“My daughter just started her periods and has extreme mood swings. Is it normal in children?”

Premenstrual tension syndrome is different in teenagers. Some medications for PMS are natural and could be helpful.

Puberty is a complex genetic program and hormonal process of sexual maturation. A child goes through the hormonal process of sexual maturation to transition from childhood to adulthood. The average female starts puberty about the age of 10 years. The average menarche for a female is around 12 and 1/2 years though there is difference in different ethnic groups. African Americans start puberty much earlier (as early as 6 years) and menarche takes place around the age of 10 years. Changes in the pituitary hormones (LH, FSH) triggers the initiation of puberty. In a female Estrogen and progesterone levels increase to mediate the process of sexual development. During this sexual development, mood swings are common as the child is going through physical and hormonal changes. This is also a more confusing and conflicting time for the child. The sexual development culminates in menarche (menstrual cycle, also known as a period). This usually happens after 2 and h1/2 years after starting puberty. Once starting menstrual cycle the adolescent goes through more mood swings (emotional roller coaster) conflict and confusions. The child goes through a stressful period. They may experience, irritable, sadness, anger, nervousness, fatigue, sleep problems loneliness etc.. Their mood changes from being sad, angry and mean to joyfulness in a short period of time. This is period were there is intense struggle for self image and identity. There is more peer pressure they confide more with their peers and become distant from the parents in search of their own space. This transition time from childhood to adulthood may take a while but it will always come back to normal unless there is psychological issue beyond simple adolescent mood swings. These hormonal changes that are causing body changes are also bringing changes in brain neurotransmitters that can cause mood swings. Changes in Estrogen levels can lead to changes on serotonin and dopamine levels. This neurotransmitters are known to be involved in anxiety and depression. Occasionally undiagnosed hyperthyroidism (toxic thyroid gland may lead to symptoms that are similar to mania and ADHD. checking thyroid hormone and cortisol cortisol levels are important.
Going back to your daughter: Your daughter is going through puberty, a process of sexual development to become an independent adult. This is a complex maturation process that involves development of breast tissue, pubic hair, body odor, acne, growth spurt, ovarian and uterine growth and finally menarche ( menstrual cycle). These changes are triggered by hormone changes from the brain (LH, FSH) and ovarian Estrogen, Progesterone) glands. These process of sexual maturation can be overwhelming and confusing to a young adolescent. The hormones of puberty mainly estrogen and to some extent progesterone for females and testosterone in males can trigger changes in brain neurotransmitters, mainly, serotonin and dopamine. Serotonin is known to be involved in mood swings such as anger, frustrations, irritability, sadness anxiety etcetera. During this transition period from childhood to adolescence many children will experience mood swings of sadness, irritability, anger, frustration, loneliness to joyfulness in a short period of time. This can create a lot of challenge and pressure for you and the family. This process is also a very challenging and overwhelming period for your daughter as she goes through these physical and hormonal changes. She is starting to develop her own self image (self-conscious), ideas, and independent thinking. She may be more confused , conflicted and embarrassed about these changes. At time she is torn between being a child and being accepted as an adult. She may do this by pushing you and every one around in trying to have her own autonomy (space). However these changes and mood swings are part of normal transitioning process from childhood to adult hood that most of us would go through. One day these things will pass and your sweet daughter and the family dynamics will be in harmony and life will continue as before. Remember you may have gone through these processes your self. You should reassure her that this is a normal process and that girls have to go through this and that things will be fine eventually. You should work with her closely and openly. You should not be critical and no blaming. You should allow her some freedom (space). You should also allow her to confide with her peers and you should try to know them. You also should address all her concerns and respect her privacy reasonably, as to put more trust on you. Allow her to sleep enough time (at list 8 hours a day). Try to involve her in regular sports activity. Let her eat healthy balanced diet with plenty of fresh fruits and vegetables with adequate micronutrients. Calcium supplement of 1200mg daily and vitamin of 2000units (50 microgram) a day would benefit her.
Please be assured that this will pass with time and that your beautiful sweet girl will be a wonderful girl the way you brought her up and the mood swings will slowly fade away and you family dynamics will be restored to your liking.
However if the mood swings take a long time to resolve and if they become unmanageable or look extreme that it is interfering with her life you should seek medical help and a counseling. There may be an element of depression, anxiety or other mood disorders that could not be explained by simple adolescent mood swings. At that stage, psychological counseling and medical intervention may be necessary. But I am very hopeful that your daughter has simple pubertal mood swings and that, with time thing will resolve on their own. Thyroid and cortisol abnormalities should be excluded by her doctor. Please talk to her doctor and work with the doctor closely. Let your doctor check her thyroid and cortisol level to rule out thyrotoxicosis and excess cortisol.
Good Luck.

It is very frequent that girls, during puberty, experience extreme mood swings.However, if they affect their relationships with family, friends, or school performance, it is recommended to seek advice from a pediatrician trained in behavioral issues.

First 6-12 months of periods can cause cramps, irregular flow, and breast tenderness as the hormone levels fluctuate. Same for mood swings, especially if there is some underlying depression, anxiety, or sleep problems. If you are concerned, best to discuss it with your primary care providers. If this persists, often low-dose birth control pills can balance these hormone swings.

Stuart Brink, MD

Yes, it can be normal. However, you may wish to have your daughter seen by her primary care provider to make sure that there isn't something else going on that she would not want to talk to you about.