PMDD in a teenager

A teenager with PMDD may have intense irritability, sadness, anxiety, anger, low motivation, trouble concentrating, sleep changes, headaches, breast tenderness or appetite changes before a period. Symptoms should improve at another point in the cycle; difficulties present all month may suggest depression, anxiety, attention problems or another health issue instead.

Puberty brings changing cycles, so a parent, caregiver or trusted adult can help record the first day of bleeding, daily symptoms, school attendance, sleep and conflicts without blaming the teenager.

Listen without treating the symptoms as bad behaviour, keep routines flexible, and arrange a visit with a family doctor, paediatric clinician or gynaecology professional. The teenager should be included in the conversation. Treatment may involve psychological support, activity and sleep measures, or prescribed options such as the Combined Pill after an individual review.

Seek prompt care when symptoms repeatedly interfere with school, friendships, family life or self-care. Ask directly about self-harm or suicide if mood becomes frightening; urgent help is needed if the teenager has a plan, cannot stay safe, becomes severely confused or stops caring for basic needs. Contact emergency services or a crisis service immediately in that situation.

What pattern would support PMDD in this teenager? Could another condition or medicine be contributing? How can privacy and family support be balanced? Which treatments are appropriate at this age, and how should mood changes be monitored?