Whole milk intake was associated with a modest increase in risk, while women who frequently consumed skim or low-fat milk had a significantly lower risk of developing PMS; the RR for women consuming 4 servings or more per day of skim or low-fat milk compared with those reporting 1 serving or less per week was 0.

The relationship between milk intake and risk of PMS did not vary by level of calcium or vitamin D supplementation results not shown. Results based on milk intake in only were similar to those before the reference year, although slightly attenuated, and are not shown. In women with a BMI of less than In this group, the RRs for quintiles 2 through 5 vs quintile 1 were 0.

We did not find evidence that the relationship between calcium and vitamin D intake and PMS varied by age or smoking status results not shown. Results of analyses limited to women with no diagnosis of depression before the reference year and those not using OCs at baseline were similar to those of the main analysis results not shown.

Findings from our nested case-control study suggest that a high dietary intake of vitamin D and calcium may lower the risk of incident PMS.

We observed a significantly lower risk of developing PMS in women with high intakes of vitamin D and calcium from food sources, equivalent to about 4 servings per day of skim or low-fat milk, fortified orange juice, or low-fat dairy foods such as yogurt.

These dietary intakes correspond to approximately mg of calcium and IU of vitamin D from food sources. While previous studies have observed the benefits of calcium supplements for treating PMS, this is the first, to our knowledge, to suggest that calcium and vitamin D may help prevent the initial development of PMS.

Calcium and vitamin D may influence the development of PMS through their relationship to endogenous estrogens. Calcium, parathyroid hormone, and vitamin D levels have been observed to fluctuate across the menstrual cycle in response to changes in estradiol at ovulation and during the luteal phase in several, 10 , 18 - 22 but not all, 23 , 24 studies.

In a study 18 of repeated blood samples drawn during a single menstrual cycle from 7 women with PMS and 5 menstrual symptom—free women, calcium levels were lower at ovulation than during the early follicular phase and had returned to their follicular levels by the end of the luteal phase.

Cases with PMS also experienced a significant increase in parathyroid hormone levels at ovulation, followed by a decrease in the luteal phase. A similar increase was not observed in controls, who had lower parathyroid hormone levels at all phases of the menstrual cycle.

It is unclear why 1,dihydroxyvitamin D and hydroxyvitamin D may be differently related to PMS, although it has been suggested that the increase in estrogens occurring at ovulation may increase metabolism of hydroxyvitamin D to 1,dihydroxyvitamin D.

If PMS may be a consequence of deficiency in circulating levels of calcium and vitamin D, high dietary intakes of vitamin D and perhaps calcium may directly prevent the manifestation of PMS symptoms associated with deficiencies.

The finding that frequent milk intake is protective against PMS is consistent with our results for calcium and vitamin D. Each serving of fortified milk contains approximately mg of calcium and IU of vitamin D; 4 servings per day would provide women with approximately the amount of calcium and vitamin D from food sources at which we saw a significantly lower risk of PMS.

It is unclear why frequent consumption of skim or low-fat milk and whole milk may be differently related to PMS. It is likely that women who frequently drink whole milk have diets higher in saturated fat than women who drink skim milk, and saturated fat intake may be positively associated with the incidence of PMS.

In a recent study in Japan, 26 women with a high dietary fat intake reported more severe menstrual symptoms than those with a lower intake. Future studies of incident PMS should evaluate the specific role of dietary fats.

Premenstrual syndrome involves a large variety of symptoms, many of which are experienced by most menstruating women and may be caused by disorders other than PMS. Our initial identification of cases among NHS2 participants was made by self-report on mailed questionnaires, and was followed by a supplemental questionnaire measuring frequency, timing, and severity of menstrual symptoms.

Because of the size of our cohort and the prospective nature of our study, we were unable to use prospective symptom charting to identify PMS cases, as is becoming the standard in clinical practice. Although many of our participants were required to recall their symptom history over several years, we tried to minimize the likelihood of symptom misreport in several ways.

We preferentially included women first reporting PMS in the later years of follow-up to minimize the time over which symptoms were recalled.

We also used established criteria to define PMS cases and controls to identify and compare women at the 2 extreme ends of the spectrum of menstrual symptom experience. Symptom recall is likely to be accurate for women who regularly experienced severe symptoms that interfered with life activities, and for those who experienced few, if any, menstrual symptoms.

Consequently, misclassification of women at these 2 extremes should be limited. An additional limitation of this study is that a relatively small proportion of our participants reported using supplemental calcium. As a result, we were unable to evaluate the effect of high doses of supplemental calcium on the risk of developing PMS.

It is possible that we were unable to observe a beneficial effect of calcium supplements because the intake levels in our population were too low. The use of calcium and vitamin D supplements to prevent incident PMS should be addressed in future prospective studies and large-scale clinical trials.

In addition, because dietary intake and exposure to sunlight contribute to circulating levels of vitamin D, and because women differ in their ability to absorb calcium, the relation of plasma calcium and vitamin D metabolite levels to the incidence of PMS should also be evaluated.

Our study has several important strengths. It is among the first to collect information on dietary factors that may be associated with future development of PMS from women free from the diagnosis at baseline; this prospective assessment greatly reduced the likelihood of recall bias.

We measured intake of calcium and vitamin D with an SFFQ that has been extensively validated in a similar population. Our findings, together with those from several small randomized trials that found calcium supplements to be effective in treating PMS, suggest that a high intake of calcium and vitamin D may reduce the risk of PMS.

Clinical trials of this issue are warranted. In the interim, given that calcium and vitamin D may also reduce the risk of osteoporosis and some cancers, clinicians may consider recommending these nutrients even for younger women.

Correspondence: Elizabeth R. Bertone-Johnson, ScD, University of Massachusetts, N Pleasant St, Amherst, MA ebertone schoolph. Financial Disclosure: Dr Bendich is an employee of GlaxoSmithKline, the manufacturer of Tums and Os-Cal calcium supplements.

full text icon Full Text. Download PDF Top of Article Abstract Methods Results Comment Article Information References.

Table 1. View Large Download. Age-Standardized Characteristics of Premenstrual Syndrome Cases and Controls at Baseline Johnson SR The epidemiology and social impact of premenstrual symptoms.

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Mortola JF Jr Issues in the diagnosis and research of premenstrual syndrome. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC American Psychiatric Association;.

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Some studies also suggest following a gluten-free diet helped reduce painful symptoms of endometriosis. Herbs are generally available as standardized dried extracts pills, capsules, or tablets , teas, tinctures, or liquid extracts alcohol extraction, unless otherwise noted.

Mix liquid extracts with favorite beverage. Some researchers think the following herbs act like estrogen in the body. Women who have a history of hormone-related cancer, who are taking hormone replacement therapy, or who have a bleeding disorder or are taking blood-thinning medication should ask their doctor before taking these herbs:.

Few studies have examined the effectiveness of specific homeopathic remedies. However, a professional homeopath may recommend one or more of the following treatments for menstrual pain based on his or her knowledge and clinical experience.

Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

Acupuncture has become a popular treatment for menstrual pain. The National Institutes of Health recommends acupuncture, either by itself or along with other treatments, for menstrual pain.

In a well-designed study of 43 women with menstrual pain, women treated with acupuncture had less pain and needed less pain medication. Acupuncturists treat people with dysmenorrhea based on an individualized assessment of the excesses and deficiencies of energy called qi located in various meridians.

In the case of dysmenorrhea, a qi deficiency is usually detected in the liver and spleen meridians. Moxibustion a technique in which the herb mugwort is burned over specific acupuncture points is often added to enhance needling treatment, and qualified practitioners may also recommend herbal or dietary treatments.

Acupressure also works to relieve pain. A study of female students found that acupressure and ibuprofen were better than placebo at reducing pain.

Some people with menstrual pain may find relief with spinal manipulation, particularly in areas that supply sensory and motor impulses to the uterus and lower back. Balbi C, Musone R, Menditto A, et al. Eur J Obstet Gynecol Reprod Biol. Barnard ND, Scialli AR, Hurlock D, Bertron P. Diet and sex-hormone binding globulin, dysmenorrhea, and premenstrual symptoms.

Obstet Gynecol. Bernstein MT, Graff LA, Avery L, Palatnick C, Parnerowski K, Targownik LE. Gastrointestinal symptoms before and during menses in healthy women. BMC Womens Health. Philadelphia, PA: Elsevier Saunders; Chen YW, Wang HH. The effectiveness of acupressure on relieving pain: a systematic review.

Pain Manag Nurs. Dennehy CE. The use of herbs and dietary supplements in gynecology: an evidence-based review. J Midwifery Womens Health. Fjerbaek A, Knudsen UB. Endometriosis, dysmenorrhea and diet -- what is the evidence? Ghodsi Z, Asltoghiri M. The effect of fennel on pain quality, symptoms, and menstrual duration in primary dysmenorrhea.

J Pediatr Adolesc Gynecol. Grimes DA, Hubacher D, Lopez LM, Schulz KF. Non-steroidal anti-inflammatory drugs for heavy bleeding or pain associated with intrauterine-device use.

Cochrane Database Syst Rev. Guerrera MP, Volpe SL, Mao JJ. Therapeutic uses of magnesium. Am Fam Physician. Habek D, Cortez Habek J, Bobic-Vukovic M, Vujic B. Efficacy of acupuncture for the treatment of primary dysmenorrheal. Gynakol Geburtshilfliche Rundsch.

Keogh E, Cavill R, Moore DJ, Eccleston C. The effects of menstrual-related pain on attentional interference. Letzel H, Megard Y, Lamarca R, Raber A, Fortea J.

The efficacy and safety of aceclofenac versus placebo and naproxen in women with primary dysmenorrhoea. Liu CZ, Xie JP, Wang LP, et al. Immediate analgesia effect of single point acupuncture in primary dysmenorrhea: a randomized controlled trial.

Pain Med. doi: Epub Dec Erratum in: Pain Med. Lloyd KB, Hornsby LB. Complementary and alternative medications for women's health issues. Nutr Clin Pract. Marziali M, Venza M, Lazzaro S, Lazzaro A, Micossi C, Stolfi VM.

Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chir. Mirbagher-Ajorpaz N, Adib-Hajbaghery M, Mosaebi F. The effects of acupressure on primary dysmenorrhea: a randomized controlled trial. Complement Ther Clin Pract.

Nagata C, Hirokawa K, Shimizu N, Shimizu H. Women need to eat Calcium-rich foods such as beans, almonds, and dark green leafy vegetables, such as spinach and kale. Studies have also highlighted the importance of Vitamin D, a steroid hormone regulating Calcium absorption and metabolism in the body.

Some foods rich in Vitamin D include some dairy products, cereals, soy milk, cheese etc. A double-blind randomized clinical trial of Female students of Hamadan University of Medical Sciences suggests that treatment with calcium supplements is an effective method for reducing mood disorders during PMS.

In another study, researchers compared the diet and supplement use in women in the age group of 27 to 44 with PMS. Although it is not clear why Calcium helps during PMS, there are theories to suggest that Calcium affects the hormone Estrogen during the menstrual cycle.

Vitamin D helps in the absorption of Calcium and is often added to dairy products to help the body absorb Calcium. PMS is a prevalent health problem among young women and merits more attention with regard to improvement in their health and nutritional status.

Calcium supplementation is a simple and effective treatment in PMS and can lead to a major reduction in overall luteal phase symptoms. When consumed with adequate Vitamin D, it can yield better outcomes. However, it is a good idea to consult with a doctor or specialist before including Calcium supplements in your diet.

Co-authored by research expert Dr Swarupa Kakani, Member, Indian Dietetic Association. Thanks for subscribing! This email has been registered! Skip to content FREE SHIPPING ON ALL ORDERS ABOVE Rs.

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