T, Shirzad N, Hosseini R, Radfar M, Bandarian F, Jafari-Adli S, Qorbani M, Hemmatabadi M. The effect of vitamin D on primary dysmenorrhea with vitamin D deficiency: a randomized double-blind controlled clinical trial. Gynecological Endocrinology. 2016 Jun 2;32(6):502-5.

  3. Amzajerdi A, Keshavarz M, Ghorbali E, Pezaro S, Sarvi F. The effect of vitamin D on the severity of dysmenorrhea and menstrual blood loss: a randomized clinical trial. BMC women's health. 2023 Mar 27;23(1):138.

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