Key Takeaways
- People with attention-deficit/hyperactivity disorder (ADHD) who menstruate have unique responses to hormone fluctuations, with increased ADHD symptoms before and during menstruation and lower response to stimulant medication.
- Higher rates of premenstrual dysphoric disorder (PMDD) and endometriosis are also seen in people with ADHD who menstruate.
- To cope with hormonal fluctuations when you have ADHD, be kind to yourself, set reasonable expectations, and ask for help from loved ones when you need it.
People with ADHD experience hormonal changes due to menstruation differently from those with non-ADHD brains. ADHDers who menstruate also have an increased risk for other complications, including premenstrual dysphoric disorder and endometriosis.
How Menstrual Hormone Fluctuations Affect ADHD Symptoms
People with ADHD who menstruate have fluctuations in their ADHD symptoms associated with the hormonal changes of their menstrual cycles.
During a typical menstrual cycle:
- Estrogen and progesterone are lowest at the start of the menstrual flow (day 1).
- Estrogen starts rising after a week, peaking just before two weeks, with ovulation (release of an egg from the ovary) on day 14. It then falls but has a second peak about a week before menstruation begins.
- Progesterone rises after ovulation, peaking around 10 days before menstruation unless a fertilized egg implants in the uterus.
Clarissa Harwell, LCSW, an AuDHD therapist in private practice, shares, “Although not all people who menstruate experience changes in their ADHD traits and symptoms, it is commonly stated that hormonal fluctuations related to menstruation impact ADHDers in approximately 40% of women.”
Hormonal fluctuations related to menstruation impact ADHDers in approximately 40% of women.
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CLARISSA HARWELL, LCSW
“A notable difference is that many people who menstruate experience an amplification of their ADHD traits and symptoms,” she said.
Research about the relationship between sex hormones and ADHD symptoms is limited, and existing studies show contradictory information. However, these effects have been noted:
- Symptoms worsening: Studies have emerged in recent years showing that the neurotransmitters that impact ADHD symptoms respond to hormonal changes of the menstrual cycle, with ADHD symptoms intensifying during the premenstrual and menstrual phases of the cycle.
- Less response to stimulant medication: Hormonal fluctuations impact how the body absorbs and responds to stimulant medication, further exacerbating symptom changes. Stimulant medication is less effective during the premenstrual and menstrual phases of the cycle.
- Menopause effects: Menopause (cessation of menstruation for at least a year) has also been tied to an increase in ADHD symptoms, including executive dysfunction and working memory issues.
It is important to note that there is a long history of sexism in the medical field and stigma surrounding menstruation. People who have periods can experience discrimination by medical providers, including downplaying or disregarding the challenges they experience as a result of their hormonal fluctuations.
Sex and Gender Differences in ADHD Symptoms
Differences in how ADHD symptoms present based on sex and gender include:
- Cisgender girls show more inattentive symptoms while cisgender boys show more hyperactive symptoms.
- Girls are diagnosed later in life than boys due to providers overlooking inattention, especially if there are no reported academic issues.
- Individuals assigned female at birth are underdiagnosed, with ADHD symptoms overlooked or misdiagnosed.
Personal Experiences of People With ADHD and Hormonal Fluctuations
Lara, who uses they/them pronouns, shares, “My ADHD symptoms heavily vary depending on where I am in my cycle. During the last phase (at least one week before menstruating) of my cycle, I feel my brain getting more and more ‘foggy.’ It feels like I have to drag every thought and memory through a dense fog, not knowing what the surface I am walking on looks like, and every thought also has a large boulder attached.”
They also notice significant emotional changes around their cycle, “Every other cycle, I experience this intense feeling of loneliness and feeling abandoned by my partners and friends. I need a lot of reassurance during these phases, and it takes a huge toll on relationships because I constantly mistrust that I really am loved by my partners, even if they say so and show it to me. It’s exhausting.”
“Abby,” who uses she/her pronouns, is a trans woman who asked to be referred to by a pseudonym. She does not menstruate, but she experiences cyclical changes in her ADHD symptoms since starting cyclical gender-affirming estrogen replacement therapy.
She shares: “Emotion regulation and executive function are more challenging at the end of my cycle, but it’s also caught up in gastrointestinal (GI) issues (low motility, exacerbated irritable bowel syndrome). My working memory is usually bad during these periods.
“I usually compensate with higher doses of stimulant ADHD medication, or by creating room to work on different things and have different expectations of myself for a few days. Stimulant medication often seems like it’s about a 30% weaker dose at the end of my cycle, like drinking coffee on a hangover.”
ADHD, PMDD, and Endometriosis
People with ADHD are at increased risk for other disorders associated with the menstrual cycle:
- Endometriosis is a condition where tissue similar to the uterine lining grows outside of the uterus. It can cause debilitating symptoms, including pain, fatigue, and gastrointestinal issues, and require surgery to remove the excess tissue. ADHDers are almost twice as likely to experience endometriosis compared to non-ADHDers.
- Premenstrual dysphoric disorder involves severe and extreme premenstrual symptoms, including mood swings, pain, and changes in cognition. Mental health symptoms of PMDD can lead to suicidal ideation. PMDD impacts approximately 10% of the population who have menstrual cycles and 31% of ADHDers with menstrual cycles.
How Can You Manage Hormonal ADHD Symptom Fluctuations?
Managing the symptoms that come with ADHD is challenging on its own, and when your symptoms fluctuate in response to hormonal changes related to your menstrual cycle, it can be even harder to cope.
Lara shares that they plan their responsibilities around their cycle: “At work, I give 130% during the first half-ish of my cycle to compensate for the fog-boulder-dragging part, where I am only able to give 80%. It’s like burning myself out in the first half only to be able to beat myself up for not showing up in the last part.”
Abby tracks her cycle to predict when she will need extra support. She found that Tenex (guanfacine) helped manage symptoms when her stimulant medication was not fully addressing symptoms.
Clarissa also recommends managing expectations and workload: “I typically collaborate with clients to identify areas in which they can do less. That’s the mantra during the most intense time of the cycle—Do Less! We look at where they can cut corners, make things easier, reduce the day-to-day tasks that require the most executive function, and increase supports and self-compassion.”
She acknowledged that this is not always possible: “I talk with clients about this, because internalized ableism can lead people who experience this to feel like they are failing, like it is an individual character flaw, rather than a biological and neurological issue combined with systemic issues.”
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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