calcium
Place in Therapy
Place in Therapy
Calcium supplementation has been showed to be beneficial for patients with symptoms of PMS. The first rather poorly designed RCT found that calcium relieved the symptoms of tiredness, depression and sadness and appetite improvements, (but did not relieve breast tenderness, headache, anxiety, irritability, sleep changes, and lack of energy).4 The second RCT of moderate quality found that calcium relieved nervousness, irritability, mood, violence tendencies, depression, fatigue, abdominal bloating, headache, breast fullness, abdominal cramps and back pain (but did not relieve increased appetite and craving for sweets).7 The third RCT of good quality found that calcium relieved every symptom except for fatigue and insomnia.8 Overall, every symptom of PMS has been shown to improvement, and this was additionally confirmed by both meta-analyses that were appraised.2,3,9
Based on the relief of a wide range of PMS symptoms, calcium is an appropriate treatment to recommend due to the evidence showing a positive benefit for patients who are self-care candidates with no red flags. Some of the trials evaluating calcium were of mixed quality, yet both meta-analyses showed a positive benefit.2 -4,7-9 Calcium is generally well tolerated. Some common mild adverse effects include constipation, headache, and nausea.1,6 Calcium should be recommended for at least 2-3 cycles in order to see benefits. Overall, calcium is an appropriate treatment option for patients presenting with PMS.
References:
1) Canadian Pharmacists Association, E-Therapeutics: Calcium Salts Oral CPhA Monograph. Updated October 2013, Accessed July 18th 2013, https://www.e-therapeutics.ca/cps.select.preliminaryFilter.action?simplePreliminaryFilter=calcium+carbonate#
2) Canning S, Waterman M, Dye L. Dietary supplements and herbal remedies for premenstrual syndrome (PMS): a systematic research review of the evidence for their efficacy. Journal of Reproductive and Infant Psychology.2006;24(4):363‐378
3) CRD reviewers, The Cochrane Library: Dietary supplements and herbal remedies for premenstrual syndrome (PMS): a systematic research review of the evidence for their efficacy (Structured abstract). (Original article: Canning S, Waterman M, Dye L. Dietary supplements and herbal remedies for premenstrual syndrome (PMS): a systematic research review of the evidence for their efficacy. Journal of Reproductive and Infant Psychology.2006;24(4):363‐378). Updated 2013, Accessed July 17th 2013.http://onlinelibrary.wiley.com/o/cochrane/cldare/articles/DARE-12006007749/frame.html
4) Ghanbari Z, Haghollahi F, Shariat M, Foroshani AR, Ashrafi M. Effects of calcium supplement therapy in women with premenstrual syndrome. Taiwan J Obstet Gynecol 2009 Jun;48(2):124-129.
5) Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
6) Lexicomp. Calcium Carbonate Lexi-Drugs. Accessed July 17th 2013. http://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/6503
7) Thys-Jacobs S, Ceccarelli S, Bierman A, Weisman H, Cohen MA, Alvir J. Calcium supplementation in premenstrual syndrome: a randomized crossover trial. J Gen Intern Med 1989 May-Jun;4(3):183-189.
8) Thys-Jacobs S, Starkey P, Bernstein D, Tian J. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Premenstrual Syndrome Study Group. Am J Obstet Gynecol 1998 Aug;179(2):444-452.
9) Whelan AM, Jurgens TM, Naylor H. Herbs, vitamins and minerals in the treatment of premenstrual syndrome: a systematic review. Can J Clin Pharmacol 2009 Fall;16(3):e407-29.
Calcium supplementation has been showed to be beneficial for patients with symptoms of PMS. The first rather poorly designed RCT found that calcium relieved the symptoms of tiredness, depression and sadness and appetite improvements, (but did not relieve breast tenderness, headache, anxiety, irritability, sleep changes, and lack of energy).4 The second RCT of moderate quality found that calcium relieved nervousness, irritability, mood, violence tendencies, depression, fatigue, abdominal bloating, headache, breast fullness, abdominal cramps and back pain (but did not relieve increased appetite and craving for sweets).7 The third RCT of good quality found that calcium relieved every symptom except for fatigue and insomnia.8 Overall, every symptom of PMS has been shown to improvement, and this was additionally confirmed by both meta-analyses that were appraised.2,3,9
Based on the relief of a wide range of PMS symptoms, calcium is an appropriate treatment to recommend due to the evidence showing a positive benefit for patients who are self-care candidates with no red flags. Some of the trials evaluating calcium were of mixed quality, yet both meta-analyses showed a positive benefit.2 -4,7-9 Calcium is generally well tolerated. Some common mild adverse effects include constipation, headache, and nausea.1,6 Calcium should be recommended for at least 2-3 cycles in order to see benefits. Overall, calcium is an appropriate treatment option for patients presenting with PMS.
References:
1) Canadian Pharmacists Association, E-Therapeutics: Calcium Salts Oral CPhA Monograph. Updated October 2013, Accessed July 18th 2013, https://www.e-therapeutics.ca/cps.select.preliminaryFilter.action?simplePreliminaryFilter=calcium+carbonate#
2) Canning S, Waterman M, Dye L. Dietary supplements and herbal remedies for premenstrual syndrome (PMS): a systematic research review of the evidence for their efficacy. Journal of Reproductive and Infant Psychology.2006;24(4):363‐378
3) CRD reviewers, The Cochrane Library: Dietary supplements and herbal remedies for premenstrual syndrome (PMS): a systematic research review of the evidence for their efficacy (Structured abstract). (Original article: Canning S, Waterman M, Dye L. Dietary supplements and herbal remedies for premenstrual syndrome (PMS): a systematic research review of the evidence for their efficacy. Journal of Reproductive and Infant Psychology.2006;24(4):363‐378). Updated 2013, Accessed July 17th 2013.http://onlinelibrary.wiley.com/o/cochrane/cldare/articles/DARE-12006007749/frame.html
4) Ghanbari Z, Haghollahi F, Shariat M, Foroshani AR, Ashrafi M. Effects of calcium supplement therapy in women with premenstrual syndrome. Taiwan J Obstet Gynecol 2009 Jun;48(2):124-129.
5) Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
6) Lexicomp. Calcium Carbonate Lexi-Drugs. Accessed July 17th 2013. http://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/6503
7) Thys-Jacobs S, Ceccarelli S, Bierman A, Weisman H, Cohen MA, Alvir J. Calcium supplementation in premenstrual syndrome: a randomized crossover trial. J Gen Intern Med 1989 May-Jun;4(3):183-189.
8) Thys-Jacobs S, Starkey P, Bernstein D, Tian J. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Premenstrual Syndrome Study Group. Am J Obstet Gynecol 1998 Aug;179(2):444-452.
9) Whelan AM, Jurgens TM, Naylor H. Herbs, vitamins and minerals in the treatment of premenstrual syndrome: a systematic review. Can J Clin Pharmacol 2009 Fall;16(3):e407-29.