PREMENSTRUAL ISSUES IN ADOLESCENTS

Katie, a 15-year-old, had suffered from progressive emotional disturbances ever since her periods began three years before coming to see me. About one week prior to each period, her anxiety levels would rise dramatically and she would become irritable, volatile and have great difficulty sleeping. On the first day of her period, relief would come and she would be back to normal, fearing the next go-round 28 days later.

During freshman year in high school, several events began to distress Katie and socially isolate her. Doctors tended to minimize her problems, telling her this was normal in teenage girls. Eventually, in reaction to her stress and the suffering the PMS would cause, Katie jumped off a bridge in a suicide attempt. She was then put on progressively higher doses of an SSRI (anti-depressant) – which caused her depression, suicidal impulses and wildness to evolve into a continuous pattern – until she begged to be taken off it. It was at this time that I first met Katie and her parents.

A neuroendocrine consultation led to a new hypothesis. Due to her family history of both mood disorders and significant PMS and post partum depressions, Katie's brain was markedly sensitive to the effects that her reproductive hormones - estrogen and progesterone - had on her emotions. She was prescribed natural progesterone, with doses administered at a key time in her cycle.

In her first menstrual cycle on the progesterone, Katie experienced a dramatic resolution of her anxiety, as well as improved sleep and no severe depression. For the first time in years, she had a positive attitude relating to her menstrual cycle.

This case illustrates a common theme in clinical neuroendocrinology. When adolescent girls start menstruating, the first several cycles can occur without normal ovulation and thus without adequate progesterone levels (but with normal levels of estrogen). This unopposed estrogen state is often highly agitating, commonly in individuals with markers of a "different" brain substrate - for example, a family history of major mood disorders, a distant history of concussion or even left-handedness. Given in the right dose with the right timing, natural progesterone brings dramatic relief to these individuals, as well as those with heightened forms of PMS and even psychotic symptoms.