Red flags & when to go in person for Premenstrual Syndrome (PMS) / PMDD - Management

Audience: pediatric

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) cause physical and emotional symptoms before a girl's period. These symptoms may include mood changes, cramps, and fatigue. Many girls manage these symptoms with lifestyle changes and support. However, some signs mean you should see a healthcare provider in person. These include very severe mood changes, thoughts of self-harm, or symptoms that stop daily activities. Telemedicine can help with education, symptom tracking, and general advice. But it cannot replace in-person exams or urgent care when symptoms are severe. Knowing when to seek in-person care helps keep girls safe and healthy.

Red flags — go in person / ER

• Severe mood changes such as intense sadness, anger, or anxiety that disrupt daily activities — seek in-person mental health support immediately.
• Thoughts of self-harm or harming others — go to emergency care or call emergency services right away.
• Sudden, severe abdominal pain or heavy bleeding — visit an emergency room or urgent care center promptly.

What telemedicine can do

• Providing education about PMS and PMDD symptoms and management.
• Helping track symptom patterns and changes over time.
• Offering general advice on lifestyle and coping strategies.
• Assessing when symptoms may require in-person evaluation.

What telemedicine cannot do

• Performing physical examinations or diagnostic tests.
• Managing severe mental health crises or emergencies.
• Prescribing or adjusting medications without in-person assessment when necessary.
• Providing urgent care for sudden severe symptoms.

What is PMS and PMDD?

PMS includes common symptoms like mood swings, cramps, and tiredness before a period. PMDD is a more severe form with stronger mood and physical symptoms that affect daily life. Both happen due to changes in hormones during the menstrual cycle.

Common Symptoms to Watch For

\1

These symptoms usually improve once the period starts.

When to Seek In-Person Care

Go to a healthcare provider if you notice:

How Telemedicine Can Help

Telemedicine is useful for:

It is not a replacement for physical exams or emergency care.

Managing Symptoms at Home

Simple steps may help reduce symptoms:

Preparing for a Telemedicine Visit

Before your visit, try to:

After Your Telemedicine Visit

Follow the advice given, such as lifestyle changes or symptom tracking. If symptoms worsen or new concerns arise, seek in-person care promptly. Keep a record of your symptoms and any treatments tried.

How to prepare for your tele-visit

• Write down all symptoms experienced, including mood and physical changes.
• Note the timing of symptoms in relation to menstrual cycle.
• List any current medications, supplements, or treatments.
• Prepare questions or concerns to discuss with the healthcare provider.
• Ensure a private, quiet space for the telemedicine visit.

After your tele-visit

• Follow recommended lifestyle changes or treatments.
• Continue to track symptoms and mood daily.
• Seek in-person care if red flag symptoms develop or worsen.
• Schedule follow-up appointments as advised.
• Reach out to trusted adults or mental health professionals if feeling overwhelmed.

FAQs

What is the difference between PMS and PMDD?

PMS includes common symptoms like mood swings and cramps before a period. PMDD is a more severe form that causes intense mood changes and physical symptoms that interfere with daily life.

Can telemedicine diagnose PMS or PMDD?

Telemedicine can help assess symptoms and provide education, but a full diagnosis often requires an in-person evaluation to rule out other causes.

When should I see a doctor in person?

If symptoms are very severe, include thoughts of self-harm, or if you have sudden severe pain or bleeding, you should seek in-person medical care immediately.

How can I manage symptoms at home?

Regular exercise, a healthy diet, good sleep, and stress reduction techniques can help manage symptoms. Talking with trusted adults or counselors is also important.

Is it normal to feel very sad or angry before my period?

Mood changes are common before periods, but if feelings are very strong or interfere with daily life, it is important to talk to a healthcare provider.

Sources

1. Premenstrual Syndrome (PMS) — MedlinePlus, U.S. National Library of Medicine.
2. Premenstrual Dysphoric Disorder — American Academy of Pediatrics.
3. Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) — Mayo Clinic.
4. Mental Health and PMS — Centers for Disease Control and Prevention (CDC).

This telemedicine guidance is for educational purposes only and is not a substitute for professional in-person medical care. If you experience severe or concerning symptoms, please seek immediate medical attention.