Role of vitamin D in PCOS
Vitamin D plays an important role in reproduction including ovarian follicular development and luteinization via altering anti-müllerian hormone (AMH) signalling, follicle-stimulating hormone sensitivity and progesterone production in human granulosa cells. It also affects glucose homeostasis through manifold roles.
The potential influences of vitamin D on glucose homeostasis include the presence of specific vitamin D receptor (VDR) in pancreatic β-cells and skeletal muscle, the expression of 1-α-hydroxylase enzyme which can catalyze the conversion of 25-hydroxy vitamin D [25(OH)D] to 1,25-dihydroxyvitamin D, and the presence of a vitamin D response element in the human insulin gene promoter.
Polycystic ovary syndrome (PCOS) is a common cause of ovarian dysfunction in women with anovulation. The main symptoms are characterized by chronic anovulation, hyperandrogenism, and/or the presence of polycystic ovary morphology from ultrasound examination. The phenotypic manifestation of this disorder is associated with various degrees of gonadotropic and metabolic abnormalities determined by the interaction of multiple genetic and environmental factors.
The prevalence of vitamin D deficiency in women with PCOS is about 67-85 per cent, with serum concentrations of 25(OH)D <20 ng/ml. Although there is no significant difference in the 25(OH)D levels between PCOS and normal control women, high prevalence of vitamin D deficiency has been found to be associated with metabolic syndrome which may have great impact on public health4. Low 25(OH)D levels may exacerbate the symptoms of PCOS, including insulin resistance, ovulatory, menstrual irregularities, infertility, hyperandrogenism, obesity and elevate the risk of cardiovascular diseases.
Many observational studies suggest a possible role of vitamin D in an inverse association between vitamin D status and metabolic disturbances in PCOS, but it is still hard to draw a definite conclusion in the causal relationship due to inconsistent findings from various individual studies and from a recent meta-analysis report of a systematic review.
Vitamin D supplementation can lower the abnormally elevated serum AMH levels and increase serum anti-inflammatory soluble receptor for advanced glycation end-products in vitamin D-deficient women with PCOS1. In particular, vitamin D and calcium supplementation in addition to metformin therapy in women with PCOS could result in the beneficial effects on menstrual regularity and ovulation.
However, Garg et al recently demonstrated that there was no significant beneficial effect on insulin kinetics and cardiovascular risk factors after supplementation of vitamin D, at a dose of 4,000 IU/day for six months, among women with PCOS treated with metformin.
Due to small sample size and the relatively short duration of follow up in previous observational study and clinical trial, the effects of vitamin D supplementation in relieving the symptoms in women with PCOS remain inconclusive. Therefore, further research with high quality randomized controlled trials is warranted to establish the impact of vitamin D supplementation on the management of PCOS.
However, others did not find significant differences in the VDR gene polymorphism frequencies between women with PCOS and normal controls4. We reported that the VDR 1a promoter polymorphisms were not associated with the risk of PCOS, but were associated with serum 25(OH)D levels in a cohort of Taiwanese Asians PCOS women. However, metformin treatment was only effective to increase serum 25(OH)D levels in women with PCOS carrying the homozygous 1521G/1012A haplotype.
You can also read our last blog on Long term health complications of polycystic ovarian syndrome (PCOS):-
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