Chelated Calcium as a Natural Remedy for Premenstrual Syndrome (PMS)

Premenstrual Syndrome (PMS) is one of the most common debilitating disorders that affect women. 95% of women of reproductive age experience symptoms during the premenstrual period, and severe, debilitating PMS symptoms, including premenstrual dysphoric disorder (PMDD), occur in 5% of these women.¹

Approximately 20% of all women experience premenstrual symptoms severe enough to impair their activities of daily life.² Thus, PMS is associated with a significant economic burden for individuals and populations due to absenteeism at work and other factors.³

PMS symptoms begin before the menstrual period, which is the luteal phase of the menstrual cycle, and typically resolve with menstruation.¹ The luteal phase begins after ovulation, as shown in this image:

Signs and Symptoms of Premenstrual Syndrome (PMS) include:

• Mood swings
• Breast Pain (also known as premenstrual mastalgia)
• Food cravings
• Fatigue
• Irritability
• Outbursts of Anger
• Depression
• Difficulty concentrating
• Crying/tearfulness
• Restlessness
• Unsociableness or Social Isolation
• Sadness
• Loneliness
• Dizziness
• Insomnia or sleeping too much
• Changes in libido
• More accident-prone
• Headaches
• Migraines
• Back pain
• Muscle and Joint pain
• Acne or other skin concerns
• Abdominal pain or cramping
• Weight Gain
• Abdominal bloating or swelling
• Water retention
• Edema of arms and legs
• Increased appetite
• Sweating
• Constipation or Diarrhea
• Low tolerance for light and sound
• Loss of confidence
• Nausea^1,4

Does Calcium Help with PMS Symptoms?

Fortunately, there are natural remedies available that may support a healthy symptom-free menstrual cycle. One option to discuss with your doctor is calcium. A recent systematic review compiled data from 14 clinical studies and determined serum calcium levels trend lower in women who experience PMS. The evidence analyzed also suggests calcium supplementation could significantly improve PMS symptoms.³

Do Sex Hormones Affect the Regulation of Blood Calcium Levels?

Yes, calcium supplementation may support a healthy menstrual cycle because the sex hormones produced by the ovaries during the menstrual cycle have an impact on calcium and the hormones that regulate blood calcium levels. Estrogen directly affects the movement of calcium into tissues, including muscles and bones. Overall, estrogen tends to lower the calcium level in the blood due to the significant effect it has on bone formation. Estrogen stimulates the mineralization of bone, which is a process that moves calcium out of the blood and into the bone.³ Progesterone also plays a role in bone formation, as explained in our last blog post.

In women with an underlying calcium disturbance or insufficient calcium intake, the increased sex hormone production that naturally occurs during the menstrual cycle could further decrease blood calcium levels, leading to PMS symptoms.³ The lower blood calcium level could contribute to abnormalities in brain cell activity due to changes in neurotransmitter synthesis and release.^3,5 Evidence also suggests that fluctuating estrogen levels alter serotonin receptor binding and serotonin receptor availability, thereby initiating mood symptoms associated with PMS.³

Furthermore, estrogen decreases calcium entry into vascular smooth muscle cells, which could also contribute to PMS symptoms.³ Calcium is a mineral that plays a central role in muscle contractions; therefore, changes in the calcium concentration in your blood will significantly affect the neuromuscular signaling pathways.^3,6

There are two estrogen peaks during the menstrual cycle that may impact calcium levels. The estrogen peaks are illustrated by the green line in the graph below:

The first estrogen surge (on Day 13 above) during the menstrual cycle occurs just before ovulation, and the second estrogen peak occurs during the luteal phase after ovulation when estrogen “follows” the progesterone released from the corpus luteum in the ovary.

The increased estrogen levels during these two times may contribute to lower calcium concentrations in the blood and an increase in the parathyroid hormone level.^3,7-8

What is Parathyroid Hormone?

Parathyroid Hormone (PTH) is a hormone produced by the parathyroid glands, which are located behind your thyroid gland. PTH regulates calcium balance in your body by acting to increase your calcium level. PTH affects the kidneys, digestion, and bone to maintain an optimal calcium level in your blood. Specifically, PTH enhances calcium reabsorption in the kidneys to decrease the amount of calcium excreted in the urine, increases the synthesis of active vitamin D to increase the absorption of dietary and supplemental calcium in the gastrointestinal tract, and increases the breakdown of bone to increase the level of available calcium in the blood.⁹

How Does Calcium Alleviate PMS Symptoms?

Overall, calcium supplementation during the menstrual cycle may resolve an underlying calcium deficiency or insufficiency, suppress parathyroid hormone secretion, reduce neuromuscular irritability, optimize neurotransmitter signaling, and decrease vascular reactivity to improve the symptoms of PMS.^3,7

Several studies have demonstrated that calcium supplementation alleviates PMS symptoms, including mood concerns. Other studies confirm calcium levels are lower during the luteal phase compared to the follicular phase as well as an association between a low blood calcium level and the presence of PMS symptoms.^3,7 An interesting relationship between PMS and bone loss has also been identified via research, which provides additional evidence that suboptimal calcium levels or abnormal calcium metabolism could be underlying causes of PMS.⁷

How Much Calcium Do I Need Per Day?

According to the Institute of Medicine, menstruating females between the ages of 19 - 50 require 1000 mg of calcium per day (from food and supplements).¹⁰ Since there is a relationship between calcium status and other nutrients, such as magnesium and vitamin D, you might also need to supplement with additional nutrients to optimize your calcium status.¹¹

What Calcium Supplement Dose is Best for PMS Symptoms?

Doctors and research scientists hypothesize that supplementation with calcium may prevent the transiently low calcium levels caused by the higher hormone levels present just before and during the luteal phase of the menstrual cycle.³

Doses of calcium that were beneficial in research studies varied from 500 mg – 1000 mg.¹² But, based on the available evidence, it is not yet possible to suggest an optimal calcium dosage for PMS. Well-designed dose-response clinical trials with large sample sizes are needed to establish the dose of calcium most effective for supporting women with PMS symptoms.³ Consider discussing your current calcium intake with your doctor to determine if calcium supplementation might be supportive.

Calcium² is a highly bioavailable, physician-formulated blend of calcium citrate and calcium bisglycinate that supports a healthy menstrual cycle.*

Adapt is a unique formulation that includes calcium, B vitamins, and Ashwagandha to support a healthy stress response and optimal hormone levels.*

* This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

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References:

1. Kwan I, Onwude JL. Premenstrual syndrome. BMJ Clin Evid. 2015;2015:0806.
2. Alshdaifat E, Absy N, Sindiani A, et al. Premenstrual Syndrome and Its Association with Perceived Stress: The Experience of Medical Students in Jordan. Int J Womens Health. 2022;14:777-785. doi:10.2147/IJWH.S361964
3. Arab A, Rafie N, Askari G, Taghiabadi M. Beneficial Role of Calcium in Premenstrual Syndrome: A Systematic Review of Current Literature. Int J Prev Med. 2020;11:156. doi:10.4103/ijpvm.IJPVM_243_19
4. Siminiuc R, Ţurcanu D. Impact of nutritional diet therapy on premenstrual syndrome. Front Nutr. 2023;10:1079417. doi:10.3389/fnut.2023.1079417
5. Tiranini L, Nappi RE. Recent advances in understanding/management of premenstrual dysphoric disorder/premenstrual syndrome. Fac Rev. 2022;11:11. doi:10.12703/r/11-11
6. Valentim MA, Brahmbhatt AN, Tupling AR. Skeletal and cardiac muscle calcium transport regulation in health and disease. Biosci Rep. 2022;42(12):BSR20211997. doi:10.1042/BSR20211997
7. Thys-Jacobs S. Micronutrients and the premenstrual syndrome: the case for calcium. J Am Coll Nutr. 2000;19(2):220-227. doi:10.1080/07315724.2000.10718920
8. Thys-Jacobs S, Alvir MJ. Calcium-regulating hormones across the menstrual cycle: evidence of a secondary hyperparathyroidism in women with PMS. J Clin Endocrinol Metab. 1995;80(7):2227-2232. doi:10.1210/jcem.80.7.7608284
9. Leung EKY. Parathyroid hormone. Adv Clin Chem. 2021;101:41-93. doi:10.1016/bs.acc.2020.06.005
10. Office of Dietary Supplements - Calcium. NIH Office of Dietary Supplements. October 6, 2022. Accessed July 14, 2023. https://ods.od.nih.gov/factsheets/calcium-HealthProfessional/#en1.
11. Khazai N, Judd SE, Tangpricha V. Calcium and vitamin D: skeletal and extraskeletal health. Curr Rheumatol Rep. 2008;10(2):110-117. doi:10.1007/s11926-008-0020-y
12. Abdi F, Ozgoli G, Rahnemaie FS. A systematic review of the role of vitamin D and calcium in premenstrual syndrome [published correction appears in Obstet Gynecol Sci. 2020 Mar;63(2):213]. Obstet Gynecol Sci. 2019;62(2):73-86. doi:10.5468/ogs.2019.62.2.73