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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (2): 272-276    DOI: 10.31083/j.ceog.2020.02.5248
Original Research Previous articles | Next articles
The effect of correction of serum level of vitamin D on hyperandrogenism in women with polycystic ovary syndrome and hypovitaminosis D
A. M. Maysara1, *(), A. T. Nassar2, H. K. Jubran3
1Department of Obstetrics & Gynecology, College of Medicine- University of Basra, Iraq
2AI Faiha Specialized Diabetes, Endocrine and Metabolic Centre, Iraq
3Department of Clinical Pharmacy, College of Pharmacy, University of Basra, Iraq
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Abstract  Background: Polycystic ovary syndrome (PCOS) is a common condition among female of reproductive age. Vitamin D may involve in the pathogenesis of PCOS. Vitamin D deficiency may exacerbate the symptom of PCOS through precipitating insulin resistance, menstrual irregularities, subfertility, hyperandrogenism, and cardiovascular dysfunction. Aim: The aim of the study is to determine whether normalization of vitamin D level in women with PCOS and hyperandrogenism (clinical and/or biochemical) would result in improvement in the parameters of hyperandrogenism. Materials and Methods: One hundred one women with PCOS and vitamin D deficiency were involved in the study, BMI, and Gallwey-Ferriman score were estimated, 25 (OH) vitamin D, total testosterone, sex hormone binding globulin (SHBG), follicular stimulating hormone (FSH), and luteinizing hormone (LH) were measured and pelvic ultrasound was performed. Forty-nine of these women received weight reduction and lifestyle modification advice and metformin only, while the remaining 52 women received vitamin D in addition, after six months all parameters were re-examined. Results: Adding vitamin D did not result in significant reduction in the Ferriman-Gallwey score or in total testosterone level, also normalization of vitamin D had insignificant effect on the level of sex hormone binding globulin and ovarian polycystic morphology, however it was associated with significant reduction in LH level. Conclusion: Despite the fact that correction of vitamin D deficiency is important for general health, however it is of limited beneficial effect on the biochemical and clinical parameters of hyperandrogenism in women with PCOS.
Key words:  Vitamin D      Hyperandrogenism      Polycystic ovary syndrome     
Published:  15 April 2020     
*Corresponding Author(s):  A. M. Maysara     E-mail:

Cite this article: 

A. M. Maysara, A. T. Nassar, H. K. Jubran. The effect of correction of serum level of vitamin D on hyperandrogenism in women with polycystic ovary syndrome and hypovitaminosis D. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(2): 272-276.

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Table 1  — General characteristic of the patients at the beginning of the study in both groups.
Group 1 (n=52) Group 2 (n=49) p
Mean ± SD Mean ± SD
Age (years) 23.12 5.78 24.71 6.25 0.060
BMI (kg/m2) 32.05 13.01 30.84 6.75 0.422
FGS 24.92 7.05 25.59 6.99 0.633
Serum Vit. D (ng/dl) 13.8 4.78 14.1 5.21 0.764
TT (ng/dl) 55.70 16.86 52.45 25.53 0.450
SHBG (nmol/L) 33.09 22.72 37.08 20.92 0.282
LH (IU/L) 12.07 5.52 11.80 8.14 0.846
FSH (IU/L) 5.25 2.37 4.89 2.39 0438
LH/FSH ratio 2.78 1.65 2.77 2.21 0.984
Table 2  — Comparison of clinical and biochemical parameters of hyperandrogenism between both groups after treatment.
Group 1 Group 2 p
Mean ±SD Mean ±SD
FGS 11.94 5.67 15.63 8.03 0.009
FGS reduction 12.98 6.17 10.69 5.40 0.083
TT 46.12 14.00 34.12 22.32 0.002
TT reduction 12.12 17.75 11.33 24.45 0.852
SHBG 56.13 33.92 52.48 39.42 0.618
SHBG elevation 23.04 20.72 14.68 35.78 0.151
LH 5.96 1.79 8.23 6.69 0.020
FSH 5.38 1.77 6.16 5.71 0.351
LH/FSH ratio 1.24 0.58 1.46 0.94 0.161
LH/FSH ratio reduction 1.54 1.53 1.32 2.24 0.555
Table 3  — Frequency and percentage of normalization of FGS, TT, LH/FSH ratio, and polycystic changes at the end of the study.
Group 1 n = 52 Group 2 n = 49 OR 95% CI p
n % n % Lower Upper
FGS <= 8 12 23.1 9 18.4 1.33 0.51 3.51 0.369
TT < 50 32 61.5 39 79.6 0.41 0.17 1.00 0.038
LH/FSH ratio < 2 46 88.5 36 73.5 1.77 0.79 3.97 0.047
Polycystic changes No 33 63.5 31 63.5 1.01 0.45 2.27 0.574
[1] Fauser B.C.J.M., Tarlatzis B.C., Rebar R.W., Legro R.S., Balen A.H., Lobo R., et al.: “Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): The Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group”. Fertil. Steril., 2012, 97, 28.
doi: 10.1016/j.fertnstert.2011.09.024
[2] Shroff R., Syrop C.H., Davis W., Voorhis B.J., Dokras A.l.: “Risk of matabolic complications in the new PCOS phenotypes based on the Rotterdam criteria”. Fertil. Steril., 2007, 88, 1389.
doi: 10.1016/j.fertnstert.2007.01.032
[3] Azziz R., Carmina E., Dewailly D., Diamanti-Kandarakis E., Escobar-Morreale H.F.: “The androgen excess and PCOS society criteria for the polycystic ovary syndrome: the complete task force report”. Fertil. Steril., 2009, 91, 456.
doi: 10.1016/j.fertnstert.2008.06.035
[4] Wild R.A., Carmina E., Diamanti-Kandarakis E., Dokras A., Escobar-Morreale H.F., Futterweit W. et al.: “Assessment of Cardiovascular Risk and Prevention of Cardiovascular Disease in Women with the Polycystic Ovary Syndrome: A Consensus Statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society”. J. Clin. Endocrinol. Metab., 2010, 95, 2038.
doi: 10.1210/jc.2009-2724 pmid: 20375205
[5] Moran L.J., Norman R.J., Teede H.J.: “Metabolic risk in PCOS: phenotype and adiposity impact”. Trends Endocrinol. Metab., 2015, 26, 136.
doi: 10.1016/j.tem.2014.12.003 pmid: 25591984
[6] Barber T.M., Dimitriadis G.K., Andreou A., Franks S.: “Polycystic ovary syndrome: insight into pathogenesis and a common association with insulin resistance”. J. Royal College of Physicians, 2015, 15, 72.
[7] Spritzer M., Barone R., De Oliveira B.: “Hirsutism in Polycystic Ovary Syndrome: Pathophysiology and Management”. Curr. Pharm. Des., 2016, 22, 5603.
doi: 10.2174/1381612822666160720151243 pmid: 27510481
[8] Harish N., Kannan L., Ganesh Balaji R., Jeyraveena N.M., Harshitha ., et al.: “A study to find out the prevalence and associated risk factors of Hirsutism in polycystic ovarian syndrome and non-polycystic ovarian syndrome individuals”. Indian Journal of Applied Research, 2017, 7, 65-68.
[9] Hahn S., Haselhorst U., Tan S., Quadbeck B., Schmidt M., Roesler S., et al.: “Low serum 25-hydroxyvitamin D concentrations are associated with insulin resistance and obesity in women with polycystic ovary syndrome”. Exp. Clin. Endocrinol. Diabetes, 2006, 114, 577.
doi: 10.1055/s-2006-948308 pmid: 17177140
[10] Wehr E., Pilz S., Schweighofer N., Giuliani A., Kopera D., Pieber T.R., Obermayer-Pietsch B., et al.: “Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome”. Eur. J. Endocrinol., 2009, 161, 575.
doi: 10.1530/EJE-09-0432 pmid: 19628650
[11] Mahmoudi T.: “Genetic variation in the vitamin D receptor and polycystic ovary syndrome risk”. Fertil. Steril., 2009, 92, 1381.
doi: 10.1016/j.fertnstert.2009.05.002
[12] Ramagopalan S.V., Heger A., Berlanga A.J., Maugeri N.J., Lincoln M.R., Burrell A., et al.: “Chip-seq defined genome-wide map of vitamin D receptor binding: associations with disease and evolution. Genome Res., 2010, 20, 1352.
doi: 10.1101/gr.107920.110 pmid: 20736230
[13] Lerchbaum E., Obermayer-Pietsch B.: “Vitamin D and fertility-a systematic review”. Eur. J. Endocrinol., 2012, 166, 765.
doi: 10.1530/EJE-11-0984
[14] Patra S.K., Nasrat H., Goswami B., Jain A.: “Vitamin D as a predictor of insulin resistance in polycystic overian syndrome”. Diabetes Metab Syndr., 2012, 6, 146.
doi: 10.1016/j.dsx.2012.09.006 pmid: 23158978
[15] Thomson R.L., Spedding S., Buckley J.D.: “Vitamin D in the aetiology and management of polycystic ovary syndrome”. Clin. Endocrinol., 2012, 77, 343.
doi: 10.1111/j.1365-2265.2012.04434.x
[16] Kinuta K., Tanaka H., Moriwake T., Aya K., Kato S., Seino Y.: “Vitamin D is an important factor in estrogen biosynthesis in both female and male gonads”. Endocrinol., 2000, 141, 1317.
doi: 10.1210/endo.141.4.7403
[17] Fr D.D., Tarlatzis R.:“Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome”. Fertil. Steril., 2004, 81, 19.
doi: 10.1016/j.fertnstert.2003.10.004
[18] Forrest K.Y.Z., Stuhldreher W.L.: “Prevalence and correlates of vitamin D deficiency in US adults”. Nutr. Res., 2011, 31, 48.
doi: 10.1016/j.nutres.2010.12.001
[19] Pereira-Santos M., Costa P.R., Assis A.M., Santos C.A., Santos D.B.: “Obesity and vitamin D deficiency: systematic review and metaanalysis”. Obes. Rev., 2015, 16, 341.
doi: 10.1111/obr.12239 pmid: 25688659
[20] Wortsman J., Matsuoka L.Y., Chen T.C., Lu Z., Holick M.F.: “Decreased bioavailability of vitamin D in obesity”. Am. J. Clin. Nutr., 2000, 72, 690.
doi: 10.1093/ajcn/72.3.690 pmid: 10966885
[21] Merhi Z., Doswell A., Krebs K., Cipolla M.: “Vitamin D Alters Genes Involved in Follicular Development and Steroidogenesis in Human Cumulus Granulosa Cells”. J. Clin. Endocrinol. Metabolism, 2014, 99, 1137.
[22] Hanif F., Ilyas N., Qamar T.: “Association of vitamin d deficiency with hyperandrogenism in females with polycystic ovarian syndrome”. Int. J. Clin. Biomed. Res., 2018, 4, 31.
doi: 10.5455/ijcbr.
[23] Nestler J.E., Powers L.P., Matt D.W., Steingold K.A., Plymate S.R., Rittmaster R.S., et al.: “A direct effect of hyperinsulinemia on serum sex hormone-binding globulin levels in obese women with the polycystic ovary syndrome”. J. Clin. Endocrinol. Metab., 1991, 72, 83.
doi: 10.1210/jcem-72-1-83 pmid: 1898744
[24] Selimoglu H., Duran C., Kiyici S., Ersoy C., Guclu M., Ozkaya G., et al.: “The effect of vitamin D replacement therapy on insulin resistance and androgen levels in women with polycystic ovary syndrome”. J. Endocrinol. Invest., 2010, 33, 234.
doi: 10.1007/BF03345785 pmid: 19820295
[25] Banaszewska B., Spaczyński R.Z., Pelesz M., Pawelczyk L.: “Incidence of elevated LH/FSH ratio in polycystic ovary syndrome women with normo- and hyperinsulinemia”. Rocz. Akad. Med. Bialymst., 2003, 48, 131.
pmid: 14737959
[26] Broekmans F.J., Knauff E.A.H., Valkenburg O., Laven J.S., Eijkemans M.J., Fauser B.C.J.M.: “PCOS according to the Rotterdam consensus criteria: change in prevalence among WHO-II anovulation and association with metabolic factors”. BJOG, 2006, 113, 1210.
doi: 10.1111/j.1471-0528.2006.01008.x pmid: 16972863
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