Teen Premenstrual Dysphoric Disorder Treatment

While almost all women experience at least some form of premenstrual syndrome (PMS), some teens experience premenstrual dysphoric disorder (PMDD). Rather than minor mood swings, this condition is characterized by major mood swings that appear more like anxiety and depression. Symptoms tend to be at their worst 10 days before the start of a period, as well as in the days right after it starts.

In some cases, PMDD is considered a form of depression triggered by the hormonal changes associated with menstruation. In other cases, a teen may have an underlying depressive disorder that is worsened by the menstrual cycle. PMDD symptoms are much worse than the traditional symptoms of moodiness and irritability commonly associated with PMS.

What Does a Premenstrual Dysphoric Disorder Look Like?

  • Anywhere from five to 10 percent of women have premenstrual dysphoric disorder. Symptoms begin as early as two weeks before menstruation begins, triggering intense depression, mood swings, and anxiety with no identifiable cause.
  • Up to 75 percent of women have both physical and psychological symptoms when they are premenstrual. Women with PMDD have symptoms that are so significant they struggle with school or work and have trouble leading normal lives. PMDD requires intensive treatment.
  • It is not uncommon for teens with PMDD to have co-occurring mood disorders. Teens who have severe symptoms during their menstrual cycles may have lesser symptoms during the rest of the month. Careful and thorough evaluation is necessary to ensure teens receive appropriate care.

Signs of a Premenstrual Dysphoric Disorder

Speech difficulties

Severe mood swings

Paranoia and anxiety

Anxiety and depression

Feeling intense shame about eating

Withdrawing socially or isolating

Stomach cramping or aching

Bloating or gastrointestinal issues

Eating quickly or secretly

Appetite changes

Stomach cramps and/or pain

Inflammation and/or joint pain

Loss of muscle strength

Extreme, intense fatigue

What Causes Premenstrual Dysphoric Disorder?

Premenstrual dysphoric disorder is unique in that all of the biological and psychological symptoms associated with it can be directly tied to the menstrual cycle. Medical conditions that impact the menstrual cycle, like pregnancy or menopause, cause PMDD symptoms to stop. This doesn’t mean underlying mood disorders will go away as well.

Hormone Sensitivity – Scientists have discovered that women with PMDD do not have abnormal hormone levels during their cycles. They are instead hypersensitive to the body’s natural changes. This is believed to be genetic.

Brain Differences – Some research has shown that some women with PMDD may not be transmitting serotonin properly. Serotonin is responsible for quite a number of processes, both physical and psychological. This disruption may impact a person’s levels of depression and anxiety. Researchers are not yet sure if any other neurotransmissions are impacted.

Co-Occurring Disorders – Progesterone and estrogen fluctuate during menstruation, and those ups and downs may intensify pre-existing mental health conditions. Almost 50 percent of women with PMDD have another disorder that is made worse when they are premenstrual.

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Teen Anxiety Treatment | Paradigm San Francisco


of women who menstruate have PMS symptoms


of women who menstruate have PMDD


of women with PMDD will attempt suicide

How Can I Help My Teen with Premenstrual Dysphoric Disorder?

Period Tracking – Your teen will need to learn to track their period. This won’t change the symptoms of PMDD, but knowing when they may begin will help them to feel like they have more control over their life. Tracking may also help them to determine when they should begin taking any medications that will help alleviate their symptoms. Journaling is a great way to identify symptoms as well as negative thinking patterns.

Establish Healthy Habits – Healthy lifestyle habits can go a long way in moderating the symptoms associated with PMDD. This means getting at least 8 hours of sleep per night, eating a healthy diet, and getting regular exercise. Exercise releases endorphins that can help boost your teen’s emotions, self-esteem, and confidence levels.

Poor diet can exacerbate the symptoms of both PMS and PMDD, so balanced nutrition and sometimes even supplementation can help. It is important for everyone to try to establish healthy habits together. It can be incredibly frustrating for a teenager to feel as though they are making these changes alone.

Relaxation – Teens with PMDD experience high levels of stress. While having home responsibilities is important, it is important to keep your teen’s age and general struggles in mind. School work and social pressure may be contributing to your teen’s symptoms of depression, which will get even worse when the menstrual cycle starts. Finding ways to keep your teen calm and relaxed all month long will help keep their emotions in check.

What Type of Teen Premenstrual Dysphoric Disorder Treatment Are Available?

Because PMDD is caused by changes in neurotransmission, the primary course of treatment is medication. Teens will also receive therapy to help them better understand and control their depression and its related thought patterns. In most case, therapy and lifestyle changes are long-term forms of premenstrual dysphoric disorder treatment, while medications are prescribed only for use during the premenstrual portion of the cycle.

Alternative Premenstrual Dysphoric Disorder Treatment

While a lot of natural alternative treatments seem as though they could be effective for PMDD, none are approved by the FDA. The main reason herbal supplements aren’t recommended is because they are not regulated the same way pharmaceutical companies are. There is no way to know if herbal supplement companies are using a standard source.

Natural or herbal remedies do not work the same for everyone, making them difficult to study. St. John’s wort, ginkgo, chasteberry, vitamin B6, calcium, and magnesium have all received limited research. Do not take any herbal supplements without talking to a doctor first, especially if you are already taking SSRIs. There are known drug interactions that could cause serotonin syndrome.

Stress Management

Stress plays a pivotal role in the severity of PMDD symptoms. It is impossible for any of us to completely avoid stress, but proper stress management techniques can help alleviate some of the symptoms. Stress management techniques vary from person to person, but most involve avoiding negative thought patterns, therapies, and strategies for staying calm and relaxed.


Selective serotonin reupate inhibitors (SSRIs) are the most common category of drug for PMDD, mostly because they have the fewest number of side effects. They work by slowing the way serotonin is used, allowing it to stay in the brian longer. This allows for better mood regulation.

Your teen’s doctor may try other antidepressants if SSRIs don’t work. Even though PMDD is not caused by abnormal hormones, the use of birth control sometimes interrupts the signals that trigger PMDD. Birth control and other estrogen-based therapies cause more side effects, including weight gain and additional mood disorders, so they are not as commonly used.

Teen Premenstrual Dysphoric Disorder Treatment at Paradigm San Francisco

It is critical for a teen with PMDD to receive a proper diagnosis as soon as possible, whether the condition stands alone or with a co-occurring disorder. Teens who only have PMDD often do well with continued outpatient therapy and medication use after their initial treatment program. Those with co-occurring disorders need a more comprehensive treatment plan. Our goal at Paradigm San Francisco is to better understand the full picture.

Taking a Holistic Approach

Everyone at Paradigm San Francisco places great emphasis on ensuring teens are properly diagnosed. Our process seems extensive, but it ensures each teen’s overall physical, mental, and emotional needs are considered. While PMDD can occur in early adolescence, it is more common in older teens and those closer to the age of 20. Teens diagnosed with PMDD need to be monitored for changes in their symptoms, as they commonly evolve. We work hard to make sure every teen has a complete, individualized treatment plan that supports overall wellness.

Life After Treatment

Teens in our program spend a lot of time educating themselves about the relationships between their physical and mental health. This knowledge gives them the tools they need to help themselves during and after their program. We also work closely with families so everyone better understands PMDD and its unique challenges, including anxiety, fatigue, physical pain, and unhealthy thought processes.

Paradigm Malibu is an exceptional program with an incredible staff. They have goals and strategies and a process to help the kids to overcome their struggles. I highly recommend!

– Kenan K.

Frequently Asked Questions About Teen Premenstrual Dysphoric Disorder

How do I know if my daughter has Premenstrual Dysphoric Disorder?

It can be difficult to diagnose PMDD without professional intervention. This is because PMDD symptoms mimic quite a number of other disorders, including PMS, chronic fatigue, depression, and anxiety. Keep a list or journal of your teen’s symptoms so you can discuss them with their doctor.

Your daughter should be journaling their symptoms as they perceive them as well. She should note when they start, what feels “off,” what feels different than normal, and how bad they feel the symptoms are. Note any medications your daughter takes, what age they were when their period started, and any other medical history they have.

I’m feeling better. Can I stop going to therapy?

We don’t recommend you stop going to therapy. As a matter of fact, teens who feel better should continue going to therapy despite their progress. Your therapist can help you to make the most of the progress you’ve made, which will make it easier for you to manage your PMDD symptoms if they come back. It is common for PMDD symptoms to return more severely if left untreated.

The same is true for medication. Talk to your doctor before attempting to stop any medications you are taking to control your PMDD, especially antidepressants. If it is truly safe for you to stop taking your meds, your doctor will help you to taper off without withdrawal symptoms.

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