High Intake of Calcium, Vitamin D May Reduce the Risk of Premenstrual Syndrome

Laurie Barclay, MD

June 14, 2005

June 14, 2005 — High intake of calcium and vitamin D may reduce the risk of premenstrual syndrome (PMS), according to the results of a case-control study published in the June 13 issue of the Archives of Internal Medicine.

"PMS is one of the most common disorders of premenopausal women," write Elizabeth R. Bertone-Johnson, ScD, from the University of Massachusetts in Amherst, and colleagues. "Studies suggest that blood calcium and vitamin D levels are lower in women with PMS and that calcium supplementation may reduce symptom severity, but it is unknown whether these nutrients may prevent the initial development of PMS."

The authors conducted a case-control study nested within the prospective Nurses' Health Study II cohort, using a subset of women aged 27 to 44 years and free of PMS at baseline in 1991. This cohort included 1,057 women who developed PMS for 10 years of follow-up and 1,968 women who reported no diagnosis of PMS and no or minimal menstrual symptoms. Using a food frequency questionnaire, the investigators measured intake of calcium and vitamin D in 1991, 1995, and 1999.

Compared with women in the lowest quintile of total vitamin D intake (median, 112 IU/day), those in the highest quintile (median, 706 IU/day) had a relative risk (RR) of PMS of 0.59 (95% confidence interval [CI], 0.40 - 0.86; P = .01 for trend), after adjustment for age, parity, smoking status, and other risk factors.

Calcium intake from food sources was also inversely related to PMS. Compared with women with low intake (median, 529 mg/day), women with the highest intake (median, 1,283 mg/day) had a relative risk of 0.70 (95% CI, 0.50 - 0.97; P = .02 for trend). Intake of skim or low-fat milk was also associated with a lower risk of PMS (P < .001).

Study limitations include difficulty in differentiating between PMS cases and noncases, inability to use prospective symptom charting to identify PMS cases, possible recall bias or symptom misreport, and inability to evaluate the effect of high doses of supplemental calcium on the risk of developing PMS.

"A high intake of calcium and vitamin D may reduce the risk of PMS," the authors write. "Large-scale clinical trials addressing this issue are warranted. Given that calcium and vitamin D may also reduce the risk of osteoporosis and some cancers, clinicians may consider recommending these nutrients even for younger women."

GlaxoSmithKline Consumer Healthcare, the National Cancer Institute, National Institutes of Health, and Department of Health and Human Services supported this study. GlaxoSmithKline, the maker of Tums and Os-Cal calcium supplements, employs one of the authors.

Arch Intern Med. 2005;1246-1252

Reviewed by Gary D. Vogin, MD


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