magnesium
Place in Therapy
Place in Therapy
Based on primary evidence and other literature that is currently available, magnesium (Mg) should not be recommended as first line treatment of premenstrual syndrome (PMS), but rather behind non pharmacological options as well as certain natural products that have better evidence than magnesium to support their use.1 Intracellular magnesium levels have been found to be lower in women with premenstrual PMS, leading to the use of magnesium supplements for PMS.2 In addition, magnesium is believed to be an antagonist at NMDA receptors, involved in the potentiating of pain, which would explain its possible effect on pain relief including PMS-associated migraines.2
The presumed benefits of Mg on PMS; however, have yet to be been proven in a satisfactory manner. For example, one of the primary studies that most guidelines rely upon to make a case for magnesium found that Mg pyrrolidone carboxylic acid 360 mg in 3 divided doses was beneficial in relieving pain, headache, bloating and mood changes.3 This study, along with subsequent studies involving Mg oxide, for example, had multiple limitations including a lack of intention to treat analysis, small sample sizes; short study duration, different Mg dosage, inconsistent methods of screening for PMS, measuring outcomes etc…The study designs are so heterogeneous, making it difficult to perform a meta-analysis.3-4 Magnesium is possibly effective in the treatment of PMS, particularly fluid retention and emotional symptoms, but since the data is still limited and preliminary, it would therefore be recommended for those patients who insist on trying it after failure of non-pharmacologic options and other natural products with better evidence.1,2,5
References:
1. Mulherin K, Thomas ER: Premenstrual Syndrome. E-therapeutics: Minor ailments. CPhA. http://www.etherapeutics.ca/psc.therapeutics.action?documentId=psc1182#psc1182n00015. Last updated February 2013. Accessed July 17/2013
2. Natural Medicines Comprehensive Database (NMCD). Magnesium Monograph. www.naturaldatabase.com. Last updated on July 2013. Accessed July/17/2013
3. Facchinetti F, Borella P, Sances et al. Oral Magnesium Successfully Relieves Premenstrual Mood Changes. Obstet Gynecol. 1991 Aug; 78(2):177-81. http://www-ncbi-nlm-nih-gov.proxy.lib.uwaterloo.ca/pubmed/2067759
4. Whelan AM, Jurgens TM, Naylor H. Herbs, Vitamins and Minerals and the Treatment of Premenstrual Syndrome: a Systematic Review. Can J clin Pharmacol. 2009 Fall; 16(3):e407-29. http://www.ncbi.nlm.nih.gov/pubmed/19923637
5. Douglas S. Premenstrual syndrome. Evidence-based Treatment in Family Practice. Can Fam Physician2002;48:1789-97. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213956/
Based on primary evidence and other literature that is currently available, magnesium (Mg) should not be recommended as first line treatment of premenstrual syndrome (PMS), but rather behind non pharmacological options as well as certain natural products that have better evidence than magnesium to support their use.1 Intracellular magnesium levels have been found to be lower in women with premenstrual PMS, leading to the use of magnesium supplements for PMS.2 In addition, magnesium is believed to be an antagonist at NMDA receptors, involved in the potentiating of pain, which would explain its possible effect on pain relief including PMS-associated migraines.2
The presumed benefits of Mg on PMS; however, have yet to be been proven in a satisfactory manner. For example, one of the primary studies that most guidelines rely upon to make a case for magnesium found that Mg pyrrolidone carboxylic acid 360 mg in 3 divided doses was beneficial in relieving pain, headache, bloating and mood changes.3 This study, along with subsequent studies involving Mg oxide, for example, had multiple limitations including a lack of intention to treat analysis, small sample sizes; short study duration, different Mg dosage, inconsistent methods of screening for PMS, measuring outcomes etc…The study designs are so heterogeneous, making it difficult to perform a meta-analysis.3-4 Magnesium is possibly effective in the treatment of PMS, particularly fluid retention and emotional symptoms, but since the data is still limited and preliminary, it would therefore be recommended for those patients who insist on trying it after failure of non-pharmacologic options and other natural products with better evidence.1,2,5
References:
1. Mulherin K, Thomas ER: Premenstrual Syndrome. E-therapeutics: Minor ailments. CPhA. http://www.etherapeutics.ca/psc.therapeutics.action?documentId=psc1182#psc1182n00015. Last updated February 2013. Accessed July 17/2013
2. Natural Medicines Comprehensive Database (NMCD). Magnesium Monograph. www.naturaldatabase.com. Last updated on July 2013. Accessed July/17/2013
3. Facchinetti F, Borella P, Sances et al. Oral Magnesium Successfully Relieves Premenstrual Mood Changes. Obstet Gynecol. 1991 Aug; 78(2):177-81. http://www-ncbi-nlm-nih-gov.proxy.lib.uwaterloo.ca/pubmed/2067759
4. Whelan AM, Jurgens TM, Naylor H. Herbs, Vitamins and Minerals and the Treatment of Premenstrual Syndrome: a Systematic Review. Can J clin Pharmacol. 2009 Fall; 16(3):e407-29. http://www.ncbi.nlm.nih.gov/pubmed/19923637
5. Douglas S. Premenstrual syndrome. Evidence-based Treatment in Family Practice. Can Fam Physician2002;48:1789-97. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213956/