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Calcium Therapy for PMDD
Philosophy
Recent studies have shown that the underlying pathophysiologic changes that occur with PMDD could be a reflection of an important physiologic disruption in calcium regulation. Significant alterations in the hormones that manage calcium metabolism have been studied during the menstrual cycle of women with PMDD with the results pointing to calcium imbalance as a possible causal factor. Retrospective and prospective investigations have identified a relationship between PMDD and bone loss, further promoting a derangement in calcium metabolism as a potential biologic trigger for PMDD. Therefore, dietary calcium supplementation may be a possible therapeutic modality for PMDD.
Previous clinical investigations have shown calcium to be helpful in alleviating symptoms such as irritability, depression, anxiety, social withdrawal, headache, and cramps. In a double-blind randomized crossover trial done by Thys-Jacobs et al5 in 1989, a 50% reduction in PMDD symptoms was found among 33 women on a daily calcium regimen of 1000 mg. In a similar study by Penland and Johnson in 1993, increasing dietary calcium intake to 1336 mg per day reduced mood, pain, and water retention symptoms among women during their menstrual cycles.
Scientific Evidence
Most of the trials regarding calcium supplementation for the treatment of PMS symptoms have been done using small study groups. However, more recently, a larger, randomized, double-blind, placebo-controlled multicenter trial was conducted by Thys-Jacobs et al to assess the effectiveness of calcium carbonate on the reducing the symptoms of PMS6. Healthy, premenopausal women between the ages of 18 and 45 years were recruited at 12 health centers to participate in this study. After screening measures, 497 women were enrolled in the trial. They were then randomly assigned to take either 1200 mg of elemental calcium per day in the form of calcium carbonate or a placebo for three menstrual cycles while keeping a diary of their symptoms. The results were published in 1998 in the American Journal of Obsterics and Gynecology. They found that during the luteal phase of the treatment cycle, women in the calcium-treated group reported a significant lowering of PMS symptoms during their 2nd and 3rd menstrual cycles. By their third menstrual cycles, calcium had effectively reduced their symptoms by 48% from baseline compared to a 30% reduction in the placebo group. All four symptom factors (negative affect, water retention, food cravings, and pain) were significantly reduced by the third treatment cycle. They concluded that calcium was a simple and effective treatment resulting in an overall reduction of luteal phase symptoms of PMDD.
Contraindications
Calcium supplementation in contraindicated in people with a history of ventricular fibrillation, hypercalcemia, hypophosphatemia, renal stones. It should be used with caution in people with arcoidosis, kidney or heart disease, cor pulmonale, respiratory acidosis, respiratory failure, and those taking digitalis for heart failure.
Adverse Reactions
The most common side effect of calcium supplementation is constipation. Rare, but life-threatening, reactions include arrhythmias and cardiac arrest. Other uncommon side effects include tingling, headache, irritability, gastrointestinal irritation, chalky taste, nausea, vomiting, thirst, renal stones, increased urination, and skin reactions.
The maximum level unlikely to cause adverse effects is 2500 mg/day. The recommended adequate level of calcium intake for girls between the ages of 14 and 18 is 1300 mg/day. For women between the ages of 19-50, the adequate amount is 1000 mg/day.
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