How hormones and the menstrual cycle can affect women with ADHD: 5 common questions

Have you noticed that your levels of attention may slightly change during your menstrual cycle?

This may be particularly noticeable for women and people assigned female at birth with attention deficit hyperactivity disorder (ADHD). They have differences in their ability to easily focus and sustain their attention. There may be times during their menstrual cycle when it seems harder to plan, organise and focus their attention. And they may find their ADHD medication doesn’t seem to work as well.

Very little research has explored the interaction between female hormones and symptoms of ADHD^[1]. But women with ADHD could gain much from greater insights into the mechanisms of this effect.

Here are five questions women and girls commonly ask about their hormones and ADHD symptoms.

1. Can hormones impact ADHD symptoms?

There is growing awareness of the relationship between sex hormones and neurotransmitters^[2]. Neurotransmitters pass messages between neurons in the brain.

Dopamine^[3] is a neurotransmitter important for motivation, reinforcement and reward. It’s a chemical that makes you feel good and has key roles for our executive functions, including attention.

For people with ADHD, the regulation of dopamine^[4] is thought to differ. For example, it is thought there are lower levels of dopamine in the brain’s synapses (the connections between neurons) in people with ADHD. Our best current theory is that lowered synaptic dopamine contributes to ADHD symptoms^[5] and difficulties with focusing attention in a flexible way, maintaining attention and regulating activity levels.

Medications for ADHD, such as the psychostimulant methylphenidate^[6] (usually called Ritalin), help to make more dopamine available in the synapse. We think this is one of the reasons why symptoms of ADHD reduce and attention is improved with ADHD medication.

Sex hormones, including estrogen and progesterone, fluctuate naturally through different phases of a woman’s life. Fluctuations in sex hormone levels can affect brain function by altering levels of neurotransmitters, including dopamine and serotonin which is important for mood.

The relationship between sex hormones and neurotransmitter levels is complex. Animal studies have shown higher levels of estrogen^[7] are linked to increased levels of dopamine. Progesterone also appears to influence dopamine levels, but the relationship between dopamine and progesterone is less clear^[8].

Read more: Autism is still underdiagnosed in girls and women. That can compound the challenges they face^[9]

2. What happens to my attention over my menstrual cycle?

Estrogen and progesterone levels fluctuate across the menstrual cycle. The key phases^[10] of the menstrual cycle are the follicular phase (referring to the first days of menstruation until ovulation), and the luteal phase (the days between ovulation and the following the period).

Estrogen levels gradually rise during the follicular phase, fall after ovulation and rise again during the mid-luteal phase, before decreasing at the end of the cycle. Progesterone levels are low during the follicular phase and rise in the luteal phase.

Research exploring whether attention changes across the menstrual cycle is inconsistent^[11].

However, for women sensitive to menstrual cycle hormone fluctuations, the premenstrual or late luteal phase is associated with poorer attention, higher anxiety and stress, or at the more severe end of the mood spectrum, premenstrual dysphoric disorder^[12] (a severe form of premenstrual syndrome).

Studies^[13] show some attention-related tasks are performed better when there are higher levels of estrogen, such as before ovulation. Performance may be poorer when there are lower levels of estrogen and higher levels of progesterone^[14], such as in the couple of weeks after ovulation and before menstruation. This fits with what many women with ADHD report anecdotally: their attention is better before ovulation and can worsen after^[15].

References

1. ^{^} female hormones and symptoms of ADHD (link.springer.com)
2. ^{^} sex hormones and neurotransmitters (www.sciencedirect.com)
3. ^{^} Dopamine (www.healthdirect.gov.au)
4. ^{^} regulation of dopamine (www.ncbi.nlm.nih.gov)
5. ^{^} contributes to ADHD symptoms (link.springer.com)
6. ^{^} psychostimulant methylphenidate (www.health.nsw.gov.au)
7. ^{^} higher levels of estrogen (www.ncbi.nlm.nih.gov)
8. ^{^} less clear (www.frontiersin.org)
9. ^{^} Autism is still underdiagnosed in girls and women. That can compound the challenges they face (theconversation.com)
10. ^{^} key phases (www.betterhealth.vic.gov.au)
11. ^{^} inconsistent (www.ncbi.nlm.nih.gov)
12. ^{^} premenstrual dysphoric disorder (www.jeanhailes.org.au)
13. ^{^} Studies (www.sciencedirect.com)
14. ^{^} progesterone (www.sciencedirect.com)
15. ^{^} worsen after (www.additudemag.com)
16. ^{^} Shutterstock (www.shutterstock.com)
17. ^{^} general population (www.sciencedirect.com)
18. ^{^} some women (theconversation.com)
19. ^{^} even higher (pubmed.ncbi.nlm.nih.gov)
20. ^{^} I think I have ADHD, how do I get a diagnosis? What might it mean for me? (theconversation.com)
21. ^{^} birth (www.ncbi.nlm.nih.gov)
22. ^{^} cognition and ADHD symptoms (ajp.psychiatryonline.org)
23. ^{^} brain fog (theconversation.com)
24. ^{^} perimenopausal and early post-menopausal women (pubmed.ncbi.nlm.nih.gov)
25. ^{^} perimenopause and menopause (pubmed.ncbi.nlm.nih.gov)
26. ^{^} 'Brain fog' during menopause is real – it can disrupt women's work and spark dementia fears (theconversation.com)
27. ^{^} this link (redcap.helix.monash.edu)
28. ^{^} Hot flushes, night sweats, brain fog? Here's what we know about phytoestrogens for menopausal symptoms (theconversation.com)