Calcium for PMS
April 1, 1999 3 minutes read
Calcium for PMS
abstract & commentary
Synopsis: To evaluate the effect of calcium carbonate on the luteal and menstrual phases of the menstrual cycle in PMS, a prospective, double-blind, placebo-controlled, parallel group, multicenter randomized national clinical trial was conducted. This New York St. Luke’s-Roosevelt Hospital Center study found that irritability, depression, food craving, aches and pains, and water retention all improved with calcium carbonate supplementation. With the exception of aches and pains, however, the placebo group improved nearly as much in each category.
Source: Thys-Jacobs S, et al. Am J Obstet Gynecol 1988;179:444-452.
Previous reports have suggested that disturbances in calcium regulation may underlie the pathophysiologic characteristics of premenstrual syndrome (PMS) and that calcium supplementation may be an effective therapeutic approach. To evaluate the effect of calcium carbonate on the luteal and menstrual phases of the menstrual cycle in PMS, a prospective, double-blind, placebo-controlled, parallel group, mulitcenter randomized national clinical trial was conducted.
The study screened 720 healthy premenopausal women (ages 18-45) for moderate to severe, cyclically recurring premenstrual symptoms, prospectively documented over two menstrual cycles. Women were randomly assigned to either calcium supplements (1200 mg) or placebo for three menstrual cycles. Daily documentation of symptoms, adverse effects, and compliance with medications were monitored, with a resulting 17 parameter score.
Data were reported for 466 of the 497 women enrolled. The calcium treated group had a significantly lower premenstrual (luteal phase) symptom score for the second (P = 0.007) and third (P < 0.001) treatment cycles. By the third treatment cycle, the calcium group was associated with a 48% reduction in total symptom scores from baseline, compared with a 30% reduction in the placebo group.
COMMENT by John La Puma, MD, FACPThis New York St. Luke’s-Roosevelt Hospital Center study found that irritability, depression, food craving, aches and pains, and water retention all improved with calcium carbonate supplementation. With the exception of aches and pains, however, the placebo group improved nearly as much in each category. The salutary effects were not apparent until the second month.
Why should calcium work in PMS? Evidence of secondary hyperparathyroidism in women with PMS has been demonstrated by the same principal investigator, who postulates serotonergic dysregulation in PMS.
Partially funded by SmithKline Beech-am, makers of TUMS®, questions of blinding (TUMS®’ texture and flavor are difficult to emulate) and adequacy of pain relief (analgesics were allowed but not tracked) mar this study’s methods. The strong placebo effect is comparable to that observed in trials of fluoxitene for premenstrual dysphoria and alprazolam for PMS.
Calcium carbonate is the least expensive form of supplemental calcium, and if not compounded from oyster shells, is unlikely to contain lead, as do some "natural" calcium supplements. Calcium supplements should be taken with food. Some of the best food sources of calcium include a cup of plain nonfat yogurt (450 mg), 3 ounces of sardines with bones (370 mg), a cup of calcium fortified orange juice (300-350 mg), and a cup of cooked turnip greens (200 mg).
A three-month therapeutic trial of 1200 mg of calcium daily for women with moderate or severe symptoms of premenstrual syndrome should be investigated more carefully. It also will, with weight-bearing exercise, reduce the chance of osteoporosis, especially in Caucasian women. Whether calcium acts as a placebo or changes biochemistry, it is an inexpensive and safe approach. (Dr. La Puma is Adjunct Professor of Nutrition, Kendall College, and Director, C.H.E.F. Clinic, Alexian Brothers Medical Center, Elk Grove Village, IL.)
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