Vitamin D and Menstrual Cycle Regularity

Original Date of Publication: July 28, 2022

Original Author: Stacy Cappadona, MS, RD, CSSD, CSCS, TSAC-F, is OmegaQuant’s science writer and reviewer. She is a registered dietitian and board-certified specialist in sports dietetics. Stacy has spent most of her career supporting the health and performance of United States military communities, applying evidence-based nutrition strategies to meet the demands of high-stress, high-performance environments. Learn more

Date of Review/Update: June 30, 2026

Reviewer: Kelly Patterson MS, RD, LDN, CSSD

Kelly Patterson the Clinical Nutrition Educator at OmegaQuant. She is a Registered Dietitian with a background in tactical and sports nutrition. Kelly spent much of her career working for the U.S. Army, including 5 years as a tactical performance dietitian for an elite Special Operations Unit at Fort Bragg, NC. Kelly came to OmegaQuant to further her work on performance biomarkers and to help OmegaQuant expand their testing options. Her work focuses on translating Omega-3 research into practical clinical applications to support performance, resilience, and health. Learn more.

 

 

The menstrual cycle is the sequence of events a woman’s body goes through to prepare for a possible pregnancy each month. Changes in hormones trigger the phases of the menstrual cycle, which include: (1) the menses phase, (2) the follicular phase, (3) ovulation, and (4) the luteal phase.

Also commonly referred to as a period or menses, menstrual cycle regularity is considered an indicator of a woman’s metabolic, hormonal, and reproductive health (1). The same hormones that regulate menstruation also play a role in reproduction and the development of chronic disease (2). Menstrual cycle irregularities are a common problem and occur in roughly 14% to 25%of women of reproductive age (3).

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What is an Irregular Menstrual Cycle?

An irregular menstrual cycle is a broad term encompassing menstruation frequency, regularity, duration, and bleeding volume (3).

Some examples of menstrual irregularities include:

• Amenorrhea: absent menstrual periods
• Oligomenorrhea: infrequent menstrual periods (more than 35 days apart)
• Polymenorrhagia: frequent menstrual periods (less than 21 days apart)
• Menorrhagia: heavy menstrual periods or excessive bleeding
• Dysmenorrhea: painful menstrual periods
• Prolonged menstrual bleeding: bleeding extending beyond 8 days
• Shortened menstrual bleeding: bleeding less than 2 days
• Intermenstrual bleeding: bleeding occurring in between menstrual periods
• Irregular menstrual periods: significant variations from period to period (3)

The reproductive system is complex, and a wide range of factors can influence period regularity, from daily stress to severe medical conditions (4).  Some modifiable lifestyle factors that could impact menstruation include gaining or losing a significant amount of weight, changing exercise routines, travel, illness, high amounts of stress, and extreme dieting or nutrient deficiencies (5).

While several nutrients are known to affect a woman’s health and fertility, vitamin D may play a unique role in menstruation. Multiple studies have emerged over the last decade demonstrating a relationship between vitamin D status and menstrual disorders, particularly menstrual cycle frequency and pain.

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Vitamin D and Menstrual Cycle Frequency

A  2021 study explored the association between serum vitamin D levels with menstrual cycle characteristics, including cycle irregularity (6). After assessing over 150 women, they found a significant difference in average vitamin D levels in females with irregular cycles vs. those with regular cycles In particular, women with regular cycles had significantly higher vitamin D levels, and lower vitamin D was associated with 13 times the odds of having an irregular cycle. In this study, vitamin D deficiency was associated with a prolonged follicular phase, delayed ovulation, and longer than normal menstrual cycles.

Another study published in 2018 came to similar conclusions after evaluating the association of vitamin D status with menstrual cycle characteristics, including amenorrhea (absence of menstruation), oligomenorrhoea (infrequent menstruation), and eumenorrhea (normal menstruation) in healthy women with different body weight (7). The investigators in this study found that women with oligomenorrhoea and amenorrhea are characterized by significantly lower vitamin D levels than women with normal menstruation.

Several other studies have  also come to similar conclusions: lower vitamin D concentrations correlate with irregular menstrual cycle frequency (8,9).

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Vitamin D and Menstrual Cycle Pain

Menstrual cycle pain, or dysmenorrhea, usually occurs just before or at the beginning of menstruation, lasts between 8-72 hours, and occurs in up to 91% of women of reproductive age (10). Common symptoms may include headache, fatigue, nausea/vomiting, diarrhea, and pelvic cramping. Dysmenorrhea can lead to absenteeism from important daily activities, such as work or school, and diminish overall quality of life. The role of vitamin deficiencies in dysmenorrhea has been highlighted, and evidence has been found that vitamin D plays a role.

A 2021 study published in the Journal of Obstetrics & Gynecology investigated the effect of vitamin D supplementation on pain and systemic symptoms in patients with primary dysmenorrhea, defined as menstrual pain in the absence of pelvic pathology (11). This was a double-blind, randomized, placebo-controlled trial conducted on over 100 females with primary dysmenorrhea and vitamin D deficiency (<30 ng/mL).

They found that participants who were vitamin D deficient and received vitamin D supplementation experienced significant reductions in pain intensity, number of days with pain, number of consumed pain-relief medications, and systemic symptom severity compared to baseline and the placebo group. This study used a weekly vitamin D dose of 50,000 IU for 8 weeks, per the Endocrine Society clinical practice guideline (12).

Several other studies have found similar reductions in dysmenorrhea symptoms with a single 300,000 IU dose five days before menstruation (13,14). According to the evidence available, vitamin D supplementation in those who are deficient, both in single and multiple doses, can reduce the severity of primary dysmenorrhea symptoms.

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Vitamin D’s Mechanism of Action

In humans, vitamin D3 can act on vitamin D receptors (VDRs) to modulate the expression of over 300 genes in various tissues, including those of the reproductive system (15). While still requiring validation, some studies suggest that menstrual disorders in women with or without Polyendocrine Metabolic Ovarian Syndrome (PMOS, formerly known as Polycystic Ovarian Syndrome) may be due to vitamin D’s effect on the genes that control anti-Mullerian hormone(AMH), (16). Vitamin D receptors have been found on the promoter region for the gene encoding AMH, suggesting vitamin D can regulate AMH expression (17).

AMH is produced and released from the granulosa cells in the ovary and is proportional to the number of developing follicles in the ovaries (18). Therefore, AMH has emerged as an indirect marker of ovarian reserve (19). Vitamin D is likely to influence ovulatory and menstrual dysfunction by acting on genes that control AMH.

Vitamin D has also been found to play a significant role in PMOS (PCOS) which is often characterized by irregular periods and infertility (7). Correcting low vitamin D levels in those with PCOS can improve metabolic and menstrual cycle changes and follicle maturation (20). Vitamin D is thought to act on PCOS pathology through several mechanisms, including (1) increasing parathyroid hormone, (2) regulating the aromatase gene which controls the biosynthesis of estrogen, (3) affecting the action of insulin through vitamin D receptors on pancreatic Beta-cells, and (4) regulating calcium metabolism, which can support ovarian follicular maturation (7).

Furthermore, it’s theorized that vitamin D’s role in calcium homeostasis plays a role in menstrual cycle pain. It may be possible that low serum calcium levels (which can occur with vitamin D deficiency) can cause uterine smooth muscle contraction and spasms, leading to some of the pain associated with primary dysmenorrhea (21). Additionally, vitamin D receptors, and the enzyme responsible for metabolizing vitamin D, can be found in myometrial cells, the smooth muscle cells involved in stretching and contracting the uterus (22). This suggests that vitamin D may play a dire role in the pathogenesis of dysmenorrhea and the severity of symptoms.

Lastly, menstrual pain is believed to be related to the excessive production of uterine prostaglandins, which can also influence vasoconstriction and myometrial contraction. It’s suggested that vitamin D decreases prostaglandin synthesis and increases prostaglandin inactivation, thereby reducing pain and uterine cramping associated with menstrual cycles. Vitamin D also has different anti-inflammatory effects, such as its role in reducing inflammatory cytokines associated with contractile factors in the endometrium, decreasing period pain (23).

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Know Your numbers

Low vitamin D levels are not uncommon, and in some of the studies cited up to 78% of the women included were vitamin D deficient (7). Low dietary vitamin D intake, shifts in lifestyle from working primarily outdoors to abundant desk jobs, increased use of sunscreen from rising skin cancer concerns, and increased environmental pollution are all contributors to the high numbers of vitamin D deficiency in society today. The Endocrine Society of North America recommends maintaining serum 25(OH)D levels above 30 ng/ml (sufficient). If your vitamin D levels are below 30 ng/ml, increasing vitamin D intake through food or supplementation is recommended.

Similarly, if you are a woman of reproductive age, knowing your menstrual cycle data trends is crucial. Health care providers suggest keeping a record of period start and stop dates, and other symptoms such as blood loss trends, headaches, or mood changes. Multiple apps available today can help you track your cycle and symptoms, or you can follow with paper and pen in your daily calendar. If you suspect your menstrual cycle has changed, or you find you are vitamin D deficient, be sure to speak with your doctor or other health care provider to determine the best way forward.

 

References

1. Rostami Dovom M, Ramezani Tehrani F, Djalalinia S, Cheraghi L, Behboudi Gandavani S, Azizi F. Menstrual Cycle Irregularity and Metabolic Disorders: A Population-Based Prospective Study.PLoS One. 2016;11(12):e0168402. Published 2016 Dec 16. doi:10.1371/journal.pone.0168402
2. Mumford SL, Steiner AZ, Pollack AZ, et al. The utility of menstrual cycle length as an indicator of cumulative hormonal exposure.J Clin Endocrinol Metab. 2012;97(10):E1871-E1879. doi:10.1210/jc.2012-1350
3. Whitaker L, Critchley HO. Abnormal uterine bleeding.Best Pract Res Clin Obstet Gynaecol. 2016;34:54-65. doi:10.1016/j.bpobgyn.2015.11.012
4. Attia GM, Alharbi OA, Aljohani RM. The Impact of Irregular Menstruation on Health: A Review of the Literature.Cureus. 2023;15(11):e49146. Published 2023 Nov 20. doi:10.7759/cureus.49146
5. Bae J, Park S, Kwon JW. Factors associated with menstrual cycle irregularity and menopause.BMC Womens Health. 2018;18(1):36. Published 2018 Feb 6. doi:10.1186/s12905-018-0528-x
6. Singh V, Tamar N, Lone Z, Das E, Sahu R, Majumdar S. Association between serum 25-hydroxy vitamin D level and menstrual cycle length and regularity: A cross-sectional observational study.Int J Reprod Biomed. 2021;19(11):979-986. Published 2021 Dec 13. doi:10.18502/ijrm.v19i11.9913
7. Łagowska K. The Relationship between Vitamin D Status and the Menstrual Cycle in Young Women: A Preliminary Study.Nutrients. 2018;10(11):1729. Published 2018 Nov 11. doi:10.3390/nu10111729
8. Sadhir M, Kansra AR, Menon S. Vitamin D Deficiency among Adolescent Females with Polycystic Ovary Syndrome.J Pediatr Adolesc Gynecol. 2015;28(5):378-381. doi:10.1016/j.jpag.2014.11.004
9. Jukic AM, Steiner AZ, Baird DD. Lower plasma 25-hydroxyvitamin D is associated with irregular menstrual cycles in a cross-sectional study.Reprod Biol Endocrinol. 2015;13:20. Published 2015 Mar 11. doi:10.1186/s12958-015-0012-5
10. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review.Hum Reprod Update. 2015;21(6):762-778. doi:10.1093/humupd/dmv039
11. Rahnemaei FA, Gholamrezaei A, Afrakhteh M, et al. Vitamin D supplementation for primary dysmenorrhea: a double-blind, randomized, placebo-controlled trial.Obstet Gynecol Sci. 2021;64(4):353-363. doi:10.5468/ogs.20316
12. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.J Clin Endocrinol Metab. 2011;96(7):1911-1930. doi:10.1210/jc.2011-0385
13. Lasco A, Catalano A, Benvenga S. Improvement of primary dysmenorrhea caused by a single oral dose of vitamin D: results of a randomized, double-blind, placebo-controlled study.Arch Intern Med. 2012;172(4):366-367. doi:10.1001/archinternmed.2011.715
14. Rahnemaei FA, Gholamrezaei A, Afrakhteh M, et al. Vitamin D supplementation for primary dysmenorrhea: a double-blind, randomized, placebo-controlled trial.Obstet Gynecol Sci. 2021;64(4):353-363. doi:10.5468/ogs.20316
15. Lerchbaum E, Obermayer-Pietsch B. Vitamin D and fertility: a systematic review.Eur J Endocrinol. 2012;166(5):765-778. doi:10.1530/EJE-11-0984
16. Łagowska K. The Relationship between Vitamin D Status and the Menstrual Cycle in Young Women: A Preliminary Study.Nutrients. 2018;10(11):1729. Published 2018 Nov 11. doi:10.3390/nu10111729
17. Malloy PJ, Peng L, Wang J, Feldman D. Interaction of the vitamin D receptor with a vitamin D response element in the Mullerian-inhibiting substance (MIS) promoter: regulation of MIS expression by calcitriol in prostate cancer cells.Endocrinology. 2009;150(4):1580-1587. doi:10.1210/en.2008-1555
18. Dewailly D, Andersen CY, Balen A, et al. The physiology and clinical utility of anti-Mullerian hormone in women.Hum Reprod Update. 2014;20(3):370-385. doi:10.1093/humupd/dmt062
19. Kevenaar ME, Meerasahib MF, Kramer P, et al. Serum anti-mullerian hormone levels reflect the size of the primordial follicle pool in mice.Endocrinology. 2006;147(7):3228-3234. doi:10.1210/en.2005-1588
20. Shojaeian Z, Sadeghi R, Latifnejad Roudsari R. Calcium and vitamin D supplementation effects on metabolic factors, menstrual cycles and follicular responses in women with polycystic ocvary syndrome: A systematic review and meta-analysis.Caspian J Intern Med. 2019;10(4):359-369. doi:10.22088/cjim.10.4.359
21. Huang L, Zhang JQ, Li YB, et al. Effect of Alpinia officinarum Hance alcohol extracts on primary dysmenorrheal.Asian Pac J Trop Med. 2016;9(9):882-886. doi:10.1016/j.apjtm.2016.07.012
22. Othman ER, Ahmed E, Sayed AA, et al. Human uterine leiomyoma contains low levels of 1, 25 dihdroxyvitamin D3, and shows dysregulated expression of vitamin D metabolizing enzymes.Eur J Obstet Gynecol Reprod Biol. 2018;229:117-122. doi:10.1016/j.ejogrb.2018.08.018
23. 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;210(4):347.e1-347.e10. doi:10.1016/j.ajog.2013.11.027