This cross-sectional study was conducted in the obstetrics and Gynecology Department of Suez Canal University Hospital. Postmenopausal women were divided into two groups regarding their levels of vitamin D: insufficient and normal (sufficient). The first group with insufficient serum 25(OH) D concentrations (i.e., ≥ 20 to < 30 ng/mL) (n = 88) and 2nd group with sufficient vitamin D levels (n = 80) [10]. Women were recruited according to inclusion and exclusion criteria. Inclusion criteria were (a) women aged 50–70 years, (b) not taking hormonal therapy, and (c) reported menopausal symptoms. Exclusion criteria were (a) women already participating in a diet or exercise intervention, (b) history of bariatric surgery, (c) history of hysterectomy/oophorectomy, (d) women using medications known to impact hot flushes and/or weight (hormone therapy, oral contraceptives, gabapentin, selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors (SSRI/SNRIs), selective estrogen receptor modulators (SERMS), clonidine, antipsychotics, steroids, weight loss medications, chemotherapy), (e) women with possible medical conditions associated with vitamin D deficiency (following a malabsorption diet, colitis, pancreatic disease, current gall bladder problems, and liver disease), and (f) women with conditions that would influence vitamin D levels (high blood calcium or incident cancer).
Eligible women were evaluated thoroughly by proper history taking including any history of medical illness (diabetes, hypertension, and thyroid disease). Women were asked to complete the menopause rating scale. Women were interviewed in a private room. A researcher was available for help.
The severity of symptoms was classified as mild, moderate, and severe by the menopause rating scale (MRS). The scale consists of 11 symptoms in 3 domains:
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Somato-vegetative: including vasomotor symptoms (hot flushes, heart discomfort, sleep problems) and musculoskeletal symptoms (joint and muscular discomfort) (domain scores 0–16)
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Psychological symptoms (depressed mood, irritability, anxiety, physical, and mental exhaustion) (domain scores 0–16)
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Urogenital symptoms (sexual problems, bladder problems, and vaginal dryness) (domain scores 0–12). Each symptom is scored from none (scored as 0) to very severe (score as 4), giving a score range from 0 to 44. Summation scores for severity were classified as [11] Table 1:
All participants provided a 12-h fasting of a 5-mL sample of the blood, which was processed within 1 h of collection by centrifugation, and serum was collected and stored at − 70 ℃. Participants were instructed to refrain from alcohol (48 h) and vigorous exercise (24 h) before clinic appointments. The relation between vitamin D levels and menopausal symptoms was evaluated.
Statistical analysis
The collected data was revised, coded, tabulated, and introduced to a PC using the Statistical Package for Social Science (SPSS 15.0.1 for windows; SPSS Inc, Chicago, IL, 2001). Data were presented as the mean and standard deviation (± SD) for quantitative parametric data, and median and interquartile range for quantitative nonparametric data. Frequency and percentage were used for presenting qualitative data. Suitable analysis was done according to the type of data obtained. Student T test or Mann–Whitney test was used to analyze quantitative data while chi-square test and Fisher’s exact test were used to analyze qualitative data: P value: level of significance, P > 0.05: non-significant (NS), P < 0.05: significant (S), and P < 0.01: highly significant (HS).