Abstract
BackgroundModerate to severe premenstrual syndrome (PMS) affects 8–20 percent of premenopausal women. Previous studies suggest that high dietary vitamin D intake may reduce risk. However, vitamin D status is influenced by both dietary vitamin D intake and sunlight exposure and the association of vitamin D status with PMS remains unclear.MethodsWe assessed the relation of plasma 25-hydroxyvitamin D (25OHD), total calcium and parathyroid hormone levels with risk of PMS and specific menstrual symptoms in a case–control study nested within the prospective Nurses’ Health Study II. Cases were 401 women free from PMS at baseline who developed PMS during follow-up (1991–2005). Controls were women not experiencing PMS (1991–2005), matched 1:1 with cases on age and other factors. Timed luteal phase blood samples were collected between 1996 and 1999 from cases and controls. We used conditional logistic regression to model the relation of 25OHD levels with risk of PMS and individual menstrual symptoms.ResultsIn analyses of all cases and controls, 25OHD levels were not associated with risk of PMS. However, results differed when the timing of blood collection vs. PMS diagnosis was considered. Among cases who had already been diagnosed with PMS at the time of blood collection (n = 279), 25OHD levels were positively associated with PMS, with each 10 nmol/L change in 25OHD associated with a 13% higher risk. Among cases who developed PMS after blood collection (n = 123), 25OHD levels were unrelated to risk of PMS overall, but inversely related to risk of specific menstrual symptoms. For example, each 10 nmol/L increase was associated with a significant 21% lower risk of breast tenderness (P = 0.02). Total calcium or parathyroid hormone levels were unrelated to PMS.Conclusions25OHD levels were not associated with overall risk of PMS. The positive association observed among women already experiencing PMS at the time of 25OHD measurement is likely due to confounding by indication related to use of dietary supplements to treat menstrual symptoms. Results from prospective analyses, which were less likely influenced by this bias, suggest that higher 25OHD levels may be inversely related to the development of specific menstrual symptoms.
Highlights
Moderate to severe premenstrual syndrome (PMS) affects 8–20 percent of premenopausal women
We evaluated associations separately by timing of 25-hydroxyvitamin D (25OHD) measurement vs. PMS diagnosis (Table 3). 25OHD levels were higher in cases who had already been diagnosed with PMS as the time of their blood collection (67.9 nmol/L) as compared to controls (64.8 nmol/L), and 25OHD was positively associated with PMS risk
Among women who had already been diagnosed with PMS by the time of blood collection, 25OHD levels were positively associated with PMS risk
Summary
Moderate to severe premenstrual syndrome (PMS) affects 8–20 percent of premenopausal women. Multiple studies have reported inverse associations between vitamin D status and risk of depression, [4,5] fibromyalgia, [6] dysmenorrhea, [7] and uterine fibroids [8,9] It remains unknown whether vitamin D may be useful for preventing or treating PMS. Our research group previously reported that women who consumed approximately 400 IU of vitamin D per day had a significant 40% lower risk of being diagnosed with PMS in the 2–4 years, as compared to women consuming approximately 100 IU/day [10] This association was present even after adjustment for calcium, which has been shown to beneficially impact PMS symptoms in some [11,12,13,14] but not all studies [15]. Assessing dietary vitamin D intake alone may be insufficient to accurately characterize a woman’s vitamin D status
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