Comparitive study on role of vitamin d supplementation among PCOS women with vitamin D deficiency

Abstract

Aim & objectives: This study was designed to compare the efficacy of vitamin D supplementation over Metformin in the management of PCOS with Vitamin D deficiency.Methodology: The present study is a hospital based prospective study conducted in the department of Obstetrics & Gynaecology Narayana medical college & hospital. A total of 100 women diagnosed with PCOS with Vitamin D deficiency fulfilling the inclusion criteria were included in to the study and are sub divided in to two groups A & B with 50 women in each group. Group A: Women were given treatment with Metformin & Calcium 1000mg daily along with Vitamin D3 60K IU weekly for 6weeks followed by monthly for 4 months. Group B: Women were given treatment with Metformin 1000mg daily only. Detailed history regarding chief complaints, menstrual cycles, hyperandrogenic symptoms like hirsutism & acne, history of features of PCOS in the family was taken. Complete physical examination, laboratory tests like serum Total testosterone, serum Fasting insulin for hyperandrogenism & IR respectively & Transabdominal ultrasound scan for ovarian volume was done before starting treatment. Results: The cases in both the groups are matched well with regards to mean age , BMI, waist hip ratio, percentage of acne & hirsutism positive women, menstrual irregularities, mean ovarian volume ,mean serum total testosterone & mean serum fasting insulin before treatment. Follow up was done during the treatment and at the end of the 6 months again women were examined clinically and investigated to access any improvement in the various features of PCOS we considered. In group A with Metformin, Vitamin-D & Calcium supplementation after treatment 78% had regular menstrual cycles (p value 0.0001), where as in group B with Metformin supplementation only 56% showed regularization of cycles. On comparing between the two groups it was found that addition of Vitamin D & Calcium to Metformin regularize the menstraul cycles significantly with p value 0.031. Regarding BMI, waist hip ratio, acne, hirsutism & serum fasting insulin there was reduction in mean values after treatment for 6months in both groups, but reduction is more in group A( Vitamin D, Calcium & Metformin) than in group B women ( Metformin). But these differences was not statistically significant. The abnormal oocyte development in ovary in PCOS is related to a state of meiotic arrest, caused by variations in Calcium &Vitamin D levels leading to menstrual abnormalities & dysregulated body mechanisms. Conclusion:The Vitamin D & Calcium are safe, inexpensive & easily available drugs their addition to Metformin can contribute for normalization of the dysregulated metabolism in various tissues including ovaries, pancreas, muscle and enhance the action of Metformin in improving the clinical biochemical features of PCOS. More widespread randomized and controlled empirical attempts seem necessary to determine the potential useful affects of the Calcium, Vitamin D supplementation on different features of the PCOS.