Use of Estrogen-Containing Contraception Is Associated With Increased Concentrations of 25-Hydroxy Vitamin D

Abstract

Context: Small studies suggest exogenous estrogen may improve vitamin D status, but the etiology is unclear because women who use hormones may make lifestyle choices that differentially affect vitamin D status.

Objective: Our objective was to investigate the association between use of hormonal contraception and 25-hydroxy-vitamin D (25(OH)D).

Design: We used linear regression modeling of cross-sectional data to estimate percent change in season-adjusted serum 25(OH)D with estrogen use after adjustment for other factors.

Setting: At the enrollment clinic visit (2010-2012) into a cohort study of uterine fibroids, each subject provided a blood sample, had anthropomorphic variables and skin reflectance measured, and answered questionnaires on demographics, dietary and supplement intake, contraceptive use, reproductive and medical history, and behaviors.

Participants: A total of 1662 African American women, community volunteers, 23-34 years old, living in the Detroit, Michigan, area were included.

Interventions: None.

Main outcomes and measures: Serum 25(OH)D was measured.

Results: Serum 25(OH)D concentrations were low (70% <20 ng/ml). Current use of an estrogen-containing contraceptive was associated with a 20% (95% confidence interval: 14-27) increase in 25(OH)D after adjustment. There was no increase in 25(OH)D among participants who had used estrogen in the past, but were not current users, indicating that results were unlikely to be due to unmeasured confounding by factors related to contraceptive choice.

Conclusions: The increase in 25(OH)D with use of estrogen-containing contraceptives raise mechanistic questions regarding the biological pathways involved, and highlights the need for studies that examine possible endogenous estrogen effects on vitamin D.

Figure 1.

Distribution of measured serum 25(OH)D (ng/ml) among 1662 young African American women from Detroit, Michigan, stratified by vitamin supplement use (top and bottom panels) and use of estrogen-containing contraception at the time of blood sample. Supplement and no estrogen, N = 561; supplement and estrogen, N = 110; no supplement and no estrogen, N = 875; no supplement and estrogen, N = 116.