09/30/26

Vitamin D After Menopause: Do You Need Supplements? #246

Vitamin D After Menopause: Do You Need Supplements?

Since my hip replacement, I’ve been thinking more about my bones and what my body needs as I recover.

I already have osteopenia, and vitamin D supplements have been part of my routine for years. When I started consulting in the early 2000s, there was enormous excitement about vitamin D. Could it help our bones, mood, energy and even weight?

I’ve been looking at the research again, and my views are becoming more selective. Adequate vitamin D matters. But does taking extra always help?

What does vitamin D do?

Vitamin D helps us absorb calcium and phosphorus, which are needed for healthy bones. Severe deficiency can cause rickets in children and osteomalacia—poorly mineralised, softened bones—in adults.

Osteomalacia is different from osteoporosis, which involves reduced bone strength and increased fracture risk.

Vitamin D’s active form also acts as a hormone. UVB rays from sunlight start its production in our skin, and processing in the liver and primarily the kidneys produces the active form.

Vitamin D receptors are found in many tissues. That explains why researchers have investigated roles beyond bone health, including muscle and immune function.

Why vitamin D matters after menopause

Declining oestrogen accelerates bone loss, making bone health particularly important during and after menopause.

Adequate vitamin D supports normal calcium absorption and bone mineralisation. But extra vitamin D does not replace appropriate exercise, sufficient nutrition or osteoporosis treatment when needed.

Dr Stacy Sims highlights adequate nutrition—including calcium and vitamin D—as part of supporting women’s bones, muscles and performance. That fits with how I think about recovery: nourishment, progressive rehabilitation and attention to genuine shortfalls.

What did the large vitamin D trials find?

The VITAL research programme involved nearly 26,000 older adults.

Taking 2,000 IU of vitamin D daily did not reduce fractures overall. Importantly, participants were not selected because they had vitamin D deficiency, osteoporosis or low bone density. The results should not be interpreted as a reason to leave deficiency untreated.

A related study involving more than 18,000 adults did not find that supplementation prevented depression or improved mood over approximately five years.

However, the autoimmune-disease study produced a promising result: a 22% lower relative risk among participants allocated to vitamin D.

The actual numbers help put that headline into perspective: 123 confirmed cases in the vitamin D group versus 155 in the placebo group—an absolute difference of approximately 0.25 percentage points. Later follow-up found that the benefit was no longer evident two years after the trial supplements stopped.

Different outcomes produced different findings. Vitamin D deserves a more careful conversation than simply calling it a miracle or a waste of money.

Can vitamin D help with fatigue or weight loss?

One of my clients had a low vitamin D result, felt awful and reported that her energy returned after starting supplementation.

I’m pleased she feels better. Her experience is worth hearing, while recognising that it cannot tell us whether everyone will benefit.

Some research suggests supplementation can improve fatigue in people with low vitamin D. That is different from recommending it as an energy supplement for anyone who feels tired.

Likewise, lower vitamin D levels and higher body weight often occur together, but supplementation has not consistently produced weight loss. A connection between two things does not necessarily mean changing one will change the other.

What about gut health and immunity?

Dr Will Bulsiewicz often discusses the close relationship between gut health and the immune system.

Research suggests vitamin D signalling helps maintain the intestinal barrier and regulate immune responses. These are interesting biological roles, but they do not establish that taking extra vitamin D improves everyone’s gut health.

A nutrient can be essential without extra supplementation providing additional benefits.

Sunshine, seasonal mood and vitamin D

Are we sometimes confusing the benefits of being outdoors with the benefits of the “sunshine vitamin”?

UVB on our skin helps us produce vitamin D. Daylight reaching our eyes helps regulate our body clock. A capsule cannot do both jobs.

Seasonal affective disorder is not simply a vitamin D shortage. Low vitamin D may coexist with seasonal depression, but supplementation studies have produced mixed results.

Health NZ recommends daily outdoor activity with face, arms and hands exposed where appropriate:

• September–April: early morning or late afternoon, before 10 am or after 4 pm.

• May–August: around midday.

Use sun protection whenever the UV index is three or higher. That threshold is a sun-protection signal, not a switch below which vitamin D production becomes impossible.

Can we get vitamin D from food?

Sources include oily fish, egg yolks, UV-exposed mushrooms and some fortified foods.

For people eating plant-based diets, check plant-milk and other food labels for added vitamin D. Calcium fortification does not automatically mean vitamin D has been added.

Fortified foods are less widely available in New Zealand than in some countries, and getting enough from food alone can be difficult.

Where have I landed on supplementation?

I still support correcting low vitamin D. I’m less convinced that everyone needs extra for better mood, energy, weight loss or stronger bones.

For women with low bone density, limited sun exposure, an absorption problem or a previous low result, discussing vitamin D adequacy with a healthcare professional makes sense. Testing may help in some circumstances; it is not routinely needed for every healthy postmenopausal woman.

My hip replacement has prompted me to review my own regimen. Surgery itself does not establish that extra vitamin D will speed recovery.

The question I’m asking is: what do I need, and does what I’m taking meet that need?

Changing our views as we learn more is part of looking after ourselves.

Listen to this week’s Outlook for Life podcast: https://www.outlookforlife.com/podcasts/outlook-for-life-weight-loss-nutrition-healthy-ageing-for-women-over-50/episodes/2149262215

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If you take prescribed vitamin D, discuss any changes with your healthcare professional.