Specific figures vary but it has been estimated that anywhere between 80-95% of the western female population experience premenstrual syndrome (PMS) to some level with up to about 35% seeking some kind of medical help. Premenstrual syndrome, or PMS, is the presence of physical and/or psychological symptoms 1-2 weeks prior to the start of your period (menstruation). These symptoms will typically be relieved within 2 days of the start of your period.
Over 150 different PMS symptoms have been described in various sources of literature! These can range from irritability, anxiety, mood swings and depression to fluid retention, breast tenderness, stomach bloating and headaches. Symptoms may vary in nature and intensity between monthly cycles. PMS is complex and varied, affecting individual women in different ways, it is definitely not predictable or easy to categorise.
There is no clear or definitive cause of PMS. This accounts for the number and variety of symptoms that occur in women and also makes treatment difficult. It seems that there may be many plausible factors at play including:
- Hormones
- Neurotransmitters (brain chemicals – a group of hormones formed within nerve cells)
- Prostaglandins (a type of fatty acid produced by the body that act in a similar way to hormones)
Diet and lifestyle
There is a lot that I could write about PMS and nutrition and I hope to revisit the topic in the very near future but today I wanted to look at the role that calcium supplementation may play in the treatment/prevention of this distressing condition.
Calcium has been implicated by many scientists as being important in PMS. Women who consume more calcium from their diet seem less likely to suffer from PMS than women who consume little calcium (1) and low levels of calcium in the blood have been linked to an increased likelihood of suffering with PMS (2). A number of well carried out clinical studies have found that calcium supplements can relieve PMS symptoms in women (3,4,5).
Recent evidence published this year (6,7,8) has also found that calcium supplementation is very useful in the treatment of PMS. One of these studies (8) compared the effects of hormone therapy (dydrogesterone) with a calcium and vitamin D supplement in women with severe PMS and found that the nutritional supplement was as effective as the dydrogesterone for the treatment of PMS. This was a well designed trial which involved over 150 women. The women were randomly assigned to take a tablet containing either 5 mg of dydrogesterone, 500 mg of calcium plus 200 mg of vitamin D, or a placebo twice daily from the 15th to the 24th day of the cycle for 2 cycles. Treatment with dydrogesterone or calcium plus vitamin D decreased symptom severity in a similar way. The authors conclude that “Treatment with dydrogesterone or calcium plus vitamin D had a similar effect on symptom severity in women with PMS”.
In the UK it is currently recommended that women aim to include 700mg of calcium per day into their daily diet. In the USA, however the recommendation is 1000mg daily. The National Diet and Nutrition Survey (NDNS) of adults aged 19-64 (9) found that many women in the UK are not achieving adequate daily calcium intakes. Calcium plays a role in hormone and neurotransmitter responses in the body. This may account for some of the benefits that women with PMS gain from calcium supplementation, especially mood and pain related symptoms. The hormone fluctuations which occur in PMS may also interfere with the way that calcium is regulated in the body causing low circulating levels which may lead to worsened PMS symptoms.
If you suffer with PMS it might be worth trying 500mg calcium daily for 3 menstrual cycles, as well as trying to boost your dietary calcium intakes, to see if you get any relief. Good dietary sources of calcium include:nuts, especially almonds, and seeds especially sesame seeds, milk and dairy products, dried fruit (especially figs), canned fish and broccoli (The calcium found in plant foods such as pulses and wholegrain cereals does not represent a good source of available calcium – this is because these sources contain phytates which lock up the calcium and limit the amount that the body can absorb)
If you decide to take supplemental calcium it is always advisable to take magnesium as well, since the two minerals work closely together in the body and a balance is needed, magnesium deficiency has also been implicated in PMS. For every 500mg calcium 250mg of magnesium is advised. Vitamin D is essential for the efficient absorption of calcium into the body and also regulates blood levels of calcium. Some studies suggest that blood vitamin D levels are lower in women with PMS and that women with the lowest vitamin D intakes are more at risk of suffering from PMS than women with the highest intakes (10). Many supplements are available that combine these three nutrients.
For information on PMS and support please visit National association for premenstrual syndrome (NAPS) website. NAPS is the only advocacy group in the world promoting the interest of PMS sufferers
1. Bertone-Johnson ER et al. 2005. Calcium and vitamin D and risk of incident premenstrual syndrome. Arch Intern Med. 165:1246-1252.
2.Shamberger RJ. 2003. Calcium, magnesium and other elements in the red blood cells and hair of normals and patients with premenstrual syndrome. Viol Trace Elem Res. 94:123-129.
3.Thys-Jacob S et al. 1989. Calcium supplementation in premenstrual syndrome: a randomised crossover trial. J Gen Intern Med. 4:183-189.
4.Penland, JG. Johnson, PE. 1993. Dietary calcium and manganese effects on menstrual cycle symptoms. Am J Obstet Gynecol. 168:1417-1423
5.Thys-Jacobs, S et al. 1998. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Premenstrual Syndrome Study Group. Am J Obstet Gynecol. 179:444-452
6. Whelan AM et al. 2009. Herbs, Vitamins and Minerals in the Treatment of Premenstrual Syndrome: A Systematic Review. Can J Clin Pharmacol. 16(3):e407-e429.
7. Ghanbari Z et al. 2009. Effects of calcium supplement therapy in women with premenstrual syndrome. Taiwan J Obstet Gynecol. 48(2):124-9.
8. Khajehei M et al. 2009. Effect of treatment with dydrogesterone or calcium plus vitamin D on the severity of premenstrual syndrome. Int J Gynaecol Obstet. 105(2):158-61.
9.Henderson L et al. 2003. The National Diet and Nutrition Survey: Adults aged 19-64 years. HMSO London.
10.Bertone-Johnson, ER. Hankinson, SE. Benedich, A. et al. 2005. Calcium and vitamin D and risk of incident premenstrual syndrome. Arch Intern Med. 165:1246-1252
Written by Ani Kowal
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