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Back to Roles on Certain Health Conditions

Pre-Menstrual Syndrome and Milk Products: Evidence Update

Pre-menstrual syndrome (PMS) affects a large proportion of women. Fortunately, certain lifestyle modifications—including adopting a healthy diet— can help control light and mild symptoms. For example, various studies have identified calcium as a key nutrient for counteracting PMS.

Sonia Pomerleau, RD, MSc

Research Professional – Dietitian
Institute of Nutrition and Functional Foods (INAF)
Laval University

Highlights

  • Epidemiological data indicate that about 80% to 90% of women have symptoms related to pre-menstrual syndrome;
  • Certain lifestyle modifications may help women reduce the frequency of pre-menstrual symptoms;
  • Observational studies show that women with a higher milk product consumption have fewer symptoms related to pre-menstrual syndrome;
  • Among the nutrients that may prevent pre-menstrual syndrome, calcium and vitamin D appear to be the most effective.

Introduction

Pre-menstrual syndrome is defined as a set of physical and emotional symptoms observed during the period prior to menstruation. These symptoms affect 80% to 90% of women of childbearing age.1 The most commonly experienced symptoms are:

  • Irritability,
  • Anxiety,
  • Depression,
  • Breast and lower belly pain,
  • Water retention,
  • Headaches or migraines.2

The best-known risk factor is heredity. However, other factors appear to increase the intensity of the symptoms:

  • Obesity,3,4
  • A diet low in calcium, magnesium and vitamin B6,4,5
  • A diet high in methylxanthines (coffee, tea, cola, chocolate),6,7
  • Smoking.3,4,6

While treatments related to pre-menstrual syndrome are generally used to reduce the intensity of the symptoms, certain lifestyle modifications, including a healthy diet, may help women reduce their frequency.

Diet

Various studies have examined the differences between the diet of women who experience pre-menstrual syndrome and the diet of women who do not. An observational study of 171 adolescents found that those who consumed less milk experienced more of certain symptoms such as abdominal cramping, bloating, food cravings and increased appetite.8 Similar results were reported in another observational study, which revealed that women who consumed 3 to 4 servings of milk products per day had fewer pre-menstrual symptoms than women who consumed none.9

A cross-sectional study of 177 women aged 18 to 24 years examined the association between certain pre-menstrual symptoms and milk product consumption.10 Researchers found that headaches and social isolation (observed during the pre-menstrual period) were less frequent among women consuming more milk products.

Calcium

Calcium appears to be the main nutrient linked to PMS symptom reduction.11 In fact, a large body of evidence shows a correlation between hypocalcemia and several PMS symptoms such as fatigue, anxiety, depression, mood swings and cramps.12 Certain authors have therefore looked at adding a calcium supplement as a treatment for PMS.

A literature review identified various non-medication approaches to provide relief to women with pre-menstrual syndrome.13 The authors cite, among others, a study indicating that a calcium intake of 1,200 mg/day is associated with a significant decrease in certain pre-menstrual symptoms, such as fatigue, depression, swelling and pain (p = 0.007 following 2 cycles and p < 0.001 following 3 cycles).12 Moreover, the authors of a systematic review concluded that only calcium could be part of natural treatments used to reduce pre-menstrual symptoms.14

A randomized, double-blind, parallel study evaluated the impact of taking a calcium supplement (1,000 mg/day) for 3 months among 179 women.15 The supplement resulted in a decrease in certain pre-menstrual symptoms, such as depression, increased appetite and fatigue.

Similarly, the authors of an observational study noted that calcium levels in the red blood cells of 46 women with pre-menstrual syndrome were lower than those of 50 women who did not experience it.16

A case-control study of 3,025 participants conducted in the United States found that those with a higher calcium intake had a 30% lower relative risk of pre-menstrual syndrome compared to those with a lower intake.17 The amount of calcium required to observe this impact was equivalent to 4 servings of milk products per day. In summary, these studies suggest that calcium may have a positive impact on pre-menstrual syndrome.

Furthermore, in a randomized, double-blind, placebo-controlled study, a calcium supplement (1,000 mg/day) was added for 2 menstrual cycles to the diet of women (n = 180) with severe pre-menstrual syndrome.18 The authors noted a decline in the severity of symptoms among women taking the calcium supplement, but the difference was not significant compared to women taking the placebo. Similar results were observed in a double-blind parallel study (n = 39) with a daily dose of calcium of 1,200 mg for 4 cycles.19 The observed benefits of taking the calcium supplement were modest and non-significant.

Among the hypotheses raised to explain the impact of calcium on pre-menstrual syndrome, certain authors suggest that there are similarities between pre-menstrual symptoms and those of hypocalcemia (e.g., depression, anxiety and fatigue).20 If these symptoms were, among others, the result of a calcium deficiency, an adequate calcium intake might alleviate some of these symptoms. Another study found that the calcium excretion level varied during the menstrual cycle, which would lead to a lower level of serum calcium during the pre-menstrual period.21 Despite these explanations, the mechanism of action of calcium on pre-menstrual syndrome remains unclear.

Vitamin D

In addition to its effects on bone health, vitamin D may provide other benefits. In a case-control study, women with a higher intake of dietary vitamin D (the equivalent of 400 IU/day) had 41% less risk of developing pre-menstrual syndrome.17

Similarly, the results from a 2010 observational study (n = 186) suggested that an increased intake of dietary vitamin D may be inversely associated with certain pre-menstrual symptoms.4 While this association does not reach the significance threshold, the authors noted that the vitamin D intake of women who met the criteria for pre-menstrual syndrome was significantly lower. Overall, the evidence allows us to conclude that vitamin D may play a role in the prevention of pre-menstrual syndrome. However, more studies are needed to further examine this effect. It is also important to note that the mechanisms associated with these effects remain unknown.

Conclusion

Pre-menstrual syndrome affects many women of childbearing age. Certain dietary modifications would make it easier to manage the symptoms. Increased milk product consumption appears to be linked to a reduced risk of pre-menstrual syndrome. More specifically, calcium and vitamin D appear to be the nutrients with the greatest impact on preventing the symptoms associated with pre-menstrual syndrome.

References

  1. Cheng SH et al. Factors associated with premenstrual syndrome - a survey of new female university students. Kaohsiung J Med Sci 2013;29:100-105.
  2. Budeiri DJ et al. Clinical trials of treatments of premenstrual syndrome: entry criteria and scales for measuring treatment outcomes. Br J Obstet Gynaecol 1994;101:689-695.
  3. Sadler C et al. Lifestyle factors, hormonal contraception, and premenstrual symptoms: the United Kingdom Southampton Women's Survey. J Womens health 2010;19:391-396.
  4. Bertone-Johnson ER et al. Dietary vitamin D intake, 25-hydroxyvitamin D3 levels and premenstrual syndrome in a college-aged population. J Steroid Biochem Mol Biol 2010;121:434-437.
  5. Chocano-Bedoya PO et al. Intake of selected minerals and risk of premenstrual syndrome. Am J Epidemiol 2013;177:1118-1127.
  6. Abraham GE. Nutritional factors in the etiology of the premenstrual tension syndromes. J Reprod Med 1983;28:446-464.
  7. Campagne DM and Campagne G. The premenstrual syndrome revisited. Eur J Obstet Gynecol Reprod Biol 2007;130:4-17.
  8. Derman O et al. Premenstrual syndrome and associated symptoms in adolescent girls. Eur J Obstet Gynecol Reprod Biol 2004;116:201-206.
  9. Abdul-Razzak KK et al. Influence of dietary intake of dairy products on dysmenorrhea. J Obstet Gynaecol Res 2010;36:377-383.
  10. Obeidat BA et al. Premenstrual symptoms in dysmenorrheic college students: prevalence and relation to vitamin D and parathyroid hormone levels. Int J Environ Res Public Health 2012;9:4210-4222.
  11. Fugh-Berman A and Kronenberg F. Complementary and alternative medicine (CAM) in reproductive-age women: a review of randomized controlled trials. Reprod Toxicol 2003;17:137-152.
  12. Thys-Jacobs S and coll. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Premenstrual Syndrome Study Group. Am J Obstet Gynecol 1998;179:444-452.
  13. Freeman EW. Therapeutic management of premenstrual syndrome. Expert Opin Pharmacother 2010;11:2879-2889.
  14. Whelan AM et al. Herbs, vitamins and minerals in the treatment of premenstrual syndrome: a systematic review. Can J Clin Pharmacol 2009;16:e407-429.
  15. Ghanbari Z et al. Effects of calcium supplement therapy in women with premenstrual syndrome. Taiwan J Obstet Gynecol 2009;48:124-129.
  16. Shamberger RJ. Calcium, magnesium, and other elements in the red blood cells and hair of normals and patients with premenstrual syndrome. Biol Trace Elem Res 2003;94:123-129.
  17. Bertone-Johnson ER et al. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med 2005;165:1246-1252.
  18. Khajehei M et al. Effect of treatment with dydrogesterone or calcium plus vitamin D on the severity of premenstrual syndrome. Int J Gynaecol Obstet 2009;105:158-161.
  19. Yonkers KA et al. A pilot study to compare fluoxetine, calcium, and placebo in the treatment of premenstrual syndrome. J Clin Psychopharmacol 2013;33:614-620.
  20. Thys-Jacobs S. Micronutrients and the premenstrual syndrome: the case for calcium. J Am Coll Nutr 2000;19:220-227.
  21. Thys-Jacobs S et al. Cyclical changes in calcium metabolism across the menstrual cycle in women with premenstrual dysphoric disorder. J Clin Endocrinol Metab 2007;92:2952-2959.

Keywords: premenstrual syndrome , milk products , calcium , vitamin D


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