One of the more common but frequently overlooked issues that affect many women beginning in perimenopause and into menopause is declining vaginal health. More specifically, vaginal dryness, atrophy, itching, irritation, and dyspareunia (painful intercourse related to vaginal dryness and atrophy) are conditions that can affect about half of postmenopausal women. In our research on signs and symptoms 37% of women reported vaginal dryness, 17% reported pelvic and rectal pain, and 7% reported prolapse. Are you one of them? Do you know someone who is affected? Would you like to know how vitamin D may be helpful? Then read on.

Vaginal health in menopause

One of the many jobs of estrogen is to support and maintain the health and vitality of the vagina and vaginal walls. Therefore, when estrogen (estradiol) levels begin declining, that protection begins to fade as well. This can lead to a variety of symptoms, many of which are associated with several conditions.

Also read menopause and vaginal dryness

One is vaginal atrophy (or vulvovaginal atrophy, involving the vulva), which has been called the second most common complication of menopause. Vaginal atrophy is characterized by drying, thinning, and inflammation of the vaginal walls that also show less flexibility. Women may also experience a reduction in vaginal secretions and an increase in vaginal pH, which makes the vagina less acidic. 

When both vaginal and urinary symptoms are involved, the condition is sometimes referred to as genitourinary syndrome of menopause. Symptoms can include vaginal dryness, vaginal burning, genital itching, burning when urinating, frequent urination, recurrent urinary tract infections, painful intercourse, less vaginal lubrication during sexual activity, urinary incontinence, bleeding after intercourse, and vaginal discharge. 

Atropic vaginitis is another vaginal health issue that can arise in menopause. It involves inflammation of the vagina in menopause in women who are not using hormone therapy. Symptoms include redness of the vagina and vaginal discharge. 

Also read menopause and its impact on sexuality

Vitamin D and vaginal health in menopause

Research has uncovered evidence that vitamin D can be an effective natural way to help support and promote vaginal health in menopausal women. Numerous studies have examined this approach.

In the most recent study, 105 postmenopausal women were randomly assigned to on three groups for eight weeks of treatment: a vaginal suppository containing 1,000 units of vitamin D3, a placebo vaginal suppository, or no treatment. The participants were assessed using the Female Sexual Function Scale (FSFI) one month before intervention, immediately after intervention, 1 month after intervention, and 2 months after intervention. 

Immediately and one month after the trial, those who received the vitamin D had the highest FSFI score, followed by the placebo group. At the two-month follow-up, both the intervention and placebo groups had similar scores. The researchers concluded that use of vitamin D suppositories “were more effective at improving sexual functioning among postmenopausal women in the short-term and appeared to prevent aging-related sexual functioning decline in the long term.”

In a 2020 double-blind, randomized, placebo-controlled trial among postmenopausal women with vulvovaginal atrophy, two groups were evaluated. Forty women received vitamin D (ergocalciferol) at 40,000 IU per week and another 40 were given a placebo. At week 12, the oral vitamin D supplement group showed improvement in vaginal pH and vulvovaginal atrophy symptoms. 

In a review study appearing in the Journal of Menopausal Medicine, the authors noted that vitamin D may “regulate the growth and differentiation of cells that are adversely affected due to low estradiol levels,” with the result being support and restoration of vaginal health. 

The reviewers evaluated six studies that involved the effects of vitamin D or related compounds (alone or with calcium) on vaginal health among menopausal women. Vitamin D used alone at 1,000 IU daily and compared with placebo or no treatment had an impact on vaginal cells and vaginal pH but did not reduce vaginal dryness. Participants took vitamin D for 8 to 10 weeks. Among those taking vitamin D plus calcium, one study showed an improvement in vaginal dryness after use of the supplement for 24 weeks. 

Overall the reviewers saw some improvement in the growth and differentiation of vaginal cells, better vaginal pH, and reduced vaginal dryness. Although the evidence of benefit over the six studies was low, the authors concluded that “vitamin D may improve the vaginal health of women, especially during menopause.”

In an earlier review, experts examined the effect of vitamin D on vaginal atrophy in postmenopausal women. Vitamin D in suppository form was used in half the women and a placebo in the other half. Specific vaginal cells increased and vaginal pH decreased significantly in the vitamin D group when compared with the placebo group after 56 days. Pain also significantly improved after 8 weeks of using vitamin D compared with controls. At 56 days, dryness and paleness declined significantly among women using vitamin D. 

Bottom line

Vitamin D may be an effective natural management remedy for perimenopausal and menopausal women who suffer with vaginal health issues, such as vulvovaginal atrophy and its symptoms. Women should have their vitamin D levels checked before starting a vitamin D supplementation regimen. 

[Note: Vitamin D is critical supplement. The only ways we can get natural Vitamin D is through sun exposure without sunscreen and from eating mushrooms. Vitamin D helps with bone health, immune function, mood, cognition, heart and respiratory health.]