Vitamin D supplementation improves PMS symptoms in young women

Tuesday, January 12, 2016

An article appearing online on December 24, 2015 in the Journal of Pediatric & Adolescent Gynecology reveals a benefit for supplementation with vitamin D among young women and adolescents with premenstrual syndrome (PMS).

"It has been noted that blood levels of calcium and vitamin D — the latter facilitating calcium absorption — fluctuate across the menstrual cycle; interestingly, randomized trials have shown that the occurrence and severity of premenstrual symptoms may be significantly reduced by adding both calcium and vitamin D as food supplementation," note authors Massimo Tartagni, MD, and colleagues. "While calcium carbonate, alone or associated with vitamin D, has been proven effective for the treatment of PMS, the possibility that vitamin D itself can be useful in alleviating these symptoms has not been evaluated."

The randomized trial included 158 young women between the ages of 15 and 21 years with severe cognitive and emotional PMS symptoms and deficient serum 25-hydroxyvitamin D levels of 10 nanograms per milliliter or less. Participants received a placebo or 200,000 international units (IU) vitamin D followed by 25,000 IU every two weeks for four months. Serum 25-hydroxyvitamin D, parathyroid hormone and calcium levels were tested at the beginning of the study and monthly thereafter. Questionnaires that assessed symptoms were completed by all participants during each of the four cycles included in the study.

Vitamin D levels significantly improved after one month among those who received the supplement. Among subjects who received vitamin D, anxiety, irritability, crying easily, sadness, and disturbed relationships improved on average by the end of the study, whereas no changes in symptom intensity were noted by those who received a placebo.

"Results obtained in this study suggest that administration of vitamin D is effective at improving symptoms of the emotional and cognitive domains in patients suffering from PMS," the authors conclude. "Based on present findings," they write, "vitamin D therapy can be suggested as a safe, effective and convenient method for reducing the intensity of PMS mood disorders, and consequently improve the quality of life in young women with severe hypovitaminosis D and concomitant mood disorders associated to PMS."


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Melatonin reduced in premenstrual syndrome
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Women affected by premenstrual dysphoric disorder (PMDD), also known as premenstrual syndrome (PMS), were found to have lower levels of the hormone melatonin in a pilot study reported on December 19, 2012 in the journal PLoS One. The finding could account for some of the sleep disturbances commonly reported by women during the premenstrual phase and the consequent adverse effects of sleep loss, including daytime drowsiness and irritability.

Dr Diane B. Boivin and her associates at the Centre for Study and Treatment of Circadian Rhythms at Douglas Mental Health University Institute matched five women with PMDD with five women who did not have the disorder. The women were evaluated during the follicular and luteal phases of their menstrual cycles (which represent the first and second halves of a woman's cycle) for mood, ovarian hormones and 24-hour plasma melatonin.

Women with PMDD had lower melatonin levels at night in comparison with those who did not have PMDD. They additionally had a reduction in melatonin during the luteal phase, when premenstrual symptoms occur, as well as a worsening of mood during this phase.

"Clearly understanding the mechanisms and specific pathophysiology of PMDD can help improve treatments, including both pharmacologic and nonpharmacologic approaches, for this disorder", commented lead author Dr Ari Shechter.

"Here, we described abnormal circadian melatonin secretion, which may relate to a serotonergic dysfunction in PMDD women," the authors write. "Findings of this pilot study indicate that pharmacological approaches such as exogenous nocturnal melatonin supplements, melatonin receptor agonists, or agomelatine should be further tested as therapeutic approaches for the management of depressive symptoms, and encourage more work on the chronobiological basis of psychiatric disorders including PMDD."


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Health Concern

Premenstrual syndrome

Levels of calcium and vitamin D fluctuate throughout the menstrual cycle in all women, most likely because calcium and vitamin D metabolism are influenced by ovarian sex hormones (Thys-Jacobs 2000). However, one study found that compared with women who do not have PMDD, women with PMDD had lower ionized calcium levels during menstruation, lower urinary excretion of calcium during the late follicular phase and early luteal phase, and lower vitamin D levels during the luteal phase (Thys-Jacobs 2007)

A randomized controlled trial compared 1000 mg calcium carbonate daily for three months to placebo. During the calcium treatment, PMS symptom scores were significantly lower during both the luteal and menstrual phases. Seventy-three percent of women reported fewer symptoms during calcium treatment. Negative mood, bloating, and menstrual pain were all significantly relieved by calcium (Thys-Jacobs 1989)

Women with lower dietary intake and blood levels of vitamin D may have an increased risk of PMS. An analysis was performed in 401 women who were free of PMS at baseline but later developed PMS. It was found that among those whose vitamin D levels were measured before they were diagnosed with PMS, lower vitamin D levels were related to a significantly higher risk of developing premenstrual breast tenderness, fatigue, depression, and constipation or diarrhea (Bertone-Johnson 2014). A case-control study compared 1057 women who developed PMS with 1968 controls; researchers found that women in the highest 20% total vitamin D intake group had a 41% lower risk of PMS compared to women in the lowest 20% total vitamin D intake group. In this study, those who consumed the most calcium had a 30% reduced risk of developing PMS (Bertone-Johnson 2005).

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