What to know about PMDD in teenagers

PMDD symptoms appear in the days before a period and improve after bleeding starts or soon afterwards. Emotional changes may include marked irritability, sadness, anxiety, mood swings, anger, feeling overwhelmed or difficulty concentrating. Physical symptoms can include breast tenderness, bloating, headaches, tiredness and changes in sleep or appetite. The symptoms can interfere with school, relationships or daily activities. Other conditions, including depression or anxiety, can worsen around the cycle, so a clinician looks at the timing and pattern rather than relying on one difficult month.

Record mood, physical symptoms, periods, sleep, school impact and medicines each day for several cycles. A parent, trusted adult, school counsellor, family doctor or gynaecologist can help arrange care. Regular meals, movement, sleep routines and reducing stress may ease some symptoms, but they do not replace assessment when daily life is affected. Treatment options can include talking therapy, medicines or hormonal approaches; the choice should reflect symptoms, health history and the teenager’s preferences.

Get urgent help if a teenager has thoughts of suicide, self-harm, feels unable to stay safe, or experiences severe depression, panic or loss of control. Do not wait for the next period if safety is a concern. Contact emergency services or a local crisis service, and stay with the young person while help is arranged. A clinician should also review symptoms that persist throughout the cycle or suddenly become much worse.

Could the symptom pattern fit PMDD or another condition? How should we track symptoms? Which treatments suit a teenager? What side effects should we watch for? What support is available if mood symptoms become unsafe?