Associate Professor of Epidemiology
Department of Public Health
University of Massachusetts

409 Arnold House
715 North Pleasant Street
Amherst, MA 01003-9304
ebertone@schoolph.umass.edu
413-577-1672 (phone)
413-545-1645 (fax)

AB, Harvard-Radcliffe College, 1994
SM, Harvard School of Public Health, 1996
ScD, Harvard School of Public Health, 1999

Current Research

I am currently investigating how a variety of factors affect the initial development of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) in two studies of premenopausal women. PMS and PMDD affect up to 20% of reproductive age women and are associated with levels of impairment comparable to those of other major affective disorders. The most common symptoms of PMS and PMDD include irritability, mood swings, anxiety, depression, breast tenderness, bloating, and headaches in the luteal phase of the menstrual cycle. While many pharmaceutical treatments for PMS and PMDD have been evaluated, all have significant limitations and none has a reported efficacy greater than 60-70%. Because of the substantial limitations of available treatments, it is important to identify ways to prevent the initial development of these disorders.

Nurses’ Health Study 2 Premenstrual Syndrome Sub-Study
This is a collaborative study with the Harvard School of Public Health, and a sub-study of the Nurses’ Health Study 2, an ongoing longitudinal epidemiologic study of women’s health. Sub-study participants include 1257 confirmed cases of moderate-to-severe PMS/PMDD and 2463 confirmed controls with minimal menstrual symptom experience. To our knowledge, this is the first prospective study of risk factors for PMS/PMDD and the largest, most comprehensive study of the etiology of these conditions conducted to date. In early studies, we have observed the following:

Dietary intake of 400 IU/day of vitamin D and 1200 mg/day of calcium from food sources reduced risk of incident PMS by 30-40%. http://www.ncbi.nlm.nih.gov/pubmed/15956003
Smoking, especially in adolescence and young adulthood, was positively associated with the development of PMS, with heavy smokers experiencing a significant 2.5-fold increase in risk compared to women who never smoked. http://www.ncbi.nlm.nih.gov/pubmed/18701443
Alcohol use was not strongly associated with increased risk of PMS or PMDD, though women who began drinking at a young age had a modestly higher risk. http://www.ncbi.nlm.nih.gov/pubmed/20044856
Body mass index, a measure of adiposity, was positively associated with risk of PMS, such that obese women (BMI ≥ 30 kg/m2) had a significant 60% increase in risk compared with lean women (BMI < 20.0 kg/m2). http://www.ncbi.nlm.nih.gov/pubmed/20874240

While we have learned a great deal from our initial work, additional studies of how dietary, lifestyle, hormonal and genetic factors interact in these debilitating conditions are essential. We are currently assessing whether plasma levels of 25-hydroxyvitamin D, total calcium and parathyroid hormone predict the future development PMS/PMDD.

UMass Vitamin D Status Study
This is a cross-sectional study of college-aged women in Western Massachusetts designed to assess the prevalence of vitamin D deficiency and evaluate health consequences of vitamin D deficiency. To date, 237 women age 18-30 have completed study questionnaires, provided a blood sample, had clinical measurements, and had a DEXA bone density scan. Recruitment for this project is ongoing. In preliminary studies in this population, we have observed the following:

Intake of at least 100 IU/day of vitamin D from food sources was associated with a significant 60% reduction in risk of PMS http://www.ncbi.nlm.nih.gov/pubmed/20398756
Fat mass is inversely associated with peak bone density, while lean mass is positively related to bone density. [in press]

Currently, we are investigating how plasma levels of vitamin D, B vitamins, and various minerals are related to bone density, asthma, depression, and body composition, as well as to PMS.

Additional study in these areas will substantially increase knowledge of the etiology of PMS/PMDD, and contribute to improved treatment options for these disorders, which substantially interfere with health and quality of life in for a large number of women of reproductive age.

Links:

Epidemiology Program: http://www.umass.edu/sphhs/bioepi/epi/

Center for Neuroendocrine Studies: http://www.umass.edu/cns/

Center for Research on Families: http://www.umass.edu/family

Nurses’ Health Studies: http://www.channing.harvard.edu/nhs/