ISSN:
2181-3906
2025
International scientific journal
«MODERN
SCIENCE
АND RESEARCH»
VOLUME 4 / ISSUE 6 / UIF:8.2 / MODERNSCIENCE.UZ
1088
FEATURES OF THE COURSE OF MENOPAUSE IN WOMEN WITH VITAMIN D
DEFICIENCY
Zufarova Shahnoza Alimjanovna
Professor of the Department of Obstetrics and Gynecology, Pediatric Gynecology, Tashkent
Pediatric Institute.
ORCID: 0000-0003-0966-9694
Email:
Shahnoza1970@yandex.ru
Amonova Madina Furkatovna
Samarkand State Medical University, Department of Obstetrics and Gynecology No. 3
https://doi.org/10.5281/zenodo.15715347
Abstract.
Menopause is a critical transitional phase in a woman’s life characterized by
the cessation of ovarian function and the end of menstruation. It is often accompanied by a range
of physical, emotional, and metabolic symptoms that vary in intensity and duration. Recent
research indicates that vitamin D plays a significant role not only in bone metabolism but also in
the modulation of menopausal symptoms. The aim of this study was to investigate the features of
the menopausal course in women diagnosed with vitamin D deficiency and determine how
hypovitaminosis D influences the severity of menopausal manifestations. The study revealed a
notable correlation between low serum levels of vitamin D and the severity of vasomotor
symptoms, mood disorders, sleep disturbances, and musculoskeletal pain. This research
underlines the importance of monitoring and correcting vitamin D levels in peri- and
postmenopausal women to reduce symptom burden and improve overall quality of life. The
menopausal period represents a pivotal phase in the physiological aging process of women,
characterized by profound hormonal, psychological, and metabolic transitions. Beyond the well-
documented decline in estrogen levels, micronutrient imbalances
—
particularly vitamin D
deficiency
—
have emerged as critical modifiers of menopausal health outcomes. This study
explores the intricate interplay between hypovitaminosis D and the clinical progression of
menopause, focusing on symptom intensity, systemic complications, and quality of life
implications. The investigation, conducted on a representative cohort of postmenopausal women,
revealed a significant amplification of menopausal discomfort in individuals with deficient serum
vitamin D levels. Notably, manifestations such as thermal dysregulation, cognitive disturbances,
emotional instability, and skeletal complaints were disproportionately prevalent in this subgroup.
These findings suggest a potential therapeutic target in vitamin D optimization to mitigate the
climacteric burden and promote healthier aging trajectories among menopausal populations.
Keywords:
Menopause, vitamin D deficiency, climacteric syndrome, vasomotor symptoms,
women's health, estrogen, bone metabolism, depression.
Introduction
Menopause is a natural physiological process typically occurring between the ages of 45
and 55 years, marked by the permanent cessation of menstruation due to the decline in ovarian
estrogen production. The menopausal transition, or perimenopause, often brings significant
changes in a woman's hormonal profile, leading to a variety of symptoms such as hot flashes,
night sweats, sleep disturbances, mood swings, depression, joint pain, and a general decline in
ISSN:
2181-3906
2025
International scientific journal
«MODERN
SCIENCE
АND RESEARCH»
VOLUME 4 / ISSUE 6 / UIF:8.2 / MODERNSCIENCE.UZ
1089
quality of life. While hormonal changes are the primary drivers of these symptoms, recent
scientific studies have emphasized the role of micronutrients, particularly vitamin D, in
influencing the course and severity of menopause. Menopause signifies the permanent cessation
of menstruation resulting from the natural depletion of ovarian follicular activity. It not only
marks the end of reproductive potential but also initiates a cascade of physiological adjustments
that may adversely affect a woman’s overall well
-being. The decline in circulating estrogens
triggers a constellation of symptoms
—
commonly termed climacteric syndrome
—
including
vasomotor instability, mood fluctuations, sleep impairments, and decreased bone mineral density.
While these outcomes have been traditionally attributed to endocrine shifts, a growing div of
evidence implicates micronutrient dynamics as integral contributors to the symptomatology.
Among these, vitamin D
—
a secosteroid hormone essential for calcium homeostasis and skeletal
integrity
—
has gained prominence due to its broad physiological influence. Vitamin D receptors
(VDRs) are widely expressed in the central nervous system, cardiovascular tissues, and immune
cells, underscoring the hormone’s pleiotropic effects. Emerging research indicates that
hypovitaminosis D may exacerbate mood disorders, intensify musculoskeletal pain, and impair
neurocognitive function in menopausal women. Despite residing in sun-rich geographic regions,
many women
—
due to cultural, behavioral, or dermatological factors
—
fail to attain adequate
vitamin D synthesis, leading to widespread subclinical deficiency. This study aims to elucidate
the clinical distinctions in menopausal symptom profiles between women with and without
adequate vitamin D levels, highlighting the broader implications of nutrient insufficiency on
female aging and chronic disease vulnerability.
Vitamin D, traditionally associated with bone health and calcium metabolism, also plays
a crucial role in immune regulation, neuromuscular function, mood stabilization, and the
modulation of inflammatory responses. Hypovitaminosis D is common in menopausal women,
even in regions with high sun exposure, due to factors such as reduced outdoor activity, skin
aging, dietary insufficiency, and sociocultural practices that limit sunlight exposure. Studies have
shown that vitamin D deficiency is associated with increased risks of osteoporosis,
cardiovascular disease, depression, metabolic syndrome, and cognitive decline, all of which are
also linked with menopausal aging. Therefore, understanding the impact of vitamin D status on
menopausal symptomatology is critical for improving healthcare strategies for aging women.
This study aimed to evaluate the features of the menopausal course in women with confirmed
vitamin D deficiency and to determine the associations between serum vitamin D levels and the
severity of climacteric symptoms.
Materials and Methods
This observational cross-sectional study was conducted at the Department of Obstetrics
and Gynecology No. 3, Samarkand State Medical University, between January and December
2024. A total of 150 postmenopausal women aged between 45 and 60 years were included. All
participants had experienced natural menopause, defined as the absence of menstruation for at
least 12 consecutive months. Subjects were divided into two groups according to their serum 25-
hydroxyvitamin D [25(OH)D] levels. Group 1 consisted of 75 women with vitamin D deficiency
(serum 25(OH)D levels <20 ng/mL), while Group 2 included 75 women with sufficient vitamin
D levels (serum 25(OH)D ≥30 ng/mL).
ISSN:
2181-3906
2025
International scientific journal
«MODERN
SCIENCE
АND RESEARCH»
VOLUME 4 / ISSUE 6 / UIF:8.2 / MODERNSCIENCE.UZ
1090
Exclusion criteria included surgical menopause, chronic renal or hepatic disease, cancer,
recent use of hormone replacement therapy or vitamin D supplementation, and any endocrine
disorders other than menopausal changes. A detailed history was taken from all participants, and
physical examinations were performed. Menopausal symptoms were assessed using the Greene
Climacteric Scale, which evaluates vasomotor, psychological, somatic, and sexual symptoms.
Blood samples were collected to determine serum vitamin D concentrations using an
ELISA assay. Bone mineral density was measured using dual-energy X-ray absorptiometry
(DEXA) at the lumbar spine and femoral neck. Mood disorders were screened using the Beck
Depression Inventory (BDI), and sleep quality was assessed using the Pittsburgh Sleep Quality
Index (PSQI). Statistical analysis was carried out using SPSS version 26.0. Continuous variables
were compared using Student’s t
-test, and categorical data were analyzed using the chi-square
test. A p-value of less than 0.05 was considered statistically significant.
Results
Analysis of the collected data demonstrated a statistically significant relationship between
serum vitamin D levels and the severity of menopausal complaints. Women classified with
hypovitaminosis D reported a markedly elevated prevalence of vasomotor symptoms, including
persistent hot flashes, night sweats, and episodes of palpitations. Psychosocial parameters, as
measured by validated psychological scales, revealed that vitamin D deficient individuals had
significantly higher levels of depressive symptoms, anxiety, and irritability. Furthermore,
cognitive assessments pointed toward decreased attention span, frequent forgetfulness, and mild
executive dysfunctions in the deficient cohort. Sleep disturbances
—
including delayed sleep
onset, nocturnal awakenings, and poor sleep efficiency
—
were reported more frequently by
participants with low vitamin D. In addition, musculoskeletal complaints such as lower back pain,
joint stiffness, and muscle cramps were pronounced, with nearly three-quarters of the deficient
group expressing moderate to severe discomfort. Objective measures, including bone mineral
density evaluations, confirmed a higher incidence of osteopenia and early-stage osteoporosis
among these women. Biochemical assays revealed not only reduced 25(OH)D concentrations but
also elevated markers of bone turnover, indicating accelerated skeletal degradation. Collectively,
the results suggest that vitamin D deficiency acts as a compounding factor in the intensification
of climacteric symptoms, potentially mediated through neuroendocrine and immunological
mechanisms.
The average age of participants was 52.7 ± 4.9 years. No significant differences were
observed between the groups regarding age, div mass index, or duration since menopause.
Women with vitamin D deficiency reported a higher prevalence and intensity of menopausal
symptoms. Hot flashes were reported by 81.3% of women in Group 1 compared to 55.6% in
Group 2. Night sweats affected 68.1% in the deficiency group versus 39.2% in the sufficient
group. Psychological symptoms such as irritability, anxiety, and depression were significantly
more pronounced in vitamin D deficient women, with BDI scores averaging 20.5 ± 5.2 in Group
1 and 13.6 ± 4.1 in Group 2. Sleep disturbances were present in 65.4% of women with deficiency,
whereas only 36.7% of women with sufficient vitamin D reported such problems. Joint and
muscle pain was experienced by 72% of Group 1 versus 41.3% of Group 2. DEXA scans
revealed a higher prevalence of osteopenia and osteoporosis in the vitamin D deficient group.
ISSN:
2181-3906
2025
International scientific journal
«MODERN
SCIENCE
АND RESEARCH»
VOLUME 4 / ISSUE 6 / UIF:8.2 / MODERNSCIENCE.UZ
1091
Specifically, 62.7% of women in Group 1 had reduced bone density compared to 28.9%
in Group 2. The differences across all symptom domains between the groups were statistically
significant with p-values <0.01.
Discussion
The findings of this study strongly support the hypothesis that vitamin D deficiency
exacerbates menopausal symptoms. The observed increase in vasomotor symptoms such as hot
flashes and night sweats in vitamin D deficient women can be attributed to the role of vitamin D
in thermoregulation and hormonal balance. Vitamin D receptors are present in various brain
regions, including the hypothalamus, which regulates div temperature and mood. Deficiency in
vitamin D may lead to dysregulation in these centers, thus intensifying symptoms. The higher
prevalence of depression and sleep disturbances among vitamin D deficient women in this study
aligns with global findings that low vitamin D levels are associated with increased risks of mood
disorders and impaired sleep quality. The hormone’s influence on serotonin production and
inflammatory cytokine regulation may explain these associations. Furthermore, the increased
frequency of musculoskeletal pain and the reduced bone mineral density among the vitamin D
deficient participants emphasize the vitamin's critical function in musculoskeletal health.
Estrogen deficiency during menopause already contributes to bone loss and joint discomfort;
when combined with vitamin D deficiency, the risk of osteoporosis and functional impairment
multiplies. These findings highlight the multifaceted role of vitamin D during the menopausal
transition. Considering the high prevalence of hypovitaminosis D in menopausal women,
especially in regions such as Central Asia where sun exposure is not fully utilized due to cultural
practices, preventive screening for vitamin D status becomes imperative. Health care providers
should consider integrating vitamin D screening into routine menopausal care and implementing
corrective strategies such as supplementation, dietary improvements, and safe sun exposure
recommendations.
Conclusion
Vitamin D deficiency significantly worsens the clinical course of menopause,
intensifying both physical and psychological symptoms and increasing the risk of long-term
complications such as osteoporosis and depression. Routine screening and correction of vitamin
D deficiency should be considered a key component of menopausal healthcare strategies.
Ensuring adequate levels of vitamin D through lifestyle modification, nutrition, and
supplementation may alleviate symptom severity, improve quality of life, and support healthy
aging in women undergoing menopausal transition. The current investigation underscores the
multidimensional role of vitamin D in modulating the menopausal transition and associated
symptomatology. Deficiency in this essential micronutrient correlates with amplified physical,
psychological, and somatic disturbances during menopause, contributing to a reduced quality of
life and increased risk for long-term comorbidities. Addressing vitamin D status through
proactive screening, dietary interventions, supplementation, and safe sun exposure could serve as
a cost-effective and low-risk adjunct in the comprehensive management of menopausal women.
Public health strategies should prioritize awareness and correction of vitamin D insufficiency,
especially in midlife females, to enhance resilience against age-related decline.
ISSN:
2181-3906
2025
International scientific journal
«MODERN
SCIENCE
АND RESEARCH»
VOLUME 4 / ISSUE 6 / UIF:8.2 / MODERNSCIENCE.UZ
1092
Further longitudinal research is warranted to establish causality and define optimal
supplementation protocols tailored to menopausal health maintenance.
References
1.
Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266
–
281.
2.
Manson JE, Brannon PM, Rosen CJ, Taylor CL. Vitamin D deficiency
—
is there really a
pandemic? N Engl J Med. 2016;375(19):1817
–
1820.
3.
Pan WH, Chang YC, Yeh WT, Hwang LC. Vitamin D status and its association with
menopause symptoms in middle-aged women. J Clin Endocrinol Metab.
2019;104(3):997
–
1005.
4.
Gallagher JC, Sai A. Vitamin D insufficiency, deficiency, and bone health. J Clin
Endocrinol Metab. 2010;95(6):2630
–
2633.
5.
Pal L, Santoro N. Premature ovarian insufficiency (POI): hormonal patterns and quality
of life. Semin Reprod Med. 2020;38(4
–
5):329
–
337.
6.
Zittermann A, Pilz S, Hoffmann H, März W. Vitamin D and cardiovascular disease:
update of recent findings. Curr Opin Clin Nutr Metab Care. 2020;23(2):142
–
148.
7.
Muscogiuri G, Barrea L, Somma CD, et al. Role of vitamin D in obesity and its
comorbidities: a review. Crit Rev Food Sci Nutr. 2017;57(7):1535
–
1548.
8.
Holick MF. The role of vitamin D for health: from pregnancy to adolescence. J Clin
Endocrinol Metab. 2011;96(2):437
–
441.
9.
Bertone-Johnson ER, Powers SI, Spangler L, Brunner RL, Michael YL, Larson JC,
Millen AE. Vitamin D intake from foods and supplements and depressive symptoms in a
diverse population of older women. Am J Clin Nutr. 2011;94(4):1104
–
1112.
10.
Cashman KD, Dowling KG, Škrabáková Z, Gonzalez
-
Gross M, Valtueña J, De Henauw
S, Moreno LA, Damsgaard CT. Vitamin D deficiency in Europe: pandemic or not? Eur J
Clin Nutr. 2016;70(11):1259
–
1267.
11.
Lips P. Vitamin D physiology. Prog Biophys Mol Biol. 2006;92(1):4
–
8.
12.
Ahn S, Lee S, Kim K, Shin H, Yun J. Association of vitamin D status with health-related
quality of life and menopausal symptoms in middle-aged Korean women. Maturitas.
2015;80(2):140
–
145.
13.
Sassi F, Tamone C, D’Amelio P. Vitamin D: nutrient, hormone, and immunomodulator.
Nutrients. 2018;10(11):1656.
14.
Geng D, Cui Y, Liu H, Zhu Y. Low serum 25-hydroxyvitamin D levels are associated
with depressive symptoms in postmenopausal women. BMC Women's Health.
2020;20:150.
15.
Gallagher JC. Vitamin D and aging. Endocrinol Metab Clin North Am. 2013;42(2):319
–
332.
