Private Blood Tests and PMDD

[started]

Our 12 year old has been struggling with her mental health for past 12 months or so.
We're on CAMHS list but it could be months if not years before we get seen.

Our GP can't help and says we need to wait on CAMHS so we're really left with no help at all for now, like so many others.

We have some private psychologist support but one possible pattern emerging (as well as neurodiversity) is likes of PMDD (more severe type of PMS) or thyroid issues. A blood test might help rule out anything like this and we know there are treatment options available if it did show something up.

All the private blood test companies online and even local private GPs appear to only treat people 18 years or over though. Can anyone help with how this would work in the UK?

Can you not go back to GP listing all symptoms and ask for a blood test to check hormone levels?

Sorry, perhaps that wasn't thorough enough, but I don't understand why a GP wouldn't refer for bloods for an under 18 if you listed symptoms that could be due to a hormone imbalance?

Thanks, TBH I don't really understand it either. GP has all symptoms as well as reports from private psychologists. I've booked another appointment for next week to push further but I'm a bit done with pushing for NHS support if there is an option where we could pay and we can get some tests.

I should maybe have said but I'm a dad and I'm only recently piecing together how some of issues could be symptoms of (extreme) hormone imbalance vs symptoms of neurodiversity. In addition to GP she's seen a variety of professionals over past year but no-one has really mentioned body chemistry much. It sounds like even SAD / vitamin deficiency could have a larger role than I understood before.
It seems possible it's also not a factor but I can't see a reason not to rule it out.

In an ideal world I'd like her to see a Dr that can take all her symptoms and try to diagnose what could be an issue and then refer to specialists to test for what they can test for in terms of physical side whilst we also wait for support from specialists at CAMHS.

I perhaps wrongly assumed that is role of the GP, to have a general overview.

If the gp thinks bloods are needed they would do them. Have you asked the gp if they think bloods are indicated?

I've not specifically asked GP to run a particular type of blood test and no blood test has been run.

A few friends have suggested it could be (partly at least) hormonal in some way and one in particular has pointed us towards PMDD and provided some real world experience of that. That's what's brought me here today.

The GP has not suggested blood tests and has said we must wait on CAMHS. We've not found our GPs very helpful TBH.

I will suggest something specific at next appointment we can get (next week now) and have Googled up the types of tests I think might relate to symptoms based on what others have explained.

I get impression the GP "should" do more but I guess CAMHS should do more too. I'm thinking getting a basic blood test might be a help (I had a private blood test myself before) but hitting the age issue.

Thanks for any help.

Then the GP probably doesn't think they are needed. PMDD is largely a clinical diagnosis and hormone bloods are notoriously unreliable in teenagers. Nothing you have said suggests thyroid dysfunction.

The sort of thinking of 'we need a basic blood test' is quite frustrating for GPs, because often no test is indicated, the person has no idea what test they are looking for and why, and there is no understanding that many diagnoses are clinical.

What symptoms of what particular vitamin deficiency are you worried about?
Is she taking a multivitamin?

"the person has no idea what test they are looking for and why" I can agree there and sort of my point!

Equally you can hopefully agree that doing nothing isn't useful either. Nothing I've said suggests thyroid disfunction but I've not said much yet! It's maybe a bad example but with no data to go on, you can't draw conclusions?

I can only do what I can do and it feels like a blood test is something I can do if it's possible to pay for it.

I'm not having a go at GPs as they're clearly under pressure but I was in the sessions and not much was asked once clear she is on CAMHS waiting list. It was the school that referred her to CAMHS and teacher vs doctor.

I guess at no point in the process has a medical professional asked questions that would diagnose much IMO. They've listened to symptoms we can tell them and seen she's on CAMHS list.

I can only do what I can do and it feels like a blood test is something I can do if it's possible to pay for it.

blood tests are only worth doing if they are indicated and you know before doing them, how the result will change your management. Do 20 blood tests on an average healthy person and one will come back abnormal. Scattergun tests lead to overdiagnosis and bad medicine.

I wouldn't generally do any bloods on someone with anxiety/depression, unless there was something in the history to suggest an organic cause.

If you are able to throw money at this and you think she might have ADHD (you mentioned ND) then a private assessment by someone reputable (i.e. a psychiatrist or specialist GP) is a better use of your cash.

I agree hormonal tests at that age can be difficult as different parts of her cycle with give different results. I would ask for full bloods to check all iron. Ferritin and even transference levels and stores. Also calcium and vit d.
These can affect mood especially in teenagers. Keep up with CAHMS and any counselling services. Has she accessed Kooth? Or other text/online support designed for teens?

PMDD or PMS is diagnosed by 2 months of symptom tracking in a calendar. Blood tests wouldn't show anything. Look up the Royal College of Gynecologists guidance.

On what basis? Everyone in the UK should be taking vitamin D anyway and she has no symptoms of deficiency and nothing that has been said suggests anaemia or hypo/hypercalcaemia.

There are studies linking anxiety and depression with low iron @letsgoskiing and a child who is menstruating is a risk factor.

Thanks everyone, I really appreciate the input. It's hard to give input without a full history I guess.

There is a lot of variety in responses here and I just don't feel like I'm best person to test or assess or diagnose. I'm floundering though in trying to figure out which professional (private or NHS) would look at all the symptoms a patient has an guide them forward.

I expect it's probably what a GP "should" do but in the 5-10 mins we have with the GP at an appointment I'm concerned that "should" is a bit of an impossibility with best will in world.
I could spend 5 mins explaining all the history and symptoms.

CAMHS and a wider team of professionals makes complete sense - a team of people with more time - but is not available to many young people. It's rubbish but it's reality.

That brings me back to private options. We have had some ND assessment work but a psychologist doesn't really consider items like hormones or vitamins and can't prescribe anything there.
I'm not even sure if a psychiatrist looks at things like that.

PMDD or PMS is diagnosed by 2 months of symptom tracking in a calendar. Blood tests wouldn't show anything. Look up the Royal College of Gynecologists guidance.

I'm feeling like we're tracking symptoms and it does really match up. It's not the full picture for her but perhaps something to smooth the hormonal peaks and troughs might help her cope with other anxieties. We'll try GP again.

Going full circle is it possible to get a private GP for under 18s in the UK? All local ones I've looked at don't work with under 18s.

No mention of heavy periods, obviously you would check if that was the case. Checking FBC isn't a necessary thing with anxiety and depression unless there are symptoms of anaemia.

I think the point you're missing here is that scattergun bloods for random vitamins and minerals aren't going to give you the answer you're looking for. Make sure she has a healthy diet, give her a multivitamin which has some vitamin D in it, and focus on the psychological support.

OK @letsgoskiing will agree to disagree. Low iron contributed to my own child's mental health. But I do know everyone is different and the OP was looking for advice. And yes scattergun blood don't always help as usually a base point is first needed and then repeats at a later date. And while most teens (can't say for all or even the OPS daughter) with some form of anxiety do spend more time indoors so low vitamin d will sometimes be even more apparent than the usual nhs guidelines that most people do need some form of supplement.
But it was only some advice from my own opinion not a clinical decision. Up to the op to decide what course of action they may want to take. And for a simple blood test to maybe rule out some clinical causes I know I would prefer to do that than not even checking. No problem always good for other opinions.

I get where you're coming from @started

My DD is always tired, heavy periods, suffers from low mood etc. and I have no faith that GPs know what to look for. Not criticising GPs, I think their hands are tied in many ways.

DD had a blood test looking at anaemia last year but by all accounts this was fine. I don't expect a full bloods includes half the vitamins/minerals/thyroid function etc. required, but I too am struggling to know where to start with a private test.

And often, especially with a ND child, restricted eating means that getting all vitamins and minerals from diet is just not possible.

https://www.phlebotomy-services.co.uk/childrens-test

Just done a quick online search and found this. Nb. I’ve never used them or are linked to them in any way.

PMDD can be common in young women and girls with ADHD. My own daughter and my niece have both suffered with it. For my daughter it was exacerbated by the pill, for my niece, aged 14 the pill was hugely beneficial in alleviating her symptoms. I would track symptoms and go back to the gp - a blood test won’t help.

Hi @letsgoskiing I can totally see your point re: scattergun blood tests. That makes sense. Perhaps it can be less scattergun or a different kind of test if I can have someone (a private GP if NHS GP doesn't have the time) listen to all the symptoms and consider what kind of test might have value.
I don't know what test would make sense.

I don't really understand how something can be "diagnosed" as psychological based on virtually no information being obtained by a medical professional. You're kind of doing the same as the GP! :) I'd agree there is, say, a 95% chance it's psychological issue but is it not worth checking the other 5% too given the recurring nature and timing of peaks. What if she waits 2 years and CAMHS find it's something else as a big factor?

At a silly level, to illustrate what I mean : what if someone gets headaches because the hat they wear is too small. They need a bigger hat vs anything more complex. To determine the best path forward, surely lot of a Qs must be asked by a professional.

An NHS GP does not have funding/time to ask those questions or consider all the symptoms. There just isn't time in a consultation to gather information never mind building a rapport where a child might provide key information.
That's where the UK is today but I presume someone out there can be paid for such a service.

I could understand your approach better if CAMHS was a working option too but it's really not and young people are left in a complete limbo.

I do appreciate the input and I'm genuinely trying to be both curious and objective - I'm not looking for or expecting some magical fix and aware its often very complex area we're in. We're continuing what we can with psychologist.

In terms of smoothing the hormonal peaks and troughs, she might not want to hear this (I certainly wouldn't have at that age), but exercise massively helps with my severe PMS, and is the first line of treatment for PMDD.
I do weight training using dumbells and an app at home, following fitness classes of as little as 10 minutes. It's a non-negotiable now for my mental health.

Private GPs will see children/teens and do bloods if needed. My teen DD was found to be deficient in vitamin D. Was able to have vitamin D injection which helped a lot. Where are you located? Someone may be able to recommend one.

Appreciated and she does not want to hear it :)

In general a few people have said exercise can be a game changer so that is interesting to hear your experience. We've had a horrible winter devoid of usual fresh sunny days and I'm convinced that hasn't helped between the darkness and lack of getting outside. She's always been very active but feels like at that point where it's just so tough.

We've agreed yesterday to do couch to 5k as a family...!