Calcium
Supplement 2: Calcium
What is it?
Calcium: Minerals are defined as chemical elements required as essential nutrients to maintain body functions1.
Calcium can be found in a variety of foods, including:
Dairy products, such as cheese, milk and yogurt
Dark green leafy vegetables, such as broccoli and kale
Fish with edible soft bones, such as sardines and canned salmon
Calcium-fortified foods and beverages, such as soy products, cereal and fruit juices, and milk substitutes2.
How does it work?
Calcium decreases with rising estrogen concentrations which leads to decrease in neurotransmitter synthesis and release, leading to decrease in serotonin levels, causing mood changes during PMS. The calcium effect on PMS is correlated to the production of serotonin and tryptophan metabolism.4
Calcium supplementation may act by resolving an underlying physiologic deficit, suppressing parathyroid hormone secretion, and, ultimately, reducing neuromuscular irritability and vascular reactivity. .
Recommended dose: ACOG recommends supplementation of 1.2 mg calcium daily to alleviate both physical and psychological PMS symptoms, especially reducing water retention and breast tenderness3.
What is the efficacy?
Methods: All three studies used randomized, double-blind designs to evaluate the effect of calcium supplementation on PMS symptoms. Sample sizes ranged from 39 to 466 women, with calcium doses between 500 mg and 1,200 mg per day, administered over 2 to 4 menstrual cycles. Interventions were compared against placebo, and in one study, also against fluoxetine.4,5,6
Results: Across all three studies, calcium supplementation significantly reduced PMS symptoms. There was a ~48% reduction in symptom severity by the third cycle in the calcium group, compared to ~30% in the placebo group. Significant improvements were noted in emotional and somatic symptoms over two cycles with 500 mg/day calcium (p ≤ 0.01). In the another study, calcium showed modest symptom improvement (effect sizes 0.10–0.44), though less effective than fluoxetine. Overall, calcium was consistently more effective than placebo.
Conclusion: Calcium supplementation—typically 500–1,200 mg daily—appears to be a well-tolerated, low‑risk, and effective option for reducing PMS symptoms, particularly mood-related issues like anxiety, depression, and emotional instability.
Side effects:
Short-term effects: Constipation, diarrhea, abdominal pain
Long-term effects: Kidney stones, Cardiovascular problems, colorectal neoplasms.7
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