Understanding How Hormones Impact ADHD in Women

How Hormones Fluctuate During the Menstrual Cycle

Before diving into the details of hormonal impacts on ADHD, it helps to understand how hormone levels change over the course of someone’s menstrual cycle. It starts with puberty, which usually occurs between the ages of 9 and 13. This is when estrogen and progesterone hormones rise significantly.

Once a young woman starts menstruating, those same hormones fluctuate every month. Menstrual cycles last for around 28-35 days, and there are two phases that occur during each cycle. For the first half of the cycle, when the ovary is in the follicular phase, estrogen levels rise and progesterone levels are low. During the second half of the menstrual cycle, progesterone levels go up and estrogen goes down. When the progesterone drops, you have a period.

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Changing hormones have noticeable effects on most women. They can affect everything from mood and energy to sleep quality and sex drive. The way these symptoms fluctuate throughout the month is directly tied to the changes in estrogen and progesterone levels.

Estrogen and ADHD: The Ripple Effect

As hormones fluctuate during the menstrual cycle, some individuals may notice a change in their ADHD. Estrogen can have a positive effect on cognitive function, with some research suggesting that rising estrogen levels may actually improve attention and executive thinking skills. Estrogen also can affect dopamine, serotonin, and norepinephrine in ways that may make ADHD symptoms temporarily improve during the earlier phases of the menstrual cycle. However, when estrogen levels start dropping, ADHD symptoms may worsen.

Hormonal ups and downs can present some challenges when it comes to managing ADHD symptoms effectively. While ADHD may seem much easier to manage during certain weeks, things can change quickly as a woman’s period approaches. Plus, hormones can impact certain ADHD treatments. Some research suggests that rising progesterone in the second half of a menstrual cycle not only hinders the beneficial effects of estrogen, but may also reduce the effectiveness of stimulant medications. This can make women struggle with more severe ADHD symptoms, such as:

Inattention
Forgetfulness
Disorganization
Difficulty concentrating
Mood swings
Anxiety
Sleep problems

What About Menopause and ADHD?

Around age 40, women can start to experience perimenopause and begin having irregular menstrual cycles. Estrogen levels start declining during this phase, which can last up to a decade. When she hasn’t had a period for a full year, a woman has reached menopause, and her estrogen levels are significantly lower than before. The hormone fluctuations during perimenopause can cause havoc for any woman but even more so with ADHD.

Menopausal estrogen loss can lead to lower levels of dopamine and serotonin in the brain. That, in turn, often can lead to negative impacts on mood, memory, cognitive function, and energy levels. Women going through menopause often have symptoms like brain fog and difficulty focusing. Unfortunately, these types of symptoms can be worse for someone with ADHD.

However, there’s a silver lining: Because hormones are no longer cycling monthly, ADHD management is often simplified. Once menopause occurs, the ups and downs of the menstrual cycle are no longer a concern, so ADHD symptoms don’t fluctuate as dramatically as they did prior to menopause.

How to Manage ADHD When Hormones Change

If you’re a woman with ADHD, it’s almost inevitable that hormonal changes will impact your ADHD symptoms. Fortunately, there are steps you can take to help manage your ADHD effectively even as those fluctuations occur, both during individual menstrual cycles and as you go through menopause. Here are a few options to consider:

Wellness habits: Managing stress, getting enough sleep, exercising regularly, and practicing other healthy lifestyle habits can help minimize the negative impacts of ADHD throughout your cycle.
Symptom tracking: Keep a log of your symptoms throughout your menstrual cycle and notice when your ADHD behaviors seem to spike. Knowing when to anticipate a worsening of your ADHD symptoms can help you be more prepared to manage them when they occur.
Hormone therapy: For those with ovaries aged 14-52, you can make #periodsOptional and have a stable hormone level using the birth control pill or rings. See the TEDx talk by Dr. Sophia Yen here.The changes in estrogen levels during perimenopause and menopause may be eased by hormone therapy, such as birth control pills as hormone treatment for perimenopausal women and estrogen patches for menopausal women. Stable hormone levels can also cause ADHD symptoms to be less severe.