What should doctors know about PMS and PMDD in teenagers?

Background: Premenstrual disorders (PMDs), including premenstrual syndrome and premenstrual dysphoric disorder, are common conditions that may substantially affect adolescents' physical and psychological well-being. However, their presentation and management during adolescence are complicated by reproductive-axis maturation, overlap with other medical conditions, and limited adolescent-specific evidence. This review aimed to provide an interdisciplinary perspective on PMDs in adolescents, integrating biological, psychological, developmental, clinical, and sociocultural aspects. Methods: A structured narrative review was conducted. Publications addressing the neuroendocrine and developmental mechanisms, clinical manifestations, psychosocial consequences, diagnosis, and treatment of PMDs were considered, with adolescent-specific evidence prioritized where available. Results: Current evidence suggests that PMDs are associated with altered sensitivity to physiological ovarian steroid fluctuations and their neuroactive effects rather than abnormal circulating hormone concentrations alone. In adolescents, PMDs may present with diverse somatic, affective, cognitive, and behavioral symptoms and are associated with impaired quality of life, school functioning, interpersonal relationships, and psychological well-being. Diagnostic assessment remains challenging because symptoms may overlap with normal pubertal changes and psychiatric disorders. Prospective monitoring of symptom cyclicity and functional impairment is therefore essential. Pharmacological treatments, particularly selective serotonin reuptake inhibitors and selected combined oral contraceptives, represent important therapeutic options, while psychological, lifestyle, physical activity, and physiotherapeutic interventions may provide additional benefits. However, most treatment evidence is derived from adult populations. Conclusions: PMDs in adolescents should be conceptualized as multidimensional conditions requiring an interdisciplinary approach integrating gynecological, psychiatric, psychological, endocrinological, primary care, and lifestyle perspectives. Greater recognition and developmentally appropriate assessment may facilitate earlier diagnosis and individualized management. Further prospective, adolescent-specific research is needed to clarify the biological and psychosocial determinants of PMDs and establish evidence-based strategies for their multidisciplinary management.

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