Additional Information
As recognized by the FDA, PMS is not a disease state. It is, in fact, a deficiency of essential vitamins and minerals in the body. Without enough calcium and vitamin D, some women will experience PMS. With enough calcium and vitamin D, most women will not.

PMS is a very common disorder among women of reproductive age with many women experiencing emotional and physical symptoms of varying degrees. When PMS is recognized, women should be reassured that there is a probable biochemical reason for their symptoms, that PMS is not a psychological disorder and that relief is available.

A realistic approach is to empirically supplement the diet with calcium (elemental calcium) at 1,000 mg and vitamin D (cholecalciferol) at 2,000-4,000 international units (IU) daily. Vitamin D deficiency has become more commonly recognized as a consequence of dietary deficiency and inadequate production of vitamin D by the skin. Ideally, a woman’s vitamin D level is assessed by measuring a serum 25 hydroxyvitamin D level. While a normal 25 hydroxyvitamin D concentration has been of some controversy recently, serum levels of 25 hydroxyvitamin D at 35-40 ng/ml appear desirable. Premcal provides optimal calcium and vitamin D dosages. In the woman of reproductive age, long term vitamin D doses of up to 4,000 IU daily are safe; short term vitamin D doses of up to 10,000 IU daily are also safe. The majority of women with PMS will experience a sense of well being and relief within one to two months of supplementation. Note that a daily maintenance dose of vitamin D necessary to achieve a serum 25 hydroxyvitamin D level above 35-40 ng/ml may vary from 2,000 IU to 4,000 IU daily.

Dietary modifications may also be helpful. Adding dairy products as yogurt or milk can reduce the total supplemental calcium while maintaining the total dietary calcium. Increases in both dietary and supplemental calcium may cause an initial exacerbation of PMS physical symptoms such as menstrual cramps. Women should be alerted to this initial symptom eruption, but comforted that continual treatment usually results in an overwhelming sense of balance and resolution of the majority of their symptoms within 2-3 months. Constipation and nausea are very common complaints with calcium supplementation. The addition of magnesium to the diet often alleviates this complaint and ingesting the calcium supplements with meals and not on an empty stomach, usually resolves the nausea. For those women who do not adequately respond to adequate calcium and vitamin D replacement, other pharmacologic interventions may be required.

Suggested Readings

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Bendich A. The potential for dietary supplements to reduce premenstrual syndrome (PMS) symptoms. J Amer College Nutrition 2000;19: 3-12.

Bendich A. Micronutrients in Women’s Health and Immune Function. Nutrition 2001; 17: 858-867.

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ACOG Practice Bulletin. Clinical management Guidelines. 2000; 15:1-9.

Thys-Jacobs S, Ceccarelli S, Bierman A, Weisman H, Cohen MA, Alvir J. Calcium supplementation in premenstrual syndrome. J Gen Intern Med. 1989; 4: 183-189.

Penland J, Johnson PE. Dietary calcium and manganese effects on menstrual cycle symptoms. Am J Obstet Gynecol. 1993; 168: 1417-23.

Thys-Jacobs S, Alvir MAJ. Calcium regulating hormones across the menstrual cycle: evidence of a secondary hyperparathyroidism in women with PMS. J Clin Endocrinol Metab 1995; 80: 2227-2232.

Thys-Jacobs S, Silverton M, Alvir J, Paddison P, Rico M, Goldsmith S. Reduced Bone Mass in women with Premenstrual Syndrome. J Women's Health 1995; 4: 161-168.

Lee SJ, Kanis JA. An association between osteoporosis and premenstrual and postmenstrual symptoms. Bone and Mineral 1994;24:127-134.

Facchinetti F, Borella P, Sances G, Fioroni L, Nappi RE, Genazzani AR: Oral Magnesium successfully relieves premenstrual mood changes. Obstet Gynecol 1991; 78:177-181.

Walker AF, De Souza M, Vickers MF. Magnesium supplementation alleviates premenstrual symptoms of fluid retention. J Women’s Health 1998; 7:1157-1165.

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 (8): 2952-2959

Thys-Jacobs, S. et al. Differences in Free Estradiol and Sex Hormone-Binding Globulin in Women with and without Premenstrual Dysphoric Disorder. J. Clin. Endocrinol. Metab 2008; 93 (1): 96-102