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While hormonal therapies show significant improvement, non\u2010hormonal therapies are considered the first\u2010line for breast cancer women. However, vaginal hormonal therapies are unavailable in all countries, particularly developing countries such as the middle east, and there are no studies that have tested these therapies in women either with a history of breast cancer or those taking endocrine therapies for their cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We conducted this meta\u2010analysis to evaluate the effectiveness of vitamin D (VD), whether alone or in combination with other therapies, in managing VVA and SI in PMW.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search Strategy<\/jats:title><jats:p>A systematic literature search was undertaken on four electronic databases (Web of Science, PubMed, Cochrane, and Scopus) from inception until June 2023.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection Criteria<\/jats:title><jats:p>The randomized controlled trials (RCTs) that used the vaginal maturation index (VMI) and vaginal pH to measure VVA and vaginal dryness and the female sexual function index (FSFI) to measure SI were included in the meta\u2010analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Results<\/jats:title><jats:p>Eight RCTs (608 PMW) were included, and 222 were assigned to the VD arm. For the oral VD subgroup, there was no statistically significant improvement in the mean difference (MD) of VMI (MD \u20137.62, 95% confidence interval [CI]: \u221223.84, 8.59). However, VMI's topical VD subgroup was statistically significant (25.16; 95% CI: 18.74, 31.59). For topical form, the total FSFI score (0.24; 95% CI: \u22121.72, 2.20) and all FSFI domains did not demonstrate statistically significant improvement except arousal (0.56; 95% CI: 0.12, 1.00). Vaginal pH's oral VD subgroup showed statistically significant improvement (\u22120.27, 95% CI: \u22120.50, \u22120.05) compared to the topical VD. Topical VD subgroup (24.45; 95% CI: 7.14, 41.77) showed a statistically significant increase of vaginal superficial cells, in contrast to the oral VD subgroup (3.25; 95% CI: \u22125.44, 11.96).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Topical VD showed significant improvements in VMI and the arousal subscale of FSFI, whereas oral VD had no substantial improvement except in vaginal pH. VD alone is not a sufficient alternative to other available treatments, and further RCTs are needed to evaluate its effectiveness without any combination with other drugs.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.70011","type":"journal-article","created":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T13:29:16Z","timestamp":1739539756000},"page":"64-81","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The effectiveness of vitamin D as an alternative to <scp>FDA<\/scp>\u2010approved treatment and other therapies for managing vulvovaginal atrophy and sexual inactivity in postmenopausal women. A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"170","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6544-6738","authenticated-orcid":false,"given":"Eman","family":"Youssef","sequence":"first","affiliation":[{"name":"Faculty of Pharmacy Alexandria University  Alexandria Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7734-2556","authenticated-orcid":false,"given":"Mostafa Saad","family":"Badie","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Al\u2010Azhar University  Cairo Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7223-5006","authenticated-orcid":false,"given":"Doaa","family":"Ismail","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Zagazig University  Zagazig Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7508-4120","authenticated-orcid":false,"given":"Aliaa","family":"Gamal","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Department Faculty of Deraya University  Minia Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7749-3154","authenticated-orcid":false,"given":"Hala Mohamed","family":"Eldamanhoury","sequence":"additional","affiliation":[{"name":"Consultant Gynecology New Cairo Hospital  Cairo Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,2,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2022.04.008"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-2236"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.839005"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/GME.0000000000000319"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2020.07.001"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/frph.2021.779398"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/gme.0000000000000329"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm5020050"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/metabo11040255"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1515\/hmbci-2015-0051"},{"issue":"12","key":"e_1_2_11_12_1","first-page":"805","article-title":"Immunohistochemical detection of the 1,25\u2010dihydroxy vitamin D receptor in the human vagina","volume":"12","author":"Kim TH","year":"2014","journal-title":"Iran J Reprod Med"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2004.02.008"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/molecules28186605"},{"key":"e_1_2_11_15_1","unstructured":"National Center for Biotechnology Information.PubChem Compound Summary for CID 5280793 Ergocalciferol.https:\/\/pubchem.ncbi.nlm.nih.gov\/compound\/Ergocalciferol"},{"key":"e_1_2_11_16_1","unstructured":"National Center for Biotechnology Information.PubChem Compound Summary for CID 5280795 Cholecalciferol.https:\/\/pubchem.ncbi.nlm.nih.gov\/compound\/Cholecalciferol"},{"key":"e_1_2_11_17_1","unstructured":"National Center for Biotechnology Information.PubChem Compound Summary for CID 5280453 Calcitriol.https:\/\/pubchem.ncbi.nlm.nih.gov\/compound\/Calcitriol"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2021.06.006"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2023.02.025"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.4103\/jfmpc.jfmpc_1364_22"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/1751-486x.12216"},{"key":"e_1_2_11_22_1","unstructured":"Vulvovaginal Atrophy \u2013 Department of Obstetrics and Gynecology Faculty of Medicine Chiang Mai University. 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