Case of a Girl with Irritability and Mood Swings with Her Periods

  • Alexandra C. Nevin Lam
  • Simone Vigod


Premenstrual syndrome and its more severe counterpart, premenstrual dysphoric disorder, are characterized by somatic, behavioral, and affective symptoms in the luteal phase of the menstrual cycle. Adolescents are particularly susceptible to these conditions, so attention to their management in youth is key. Using a case-based approach, we highlight the importance of using a validated adolescent screening tool in assessment. Prospective evaluation should be used to establish either diagnosis, and clinicians should rule out the possibility that symptoms are better explained by another psychiatric disorder, a medication or drug of abuse, or another medical condition. We also discuss the fundamentals of treatment, including the importance of menstrual cycle education; self-care techniques such as diet, exercise, and sleep; and non-pharmacologic and pharmacologic treatments, using adolescent-specific evidence where available. A stepwise management approach based on symptom severity and functional impairment will aid the clinician in effectively treating these conditions while minimizing side effects.


Premenstrual syndrome PMS Premenstrual dysphoric disorder PMDD Adolescents 


  1. 1.
    Yonkers KA, O’Brien PM, Eriksson E. Premenstrual syndrome. Lancet. 2008;371(9619):1200–10.CrossRefGoogle Scholar
  2. 2.
    Rapkin AJ, Mikacich JA. Premenstrual syndrome and premenstrual dysphoric disorder in adolescents. Curr Opin Obstet Gynecol. 2008;20:455–63.CrossRefGoogle Scholar
  3. 3.
    Steiner M, Peer M, Pavlova E, et al. The premenstrual symptoms screening tool revised for adolescents (PSST-A): prevalence of severe PMS and premenstrual dysphoric disorder in adolescents. Arch Womens Ment Health. 2011;14:77–81.CrossRefGoogle Scholar
  4. 4.
    Vichnin M, Freeman EW, Lin H, Hillman J, Bui S. Premenstrual syndrome (PMS) in adolescents: severity and impairment. J Pediatr Adolesc Gynecol. 2006;19:397.CrossRefGoogle Scholar
  5. 5.
    Allen LM, Nevin Lam AC. Premenstrual syndrome and dysmenorrhea in adolescents. Adolesc Med State Art Rev. 2012;23(1):139–63.PubMedGoogle Scholar
  6. 6.
    Vigod SN, Frey BN, Soares CN, Steiner M. Approach to premenstrual dysphoria for the mental health practitioner. Psychiatr Clin North Am. 2010;33(2):257–72.CrossRefGoogle Scholar
  7. 7.
    Derman O, Kanbur NO, Tokur TE, Jutluk T. Premenstrual syndrome and associated symptoms in adolescent girls. Eur J Obstet Gynecol. 2004;116:201–6.CrossRefGoogle Scholar
  8. 8.
    Clecker-Smith CS, Doughty AS, Grossman JA. Premenstrual symptoms. Prevalence and severity in an adolescent sample. J Adolesc Health. 1998;22:403–8.CrossRefGoogle Scholar
  9. 9.
    Tadakawa M, Takeda T, Monma Y, Koga S, Yaegashi N. The prevalence and risk factors of school absenteeism due to premenstrual disorders in Japanese high school students—a school-based cross-sectional study. BioPsychoSocial Medicine. 2016;10:13–9.CrossRefGoogle Scholar
  10. 10.
    Hantsoo L, Epperson CN. Premenstrual dysphoric disorder: epidemiology and Treatment. Curr Psychiatry Rep. 2015;17(11):87.CrossRefGoogle Scholar
  11. 11.
    Timby E, Backstrom T, Nyberg S, Stenlund H, Wihlback AC, Bixo M. Women with premenstrual dysphoric disorder have altered sensitivity to allopregnanolone over the menstrual cycle compared to controls—a pilot study. Psychopharmacology (Berl). 2016;233(1):2109–17.CrossRefGoogle Scholar
  12. 12.
    Comasco E, Sundstrom-Poromaa I. Neuroimaging the menstrual cyle and premenstrual dysphoric disorder. Curr Psychiatry Rep. 2015;17(10):77.CrossRefGoogle Scholar
  13. 13.
    Eisenlohr-Moul TA, Rubinow DR, Schiller CE, Johnson JL, Leserman J, Girdler SS. Histories of abuse predict stronger within-person covariation of ovarian steroids and mood symptoms in women with menstrually related mood disorder. Psychoneuroendocrinology. 2016;67:142–52.CrossRefGoogle Scholar
  14. 14.
    Kendler KS, Gardner CO, Prescott CA. Toward a comprehensive developmental mode for major depression in women. Am J Psychiatry. 2002;159(7):1133–45.CrossRefGoogle Scholar
  15. 15.
    Peterson N, London ED, Liang L, Ghahremani DG, Gerards R, Goldman L, Rapkin AJ. Emotion regulation in women with premenstrual dysphoric disorder. Arch Womens Ment Health. 2016;19(5):891–8.CrossRefGoogle Scholar
  16. 16.
    Halbreich U. The diagnosis of premenstrual syndromes and premenstrual dysphoric disorder—clinical procedures and research perspectives. Gynecol Endocrinol. 2004;19:320–34.CrossRefGoogle Scholar
  17. 17.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: Author; 2013.CrossRefGoogle Scholar
  18. 18.
    Chau JP, Chang AM. Effects of an educational programme on adolescents with premenstrual syndrome. Health Educ Res. 1999;14:817–30.CrossRefGoogle Scholar
  19. 19.
    Nevatte T, O’Brien PM, Backstrom T, et al. ISPMD consensus on the management of premenstrual disorders. Arch Womens Ment Health. 2013;16:279–91.CrossRefGoogle Scholar
  20. 20.
    Endicott J, Nee J, Harrison W. Daily Record of Severity of Problems (DRSP): reliability and validity. Arch Womens Ment Health. 2006;9:41.CrossRefGoogle Scholar
  21. 21.
    Samadi Z, Taghian F, Valiani M. The effects of 8 weeks of regular aerobic exercise on the symptoms of premenstrual syndrome in non-athlete girls. Iran J Nurs Midwifery Res. 2013;18(1):14–9.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Dante G, Facchinetti F. Herbal treatments for alleviating premenstrual symptoms: a systematic review. J Psychosom Obstet Gynaecol. 2011;32(1):42–51.CrossRefGoogle Scholar
  23. 23.
    Kleinstauber M, Witthoft M, Hiller W. Cognitive-behavioral and pharmacological interventions for premenstrual syndrome or premenstrual dysphoric disorder: a meta-analysis. J Clin Psychol Med Settings. 2012;19(3):308–19.CrossRefGoogle Scholar
  24. 24.
    Jasuja V, Purohit G, Mendpara S, Palan BM. Evaluation of psychological symptoms in premenstrual syndrome using PMR technique. J Clin Diagn Res. 2014;8(4):BC01–3.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Bluth K, Gaylord S, Nguyen K, Bunevicius A, Girdler S. Mindfulness-based stress reduction as a promising intervention for amelioration of premenstrual dysphoric disorder symptoms. Mindfulness (NY). 2015;6(6):1292–302.CrossRefGoogle Scholar
  26. 26.
    Brown J, O’Brien PM, Marjoribanks J, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2009;(6):CD001396.Google Scholar
  27. 27.
    Shah NR, Jones JB, Aperi J, Shemtov R, Karne A, Borenstein J. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder: a meta-analysis. Obstet Gynecol. 2008;111:1175–82.CrossRefGoogle Scholar
  28. 28.
    Yonkers KA, Kornstein SG, Gueorguieva R, Merry B, Van Steenburgh K, Alternus M. Symptom-onset dosing of sertraline for the treatment of premenstrual dysphoric disorder. JAMA Psychiat. 2015;72(10):1037–44.CrossRefGoogle Scholar
  29. 29.
    Cipriani A, Zhou X, Del Giovane C, et al. Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. Lancet. 2016;388(10047):881–90.CrossRefGoogle Scholar
  30. 30.
    Silber TJ, Valadez-Meltzer A. Premenstrual dysphoric disorder in adolescents: case reports of treatment with fluoxetine and review of the literature. J Adolesc Health. 2005;37(6):518–25.CrossRefGoogle Scholar
  31. 31.
    Nur MM, Romano ME, Siqueira LM. Premenstrual dysphoric disorder in an adolescent female. J Pedatr Adolesc Gynecol. 2007;20(3):201–4.CrossRefGoogle Scholar
  32. 32.
    Yonker KA, Brown C, Pearlstein TB, Foegh M, Sampson-Landers C, Rapkin A. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol. 2005;106:492–501.CrossRefGoogle Scholar
  33. 33.
    Pearlstein TB, Bachmann GA, Zacur HA, Yonkers HA. Treatment of premenstrual dysphoric disorder with a new drospirenone-containing oral contraceptive formulation. Contraception. 2005;72:414–21.CrossRefGoogle Scholar
  34. 34.
    Coffee AL, Kuehl TJ, Willis S, Sulak PJ. Oral contraceptives and premenstrual symptoms: comparison of a 21/7 and extended regimen. Am J Obstet Gynecol. 2006;195:1311–9.CrossRefGoogle Scholar
  35. 35.
    Reid R, Leyland N, Wolfman W, et al. SOGC clinical practice guidelines: oral contraceptives and the risk of venous thromboembolism: an update: no 252. Int J Gynaecol Obstet. 2010;112:252–6.CrossRefGoogle Scholar
  36. 36.
    ACOG American College of Obstetricians and Gynecologist. ACOG practice bulletin: premenstrual syndrome. Obstet Gynecol. 2000;15:1–19.Google Scholar

Suggested Reading

  1. ACOG Practice Bulletin 2000;15:1–19.Google Scholar
  2. Arch Womens Ment Health 2011;14(1):77–81 (PSST-A).Google Scholar
  3. Life (period and symptom tracker available at the App Store by Lovetap LLC) (DRSP sheet)

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyNorth York GeneralTorontoCanada
  2. 2.Reproductive Life Stages Program, Women’s Mental Health ProgramWomen’s College HospitalTorontoCanada

Personalised recommendations