Purpose <p>This retrospective study aimed to investigate the association between premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) and the presence of autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) in adolescent females. While PMS and PMDD are well-studied in the general population, limited research exists on their prevalence and impact in adolescent females with ASD or ADHD.</p> Methods <p>Retrospective data collection was conducted using electronic medical records, covering 290 patients aged 10–19 years. PMS severity, depressive symptoms, and autistic tendencies were assessed using standardized tools, including the Quick Inventory of Depressive Symptomatology (QIDS) for depressive symptoms, Autism-Spectrum Quotient (AQ) for autistic tendencies, and a PMDD assessment scale for PMS severity.</p> Results <p>The results revealed a significant association between moderate to severe PMS and ADHD (odds ratio [OR]: 2.43) as well as comorbid ASD + ADHD (OR: 3.27). In contrast, ASD alone did not exhibit a significant link to PMS severity.</p> Conclusion <p>These findings highlight the heightened vulnerability of females with ADHD or comorbid ASD + ADHD to premenstrual psychological distress, emphasizing the importance of early detection and intervention. The study underscores the need for tailored treatment strategies addressing the unique challenges faced by this population.</p>