Identify data provided in your chosen case and any additional data needed.

Objective findings.

Identify findings provided in your chosen case and any additional data needed.

Describe the rationale for each test or intervention with supporting references.

Describe the rationales for your choice of each diagnosis with supporting references.

Describe rationales and supporting references for each.

Social Determinants of Heath (SDoH) for your chosen case.

Describe rationales and supporting references for each.

Symptoms begin a few days prior to the menstrual period and are relieved after three days, making her miss school and leave her usual activities. She denies that she is depressed and refuses to take sertraline, which a psychiatrist had prescribed.

To further clarify the diagnostic impression, additional data should consist of a detailed symptom diary of at least two to three menstrual cycles, psychosocial stressors, sleep and appetite patterns, and a family history of psychiatric or gynecologic disorders will be necessary.

Pelvic examination revealed normal results, such as a non-tender uterus and adnexa, no masses, and intact external genitalia. Although the physical manifestations are non-pathological, additional mental status assessment, investigation of possible hirsutism, acne, or review of growth patterns would provide clues to potential endocrine or mood problems.

This supplementary information is crucial for making a conclusive clinical profile that would enable proper diagnosis.

Thyroid-stimulating hormone (TSH) test is also taken to eliminate hypothyroidism, which can be confused with depressive symptoms and menstrual symptoms.

Complete metabolic panel (CMP) evaluates the problem in the kidney and liver with a disrupted electrolyte balance that may be hindered by prolonged or heavy menses. Some of the hormonal tests should also be ordered to detect any possible hyperandrogenism that accompanies polycystic ovarian syndrome (PCOS), which includes total testosterone, free testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS).

To check the presence of any anatomic abnormalities or a specific polycystic shape of the uterus and ovaries that can be the reason for the abnormal bleeding and hormonal imbalance, a pelvic ultrasound is required.

Insulin resistance should be checked by measuring the hemoglobin A1C level, mainly due to a high BMI and possible PCOS (Eyth et al., 2025). Also, urine tests, such as urinalysis and pregnancy tests, will be necessary to exclude the possibility of urinary tract infections or pregnancy, which are not likely to be present.

Lastly, it would be advisable to screen her against sexually transmitted infections since they can occasionally result in discomfort in the pelvic region. These diagnostic tests give a balanced hormonal, metabolic and gynecologic assessment.

The first differential diagnosis is Premenstrual Dysphoric Disorder (PMDD) because of the timing of the appearance and cyclical nature of the emotional and physical responses to Stephanie’s menstrual cycle. The fact that she experienced severe mood swings and, anxiety and difficulty with functioning months before her period also fits the diagnostic criteria of PMDD (Mishra et al., 2023).

These symptoms clear up soon after menstruation begins, and this makes an association with the luteal phase characteristic of PMDD. Her refusal to be considered a depressed person could be caused by her ignorance of the hormonal basis of PMDD. PMDD can also be backed by the high degree of social and academic disruption that occurs during her menstrual periods.

Polycystic Ovary Syndrome (PCOS)

The second possible differential diagnosis is polycystic ovary syndrome, which is a possibility given that Stephanie is overweight and has recent irregular menstrual periods. PCOS can be linked to hormone problems where the presence of abnormally high androgen levels can lead to idiosyncratic periods, mood fluctuations as well as insulin resistance (Shukla et al., 2025).

Though none of the physical symptoms, such as hirsutism or acne, are noted, a pelvic ultrasound and hormonal analysis may prove the existence of cystic ovaries or biochemical hyperandrogenism. It is important to diagnose the disease as early as possible in adolescents to prevent further complications like infertility or type 2 diabetes. This renders PCOS a significant variable in the entire diagnostic evaluation.

Primary Dysmenorrhea

Primary dysmenorrhea is a gynecologic condition that affects teenagers and can justify the prohibitive pain that Stephanie experiences in the pelvis and back during menstruation. Painful uterine cramps mark it as a result of the release of prostaglandins and are usually experienced in the absence of pelvic pathology.

Although her symptoms are severe because they involve intense pain, they are also emotional and follow a cycle, which can indicate overlapping with PMDD. The existence of heavy bleeding and the use of two pads, however, alludes to the concurrent diagnosis (Mishra et al., 2023).

Primary dysmenorrhea is an issue to consider in adolescents who experience painful and incapacitating menstruation but who do not exhibit anatomical abnormalities.

The pharmacological management of PMDD involves the use of selective serotonin reuptake inhibitors (SSRIs), such as sertraline, which can be taken daily or limited to the luteal phase. Despite her reluctance to take sertraline, the choice of psychoeducation about sertraline as a hormonal medication, not solely a psychiatric medication, can enhance compliance. Metformin is prescribed in PCOS to enhance insulin sensitivity and stabilize ovulatory cycles (Attia et al., 2023). Oral contraceptives such as ethinyl estradiol and norgestimate control menstruation and minimize androgen synthesis, positively affecting both PCOS and dysmenorrhea. To ease menstrual cramping pains, NSAIDs like ibuprofen can be prescribed to stop the production of prostaglandins. The effectiveness of this pharmacological plan relates to all possible diagnoses.

Non-Pharmacological Management

Non-pharmacological therapies also contribute to the treatment of Stephanie. According to Hoppe et al. (2025), it is advised that for existing PMDD, cognitive behavioral therapy be applied to help reframe mood distortions and better manage emotional control.

In the case of PCOS, dietary change and exercise are key to controlling weight and metabolic health. Yoga and heat therapy can be effective secondary remedies to the distress caused by dysmenorrhea.

A menstrual symptom diary can be used to monitor the effectiveness of treatment and trends, thereby improving the accuracy of diagnosis. Family counselling can also help in understanding and observing treatment schedules, which helps create a conducive home environment that aids in healthy living among teenagers.

The potential adverse effects of missing school are long-term educational and psychological implications on her performance. Her noncompliance with medications could be caused by the stigma associated with psychiatry treatment.

All these factors are relevant when developing a practical, empathetic, and realistic care plan that is respectful of her stage of development.

Education of the patient and their family members is needed on the hormonal nature of PMDD, the advantages of SSRI, the necessity of a regular follow-up appointment and compliance adherence. According to Guinaudie et al. (2020), focusing on non-stigmatizing language and shared decision-making can enhance trust and empower adolescents like Stephanie.

Education and teamwork are needed to integrate holistic care, respecting Stephanie’s stage of life and her physical and mental needs.