The Menstrual Cycle Impacts ADHD Symptoms in Disparate Ways

What do fluctuating hormones across the menstrual cycle mean for my ADHD symptoms and treatment? What do I need to know, and what should I expect?

For girls, women, and naturally cycling individuals with ADHD, fluctuating estrogen and progesterone across the menstrual cycle invariably impact ADHD symptoms, emotions, and functioning. We know this to be true, but there is almost no research validating this relationship. So, we arrive at this conclusion using available research on how hormonal changes affect the body, along with anecdotal information and clinical observations of patients with ADHD.

But how hormonal fluctuations affect your ADHD symptoms  — and even medication efficacy — is for you to learn and discuss with your doctor.

[Get This Free Guide: Women, Hormones, and ADHD]

ADHD Symptoms Through the Menstrual Cycle

Estrogen and progesterone are produced in the ovaries, among other places in the body. These hormones easily pass through the blood-brain barrier to access the brain, which is filled with receptors that are involved in emotional regulation and cognitive functioning. Note that dopamine, which is heavily implicated in ADHD, is modulated by estrogen.

Through the menstrual cycle, which lasts 28 days on average, estrogen and progesterone levels rise and fall as the body prepares for possible pregnancy. Day 1 through Day 14 marks the follicular phase, where estrogen levels rise and rise, peaking at ovulation. After this point comes the luteal phase, where progesterone levels rise, and estrogen levels fall quite steeply before stabilizing at a low level. In this hormonal environment leading up to menstruation, women generally report more symptoms of depression, anxiety, stress, sleeping problems, binge eating, cognitive difficulties, memory problems, and other symptoms of premenstrual syndrome (PMS).¹

If your ADHD profile comprises traits like low energy levels, inattention, and anxiety, then the follicular phase, when estrogen is highest, might offer a welcome boost of energy, good mood, and clarity. In the luteal phase, you may suffer tremendously with PMS or its more severe form, PMDD, which disproportionately impacts women with ADHD.^{2 3 4}

If your ADHD profile comprises impulsivity and hyperactivity, high-estrogen states may be the most challenging part of each month for you. This is because high estrogen levels could cause a surge in positive emotions that may increase the likelihood of engaging in risky, sensation-seeking behaviors.²

[Read: PMS and ADHD — How the Menstrual Cycle Intensifies Symptoms]

Medication Efficacy Through the Menstrual Cycle

Many naturally cycling individuals with ADHD report differences in symptom severity and, thus, stimulant efficacy across the menstrual cycle.^{2 5} Research on this front is limited, but it’s a valid hypothesis that fluctuating hormonal status can influence the effectiveness of ADHD medication. In the low-estrogen luteal phase, for example, some individuals may find that their ADHD medication doesn’t work at all, which only worsens functioning. For those who face increased risk for risky behaviors in the high-estrogen follicular phase, it’s possible that a medication dose can suddenly be too high (as estrogen and dopamine potentiate each other) further increasing the risk for these behaviors and other side effects.

Tailoring medication dosages to hormonal status — known as cycle dosing — could be key for optimizing treatment.^{2 5} Tracking your cycle will give you powerful insights into how hormonal fluctuations influence your ADHD symptoms, medication effectiveness, and overall functioning. With this data, you’ll be in a better position to talk to your doctor about enhancements to your treatment plan to improve your health and wellbeing.

ADHD and Periods: Next Steps

• Free Workbook: Track Your ADHD Symptoms During Your Menstrual Cycle
• Read: Women, Hormones, and ADHD
• Read: “PMDD Has Affected My Whole Life.”

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Emotional Lives of Girls with ADHD” [Video Replay & Podcast #488] with Lotta Borg Skoglund, M.D., Ph.D., which was broadcast on January 23, 2024.

ADDitude readers: Sign up to access LetterLife, an app co-founded by Dr. Lotta Borg Skoglund that provides users with personalized insights — on hormonal cycles, ADHD symptoms, and lifestyle factors — to better manage ADHD.

Use the discount code ADDWEB20 to get 20% off Dr. Skoglund’s book, ADHD Girls to Women, when purchased via uk.jkp.com.

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Sources

¹ Handy, A. B., Greenfield, S. F., Yonkers, K. A., & Payne, L. A. (2022). Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review. Harvard review of psychiatry, 30(2), 100–117. https://doi.org/10.1097/HRP.0000000000000329

² Roberts, B., Eisenlohr-Moul, T., & Martel, M. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015

³ Dorani, F., Bijlenga, D., Beekman, A. T. F., van Someren, E. J. W., & Kooij, J. J. S. (2021). Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research, 133, 10–15. https://doi.org/10.1016/j.jpsychires.2020.12.005

⁴ Eng, A. G., Nirjar, U., Elkins, A. R., Sizemore, Y. J., Monticello, K. N., Petersen, M. K., Miller, S. A., Barone, J., Eisenlohr-Moul, T. A., & Martel, M. M. (2024). Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and behavior, 158, 105466. https://doi.org/10.1016/j.yhbeh.2023.105466

⁵ de Jong, M., Wynchank, D. S. M. R., van Andel, E., Beekman, A. T. F., & Kooij, J. J. S. (2023). Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage. Frontiers in psychiatry, 14, 1306194. https://doi.org/10.3389/fpsyt.2023.1306194

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