The Effect of Vitamin D and E Supplementation on Primary Dysmenorrhea and PMS

Primary dysmenorrhea is characterized by painful menstrual cramps that occur just before and/or during menstruation without any underlying pelvic pathology.  Some women are significantly impacted not only by those who have moderate to severe pain, but also those who have nausea, vomiting, and/or diarrhea.

One of the main roles of vitamin D is its role in calcium absorption and bone health.  Many of us do not realize it also has a role in modulating prostaglandin synthesis meaning an insufficiency or deficiency could lead to higher concentrations of PGF2alpha (PGF2α), a prostaglandin associated with smooth muscle pain, cramping and inflammation.  Vitamin E has antioxidant and anti-inflammatory properties than can also potentially influence primary dysmenorrhea.  Women with dysmenorrhea can have elevated concentrations of PGF2alpha and by inhibiting the release of arachidonic acid and its conversion to prostaglandins, vitamin E may have a role in treating primary dysmenorrhea.

The current study was a double blind randomized controlled trial in Iran, with Iranian women who met the inclusion criteria for the study, including at least four consecutive painful periods in the last 6 months.  They also had to have a serum 25-hydroxyvitamin D level < 30 ng/mL (20-30 is insufficient vitamin D level and < 20 is deficient).  PMS symptoms were evaluated as well.

Participants in the intervention group were given vitamin E 400 IU daily and vitamin D 50,000 IU once weekly for 8 weeks.  After the initial 8 weeks, the vitamin D was continued at 50,000 IU once monthly for an additional two months.   The control group received placebo treatment on the same schedule.  There was a total of 106 women who were enrolled in the study.

Results: The supplement intervention group exhibited a significant reduction in pain intensity from 7.85 to 3.75 compared to controls were 7.68 to 6.02.  Premenstrual symptoms significantly improved as well in the supplement group with a score of 32.42 to 9.02 and 31.83 to 21.53 in the control group.  There was a clear significant inverse relationship between the vitamin D level and pain experienced during menses as well as an inverse relationship with the physical symptoms score of PMS.

Commentary:  This study demonstrates beneficial effects of a combined Vitamin D and Vitamin E supplementation for dysmenorrhea and PMS in those who are insufficient or deficient in vitamin D serum levels.  This was punctuated by the observation being there is an inverse relationship between vitamin D levels and dysmenorrhea pain as well as physical symptoms of PMS.

This is a simple enough strategy to try, and I am especially interested in following cases of primary dysmenorrhea with this approach.  For PMS physical symptoms, I am of the opinion that the research on chaste tree berry in particular is compelling enough for the PMS symptom of cyclic mastalgia (breast pain) but the vitamin E is also likely the main driver of benefit in breast pain, in this study rather than the vitamin D.  I’m thinking that other PMS physical symptoms that were noted such as muscle or joint pain and backache may benefit more from the vitamin D supplementation in the protocol.  A study on just Vitamin E and just vitamin D for PMS and for primary dysmenorrhea would be more helpful.

Reference:  Hosseini M, Talayeh M, Toutounchi A, et al.  Effect of vitamin D and E supplementation on pain relief and premenstrual symptoms in primary dysmenorrhea: a randomized controlled trial.  BMC Women’s Health 2025:25:455