Table 4.

Characteristics of the studies included in the systematic review

Author	Region	Design	Sample size	Age (yr)	Menarche age (yr)	BMI (kg/m2)	Duration of each menstrual dysmenorrhea (day)	Duration of menstruation cycle (day)	Intervention	Control	Pain intensity		Serum level of Vit D		Assessment tools	Definition	Results	Quality
											Baseline	After	Baseline	After
Rahnemaie et al. [22]	Iran	Cross sectional	143	22.52±2.97	13.46±1.03	23.53±3.70	2.43±1.32	NR	-	-	6.91±1.59	-	24.45±11.85 ng/mL	-	VAS	≥4	Not significant	21a)
Zeynali et al. [25]	Iran	Cross sectional	372	22.40±2.01	13.21±1.44	24.03±3.07	2.18±1.04	6.09±1.11	-	-	24.73% severe 53.22% moderate 22.04% mild	-	37.09% insufficiency 36.55% moderate deficiency 26.34% severe deficiency	-	VAS	≥1	Significant	20a)
Karacin et al. [18]	Turkey	Case control	368	20.80	12.15	22.26	NR	5.1	-	-	7.30±1.40	-	7.10±3.80 ng/mL	-	VAS	1–10	Significant	20a)
Abdul- Razzak et al. [26]	Jordan	Cross sectional	56	21.90±2.76	13.60±1.40	NR	NR	NR	-	-	60.7% very severe: 8.73±1.00 39.3% severe: 7.53±1.23	-	9% deficient 80% insufficient 11% normal	-	NRS	0–10	Not significant	19a)
Kucukceran et al. [27]	Turkey	Quasi experiment	100	20.50	13.13	21.42	2.33	5.86	Insufficient (21–29 ng/mL): 8–7 drops of Vit D3/day Deficient (10–20 ng/mL): 15–9 drops of Vit D3/day Severely deficient (<10 ng/mL): 16–23 drops of Vit D3/day		7.00±2.00	4.10±1.60	13.90±6.10	31.10±3.90	VAS	0–10	Significant	18b)
									Duration: 2 mon Maintenance therapy: (6 drops of Vit D3 per day) for 1 mon
Bahrami et al. [28]	Iran	Quasi experiment	897	14.72±1.50	12.57±1.19	NR	NR	71.8% normal cycle	High-dose Vit D supplements (as 50,000 IU/wk of cholecalciferol)	-	9.5% mild 20.8% moderate 18.1% severe 12.3% very severe 8.1% worst	11% mild 19% moderate 16.2% severe 9% very severe 7.8% worst	22.70±22.60 nmol/mL	89.90±38.30 nmol/mL	VIPS	0–5	Significant	18b)
									Duration: 1 capsule over 9 wk
Pakniat et al. [20]	Iran	RCT	200	22.44±1.92	12.55±1.00	21.62±3.15	2.60±0.89	5.20±0.95	Ginger capsules500 mg per day+mefenamic acid 250 mg capsule 1,000 mg Vit D+mefenamic acid 250 mg 100- unit Vit E+mefenamic acid 250 mg	Placebo+ mefenamic acid 250 mg	7.13±0.80	4.93±1.48	-	-	VAS	0–10	Significant	22b)
									Drop on: 2 day before the onset of menstrual flow Drop out: 3 day after the onset of menstrual flow Duration: 5 day in a cycle
Ayşegül et al. [29]	Turkey	RCT	142	22.00	23.40±5.60	NR	NR	NR	667 UI of Vit D/day 200 IU of Vit E/day	400 mg ibuprofen twice a day	8.50±1.20	4.90±2.40	-	-	VAS	1–10	Vit D more significant	20b)
									Drop on: 2 days before the expected date of menstruation Drop out: first 3 day of menstruation Duration: 5 day in 2 consecutive cycles
Lama et al. [30]	Saudi Arabia	RCT	22	13–40	NR	NR	NR	NR	50,000 IU Vit D/wk+their usual analgesics regimen Duration: 8 wk	Their usual analgesics regimen	7.80	3.60	30.10±13.40 nmol/L	80.20±14.30 nmol/L	VAS	0–10	Significant	20b)
Zarei et al. [19]	Iran	RCT	85	23.66	13.10	21.83	NR	NR	1,000 mg of calcium carbonate+5,000 units of Vit D/day 1,000 mg of calcium carbonate/day	Placebo	Ca+Vit D: 7.7±1.2 Ca: 7.7±1.3	Ca+Vit D: 5.0±2.6 Ca: 3.9±2.5	NR	NR	VAS	0–10	Significant for calcium	22b)
									Drop on: from 15th cycle day Drop out: until menstrual pain disappearance Duration: 3 cycles
Mehrpooya et al. [31]	Iran	RCT	80	25.24	NR	23.16	NR	5.80	Ibuprofen 400 mg as needed plus 1,000 mg omega-3	Ibuprofen 400 mg as needed plus 1,000 mg calcium	Omega-3: 6.67+1.80 Calcium: 7.50+2.70	Omega-3: 2.30+0.63 Calcium: 3.20+1.50	-	-	VAS	≥4	Significant	20b)
									Drop on: every day in the first cycle and 8 day of second and third cycle Drop out: till 2 day after initiation of menstruation Duration: 3 cycles
Charandabi et al. [32]	Iran	RCT	61	21.00±2.20	12.60	22.30±3.00	NR	6.2	300 mg magnesium+600 mg calcium carbonate 600 mg calcium carbonate	Placebo	Ca+Mg: 6.00±2.30 Ca: 5.20±2.00	Ca+Mg: 3.90±2.10 Ca: 4.20±2.00	-	-	VAS	≥5	Significant	20b)
									Drop on: 1 pill a day, from the day 15th of their cycle Drop out: till the day with no menstrual pain Duration: 2 cycles
Fareena Begum et al. [33]	India	RCT	50	21.18	62% earlier onset of menarche	88% normal 12% overweight	NR	NR	Single oral dose of Vit D3 3,00,000	Placebo	8.76±0.97	3.56±0.76	17.84±10.1 ng/mL	34.70±8.10 ng/mL	VAS	0–10	Significant	22b)
									Followed up: for the next 2 and 4 mon
Moini et al. [2]	Iran	RCT	50	26.36	12.72	22.95	NR	NR	50,000 IU oral vit D/wk Duration: 8 wk	Placebo	7.80	2.80	9.69±5.09 ng/mL	55.44±6.02 ng/mL	VAS	0–10	Significant	22b)
Ataee et al. [34]	Iran	RCT	54	NR	NR	NR	NR	NR	Single high dose of oral cholecalciferol (300 000 IU)	Placebo	7.53±1.85	3.77±1.77	7.28±3.64 ng/mL	-	VAS	0–10	Significant	22b)
									Drop on: 5 day before the beginning of menstruation Drop out: beginning of menstruation Duration: 2 cycles
Zangene et al. [35]	Iran	RCT	54	22.43	NR	21.03	NR	NR	Single high dose of oral cholecalciferol (300 000 IU)	Placebo	7.53±1.85	3.77±1.78	7.37 ng/mL	NR	VAS	0–10	Significant	20b)
									Drop on: 5 day before menstruation Drop out: onset of menstruation Duration: 3 cycles
Lasco et al. [36]	Italy	RCT	40	26.65	NR	21.56	NR	NR	Single oral dose of cholecalciferol (300,000 IU/1 mL	Placebo	5.85±2.00	3.50±1.27	27.19±7.53 ng/mL	-	VAS	0–10	Significant	22b)
									Drop on: 5 day before the putative beginning of their next menstrual cycle Drop out: onset of menstruation Duration: 2 mon

BMI, body mass index; Vit, vitamin; VAS, visual rating scale; NRS, numeric rating scale; RCT, randomized clinical trial; NR, not reported; VIPS, verbal intensity pain scale.

^a)By Strengthening the Reporting of Observational Studies in Epidemiology (STROBE);

^b)By Consolidated Standards of Reporting Trials (CONSORT).