Current best practices for diagnosing and treating menstrually‐related mood disorders

Clinical observation and lived experience have long suggested that changes in ovarian steroid hormones (estradiol, progesterone) can affect mood and behavior across the menstrual cycle. Only recently, however, has research begun to systematically characterize these patterns. A growing body of work suggests that some females have heightened or atypical neural sensitivity to normal fluctuations in ovarian steroid hormones across the cycle (hormone sensitivity). These sensitivities are thought to underlie conditions such as premenstrual dysphoric disorder (PMDD) and premenstrual exacerbation of preexisting symptoms (PME). Although most research in this area has focused on adults, emerging studies suggest that similar patterns are also seen in adolescents, and understanding how these symptoms show up in younger patients can help clinicians recognize problems earlier and tailor treatment more effectively. Importantly, because hormone sensitivity could begin after menarche (the first menstrual cycle), adolescence represents a critical window for identifying and addressing these cyclical symptom changes.