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Calcium and Premenstrual Syndrome
Calcium is universally recommended for women with PMS and rightly so. This mineral has been conclusively proven to be involved in PMS and also effective in the management of the syndrome. Calcium deficiency does not only raise the risk of osteoporosis in women; it can also predispose them to PMS. Studies also show that calcium supplements can be used to treat and prevent PMS. But how does calcium deficiency cause PMS and how does calcium supplementation help the condition? What is the recommended dose of calcium supplement when used in PMS treatment? This article answers those questions and also discusses the roles of vitamin D and magnesium in the treatment of PMS with calcium.
Calcium is one of the essential minerals in humans. Although it is most commonly known as the mineral required for healthy bones, calcium has a lot more roles in the body.
Calcium is a cofactor for a number of enzymes especially those involve in blood clot formation. It is also important for proper muscle contraction, for signal transduction between cells and for the release of neurotransmitters in the neurons of the central nervous system.
The recommended daily intake of calcium for adult ranges from 1000 mg to 1200 mg.
Although milk is the traditional dietary source of calcium, the mineral can also be found abundantly in other foods including vegetables, nuts, seeds, beans and fortified foods.
Prolonged low calcium levels can cause calcium deficiency. The major presentations of calcium deficiency are increased risks of osteoporosis, rickets and blood clotting.
Calcium deficiency can result from diets poor in the mineral or malabsorption of the mineral. The absorption of calcium is heavily dependent on vitamin D status. Therefore, vitamin D deficiency can also cause calcium deficiency.
Vitamin D3 is converted to a bioactive metabolite known as calcitriol. Calcitriol functions as a hormone and promotes the release of intestinal proteins needed to drive calcium absorption.
The conversion of vitamin D3 to calcitriol depends on the parathyroid hormone. Therefore, hypoparathyroidism can also cause calcium deficiency.
Besides calcium-rich foods, calcium deficiency can also be treated with calcium supplements.
Studies show that calcium levels fluctuate in women according to the cyclic nature of their menstrual cycles. Serum calcium level is at its lowest during the luteal phase of the cycle.
However, vitamin D level also fluctuates along with calcium and this fluctuation is also associated with the menstrual cycle. Therefore, the height of the PMS represents a phase during which calcium absorption is at its lowest.
In addition, the hormonal changes that occur around the menstrual cycle can expose any underlying hypocalcemia.
Although dietary sources of calcium abound, a sizable proportion of the population still suffers from chronic hypocalcemia. The effects of long-term low calcium levels are usually masked but the changes in level of sex hormones can unmask hypocalcemia during the menstrual cycle.
It is known that ovarian hormones influence the metabolism of calcium (as well as vitamin D and magnesium, both of which are also important to PMS).
Estrogen, the chief female sex hormone, can lower the absorption of calcium from the intestines by inhibiting the activities of the parathyroid hormone.
Because ovarian hormones can affect calcium levels, PMS is sometimes described as a state of hypocalcemia. However, it is more accurately a state of calcium dysregulation that can be worsened by vitamin D deficiency.
Some experts believe that women with PMS lose more calcium that they can obtain from their diet.
Therefore, PMS symptoms such as depression and anxiety are believed to be the result of low calcium levels in the central nervous system. Low calcium level in the brain inhibits the release of neurotransmitters from brain cells.
Can PMS symptoms be managed by calcium supplementation? The overwhelming answer is yes.
Calcium is one of the very few natural supplements that have been conclusively proven to help women with PMS. Clinical trials show that calcium can provide relief for almost all the symptoms experienced during PMS.
But can calcium supplementation also help prevent PMS? Again, the answer is yes.
Studies show that women who eat more foods rich in calcium and vitamin D have lower risks of PMS.
Therefore, calcium is not only useful in the treatment of PMS but also in preventing the condition. This means that women can increase their calcium and vitamin D intakes in order to avoid and reduce the severity of PMS.
The established efficacy of calcium for treating and preventing PMS confirms that hypocalcemia is a major factor in the development of this syndrome.
Maintaining an optimal calcium level is, therefore, not only important for postmenopausal women hoping to lower their risks of osteoporosis but also for younger women suffering from PMS symptoms.
Calcium supplementation can be used to address PMS. Doses ranging from 1,000 – 1,500 mg per day are usually recommended for women with PMS. Such doses can help women meet their recommended daily intake of calcium and, therefore, prevent hypocalcemia.
Calcium supplementation may not produce significant improvements in PMS symptoms unless it is combined with magnesium and vitamin D supplements.
Both magnesium and vitamin D are closely involved in the absorption, metabolism and utilization of calcium in the body.
In addition, magnesium and vitamin D deficiencies are both linked to PMS.
Magnesium deficiency is a lot more common than calcium deficiency because half of the population do not get enough magnesium from their diets.
In addition, magnesium deficiency shares some symptoms with PMS. Magnesium deficiency can cause muscle cramps, fatigue and insomnia.
Chronic and severe magnesium deficiency can also cause hypoparathyroidism and calcium deficiency.
Studies also show that magnesium supplementation can provide relief for PMS. Magnesium reduces the pains, aches, bloating and mood changes associated with PMS. It can be used alone or combined with calcium.
To improve mood, magnesium boosts the release of the neurotransmitter, serotonin, in the brain.
Vitamin D is also commonly combined with calcium in the management of PMS although it can be given alone.
Besides promoting the absorption and utilization of calcium, vitamin D can also provide relief for the pain experienced by women with PMS.
To relieve PMS pain, vitamin D (as vitamin D3) blocks the generation of prostaglandins in the body.
However, the analgesic effect of vitamin D is only significant when the vitamin is given in high doses.
Unfortunately, high doses of vitamin D is not recommended because the increased absorption of calcium that results will cause hypercalcemia and also lower the absorption of other minerals.
Moderate doses of vitamin D3 may still help improve PMS symptoms. One study looked into the diet of over 3,000 women over a period of 10 years to find that those who ate foods with high vitamin D content had their PMS risk cut by 40%.
A 1995 study published in The Journal of Clinical Endocrinology and Metabolism investigated the fluctuation of hormones needed for regulating calcium levels in women during their menstrual cycles.
For the study, the researchers recruited 12 healthy women with 7 of them diagnosed with PMS while the other 5 acted as controls. During one menstrual cycle, the researchers drew fasting blood samples from these women at 6 different points during their ovulatory periods.
The results of their analysis showed that
The study confirms that fact that calcium and vitamin D levels fluctuate during the menstrual cycle. It also proves that this fluctuations are central to the appearance of PMS symptoms.
However, calcium and vitamin D levels fluctuate during the menstrual cycles of both women with and without PMS. The difference was the level of parathyroid hormone during the middle of the menstrual cycle.
Therefore, the researchers concluded that PMS may result from low calcium and vitamin D levels worsened by elevated parathyroid levels (hyperparathyroidism).
A number of studies have been done to determine the benefits of natural supplements in the management of PMS. A 2000 review published in the Journal of the American College of Nutrition found that the one supplement repeatedly and thoroughly proven to help with PMS was calcium.
In a 1998 study published in the American Journal of Obstetrics and Gynecology, a group of researchers investigated the efficacy of a calcium supplement in the treatment of PMS symptoms.
The researchers recruited 497 participants from 12 medical facilities in the US and then randomly assigned them to 1200 mg of elemental calcium (in the form of calcium carbonate supplement) or placebo every day for 3 menstrual cycles.
The results of the study showed that the benefits of calcium started to appear at the luteal phase of the second menstrual cycle.
By the 3rd cycle, the women who were given calcium experienced significant reduction in PMS symptoms.
The researchers, therefore, concluded that calcium carbonate is a simple and effective treatment of PMS.
Another 1989 study published in the Journal of General Internal Medicine also came to the conclusion that calcium supplementation is a simple, effective, safe and affordable treatment for PMS.
In this randomized, double-blind, crossover study, the researchers also used calcium carbonate (1,000 mg per day for 3 months). They found that 73% of the women preferred the calcium treatment to the placebo.
A 1999 review published in The Annals of Pharmacotherapy examined studies published between 1967 and 1999 to conclude that calcium supplementation can help with PMS symptoms. This review found doses between 1,200 and 1,600 mg/day to be effective and tolerable.
However, the reviewers recommended that women who regularly eat calcium-rich foods should take lower doses of the supplement in order to avoid hypercalcemia.
A 1994 study published in Headache: The Journal of Head and Face Pain discussed the treatment of 2 premenopausal women treated for PMS-related migraine headaches.
The author described that the women were given a combination of calcium and vitamin D. Within 2 months of this therapy, both women reported great relief in their migraine headaches as well as other PMS symptoms.
This study showed that a combination of calcium and vitamin D supplements was effective for treating PMS. However, calcium and vitamin D combinations can also be used to prevent PMS.
In a 2005 study published in the Archives of Internal Medicine, a group of researchers used data from the Nurses’ Health Study II cohort to determine the effect of calcium and vitamin D intakes on the risk of PMS.
By pooling data from over 3,000 women over a follow-up period of 10 years, the researchers found that a high intake of calcium and vitamin D lowered the risk of PMS. In their conclusion, the researchers advised that doctors should recommend calcium and vitamin D for younger women for the double purpose of lowering the risks of PMS and osteoporosis.
A 1998 study published in the journal, Fertility and Sterility, investigated the effects of sex steroid hormones on the serum levels of calcium and magnesium during the menstrual cycle.
For the study, the researchers recruited 6 women with children and 4 women who had never given birth. They also measured the levels of estrogen, progesterone and testosterone in these women during 5 (menstrual, early follicular, late follicular, ovulatory and luteal phases) stages of their cycles.
The results of the study showed that all of these women had the highest levels of magnesium during the early follicular phases of their cycles.
In addition, magnesium levels were decreased when progesterone and testosterone levels were raised.
Lastly, the results showed that the calcium-magnesium ratio was raised during the ovulatory and luteal phases.
These studies indicate that magnesium levels are even more significantly reduced during the menstrual cycle. The researchers attributed the symptoms of PMS to the changes in calcium and magnesium levels during the luteal phase.
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