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Vitamin D and Menopause: Beyond Bone Health

Summary

Vitamin D plays a clinically relevant role in menopause by influencing bone mineral density, genitourinary health, and breast cancer pathways. Vitamin D deficiency is highly prevalent in postmenopausal women and contributes to increased fracture risk and genitourinary tissue vulnerability. Identifying and correcting deficiency is a practical, evidence-based strategy to optimize outcomes in menopause care.

Table of Contents

INTRODUCTION

MENOPAUSE AND BONE HEALTH

GENITOURINARY SYNDROME OF MENOPAUSE (GSM)

VITAMIN D AND BREAST CANCER

Conclusion

References

Introduction

As summer approaches and sunlight exposure increases, vitamin D becomes a more visible part of the conversation around health. Vitamin D plays a key adjunctive role in menopause, influencing bone health, genitourinary function, and breast cancer pathways. While it does not replace hormone therapy, it interacts with estrogen-related physiology in ways that can impact clinical outcomes. Understanding this relationship helps providers optimize menopause care.

MENOPAUSE AND BONE HEALTH

Menopause is characterized by a decline in estrogen that drives multiple physiological changes. Estrogen deficiency increases bone turnover, reduces bone mineral density, and alters body composition by increasing fat mass and decreasing lean mass. These changes may contribute to lower circulating vitamin D levels [1]. Together, estrogen deficiency and vitamin D deficiency create a high-risk environment for bone loss and fracture.

Even during months with higher sun exposure, many patients remain deficient due to lifestyle factors, sunscreen use, skin pigmentation, and age-related changes in cutaneous synthesis. Vitamin D deficiency is common in menopause, affecting an estimated 50% to 80% of women [2]. This widespread deficiency contributes to increased skeletal vulnerability. Vitamin D supplementation, particularly when combined with calcium, has been associated with reduced fracture risk, as well as reduced mortality in postmenopausal women undergoing treatment for osteoporosis [3,4].

Vitamin D may be most effective when combined with lifestyle interventions. Pairing supplementation with high-intensity interval training improves bone mineral density more than either intervention alone, highlighting the importance of integrating lifestyle strategies alongside pharmacologic therapy [5]. While vitamin D is best known for its role in bone health, estrogen deficiency also affects epithelial tissues, where vitamin D can support tissue integrity and function.

GENITOURINARY SYNDROME OF MENOPAUSE (GSM)

Estrogen decline affects epithelial tissues throughout the genitourinary tract. This leads to symptoms such as vaginal dryness, irritation, and increased susceptibility to infection, commonly referred to as genitourinary syndrome of menopause.

Vitamin D contributes to epithelial integrity and can improve symptoms of vaginal atrophy within weeks of supplementation [6]. It also enhances bladder and urinary tract barrier function, which may reduce susceptibility to infection [7]. These findings suggest that vitamin D complements hormone therapy by supporting tissue resilience in estrogen-deficient states. In addition to its effects on tissue integrity, vitamin D has also been investigated in disease processes influenced by estrogen signaling.

VITAMIN D AND BREAST CANCER

Vitamin D has been studied for its role in breast cancer, which is the most common cancer and a leading cause of death among women worldwide [8-13]. One area of interest is vitamin D’s interaction with estrogen signaling pathways. A proposed mechanism involves 27-hydroxycholesterol, a cholesterol-derived metabolite that activates estrogen receptors and promotes tumor growth. Vitamin D supplementation has been shown to reduce circulating levels of this metabolite, suggesting a pathway for influencing estrogen-driven cancer activity [14].

Beyond this mechanism, vitamin D influences cellular differentiation and immune signaling. Higher levels of vitamin D and sunlight exposure have been associated with lower breast cancer risk, slower progression, and reduced mortality [15-25]. Overall, these findings suggest a plausible role for vitamin D in cancer pathways.

Conclusion

Vitamin D remains a foundational component of menopausal care, with the strongest evidence supporting its role in bone health and expanding evidence in genitourinary function and oncology. While increased sunlight exposure may improve vitamin D status, deficiency remains common due to physiological and lifestyle factors. For providers, identifying and correcting deficiency is a practical, evidence-based strategy to support patients with estrogen deficiency. Vitamin D is a valuable adjunct that can improve clinical outcomes when integrated into comprehensive menopause management. Carie Boyd Pharmaceuticals supports this approach by providing individualized hormone therapy options, including estradiol pellets, topical creams, and sublingual tablets, enabling providers to deliver tailored, evidence-informed care.

  1. Lerchbaum E. Vitamin D and menopause–a narrative review. Maturitas. 2014;79(1):3-7. doi:10.1016/j.maturitas.2014.06.003
  2. Mei Z, Hu H, Zou Y, Li D. The role of vitamin D in menopausal women’s health. Front Physiol. 2023;14:1211896. Published 2023 Jun 12. doi:10.3389/fphys.2023.1211896
  3. Yao, P., Bennett, D., Mafham, M., Lin, X., Chen, Z., Armitage, J., & Clarke, R. (2019). Vitamin D and Calcium for the Prevention of Fracture: A Systematic Review and Meta-analysis. JAMA network open, 2(12), e1917789. https://doi.org/10.1001/jamanetworkopen.2019.17789
  4. Migliorini, F., Maffulli, N., Colarossi, G., Filippelli, A., Memminger, M., & Conti, V. (2025). Vitamin D and calcium supplementation in women undergoing pharmacological management for postmenopausal osteoporosis: a level I of evidence systematic review. European journal of medical research, 30(1), 170. https://doi.org/10.1186/s40001-025-02412-x.
  5. Alghadir, A. H., Gabr, S. A., & Iqbal, A. (2025). Concurrent effects of high-intensity interval training and vitamin D supplementation on bone metabolism among women diagnosed with osteoporosis: a randomized controlled trial. BMC musculoskeletal disorders, 26(1), 381. https://doi.org/10.1186/s12891-025-08275-x
  6. Kamronrithisorn T, Manonai J, Vallibhakara SA, Sophonsritsuk A, Vallibhakara O. Effect of Vitamin D Supplement on Vulvovaginal Atrophy of the Menopause. Nutrients. 2020;12(9):2876. Published 2020 Sep 21. doi:10.3390/nu12092876
  7. Mohanty S, Kamolvit W, Hertting O, Brauner A. Vitamin D strengthens the bladder epithelial barrier by inducing tight junction proteins during E. coli urinary tract infection. Cell Tissue Res. 2020;380(3):669-673. doi:10.1007/s00441-019-03162-z
  8. Danaei G., Vander Hoorn S., Lopez A.D., Murray C.J., Ezzati M. Causes of cancer in the world: Comparative risk assessment of nine behavioural and environmental risk factors. Lancet. 2005;366:1784–1793. doi: 10.1016/S0140-6736(05)67725-2.
  9. Lukasiewicz S., Czeczelewski M., Forma A., Baj J., Sitarz R., Stanislawek A. Breast Cancer-Epidemiology, Risk Factors, Classification, Prognostic Markers, and Current Treatment Strategies-An Updated Review. Cancers. 2021;13:4287. doi: 10.3390/cancers13174287.
  10. Ang B.H., Teo S.-H., Ho W.-K. Systematic Review and Meta-Analysis of Lifestyle and Reproductive Factors Associated with Risk of Breast Cancer in Asian Women. Cancer Epidemiol. Biomark. Prev. 2024;33:1273–1285. doi: 10.1158/1055-9965.EPI-24-0005.
  11. Lofterod T., Frydenberg H., Flote V., Eggen A.E., McTiernan A., Mortensen E.S., Akslen L.A., Reitan J.B., Wilsgaard T., Thune I. Exploring the effects of lifestyle on breast cancer risk, age at diagnosis, and survival: The EBBA-Life study. Breast Cancer Res. Treat. 2020;182:215–227. doi: 10.1007/s10549-020-05679-2.
  12. Zhang Y., Lindstrom S., Kraft P., Liu Y. Genetic Risk, Health-Associated Lifestyle, and Risk of Early-onset Total Cancer and Breast Cancer. J. Natl. Cancer Inst. 2024;117:40–48. doi: 10.1093/jnci/djae208.
  13. Bray F., Laversanne M., Sung H., Ferlay J., Siegel R.L., Soerjomataram I., Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 2024;74:229–263. doi: 10.3322/caac.21834.
  14. Going, C., et al., “Vitamin D supplementation decreases serum 27-hydroxycholesterol in a pilot breast cancer trial,” Breast Cancer Res Treat 2018; 167(3):797-802.
  15. Abbas, S., et al., “Serum 25-hydroxyvitamin D and risk of post-menopausal breast cancer–results of a large case-control study,” Carcinogenesis 2008; 29(1):93-9.
  16. Estebanez, N., et al., “Vitamin D exposure and risk of breast cancer: a meta-analysis,” Sci Rep 2018; 8(1):9039.
  17. Eliassen, A., et al., “Plasma 25-hydroxyvitamin D and risk of breast cancer in women followed over 20 years,” Cancer Res 2016; 76:5423–30.
  18. Wulaningsih, W., et al., “Serum calcium and the risk of breast cancer: findings from the Swedish AMORIS study and a meta-analysis of prospective studies,” Int Jour Sci 2016; 17:1487.
  19. Ramasamy I. Vitamin D Metabolism and Guidelines for Vitamin D Supplementation. Clin. Biochem. Rev. 2020;41:103–126. doi: 10.33176/AACB-20-00006.
  20. Dallavalasa S., Tulimilli S.V., Bettada V.G., Karnik M., Uthaiah C.A., Anantharaju P.G., Nataraj S.M., Ramashetty R., Sukocheva O.A., Tse E., et al. Vitamin D in Cancer Prevention and Treatment: A Review of Epidemiological, Preclinical, and Cellular Studies. Cancers. 2024;16:3211. doi: 10.3390/cancers16183211.
  21. Keum N., Lee D.H., Greenwood D.C., Manson J.E., Giovannucci E. Vitamin D supplementation and total cancer incidence and mortality: A meta-analysis of randomized controlled trials. Ann. Oncol. 2019;30:733–743. doi: 10.1093/annonc/mdz059.
  22. Becerra-Tomas N., Balducci K., Abar L., Aune D., Cariolou M., Greenwood D.C., Markozannes G., Nanu N., Vieira R., Giovannucci E.L., et al. Postdiagnosis dietary factors, supplement use and breast cancer prognosis: Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int. J. Cancer. 2023;152:616–634. doi: 10.1002/ijc.34321.
  23. Garland, F., et al., “Geographic variation in breast cancer mortality in the United States: A hypothesis involving exposure to solar radiation,” Prev Med 1990; 19:614–22.
  24. Boscoe, F., et al., “Solar ultraviolet-B exposure and cancer incidence and mortality in the United States 1993–2002,” BMC Cancer 2006; 6:264.
  25. Zhu, A., Kuznia, S., Boakye, D., Schöttker, B., & Brenner, H. (2022). Vitamin D-Binding Protein, Bioavailable, and Free 25(OH)D, and Mortality: A Systematic Review and Meta-Analysis. Nutrients, 14(19), 3894. https://doi.org/10.3390/nu14193894
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