By: Johanna McCarthy
ADHD (Attention-Deficit/Hyperactivity Disorder) is not a new diagnosis, however, in recent years, research and awareness of how ADHD may present in women and girls has grown.
This has contributed to a rise in individuals seeking professional support or assessment for ADHD. In childhood, boys are diagnosed with ADHD at a rate three times higher than girls. By adulthood, this ratio evens out, suggesting underdiagnosis in young girls. Historically, research has focused on male presentations and hyperactivity symptoms, whereas females are more likely to present with inattentive type ADHD and fly under the radar.
The good news is, that as research in this area grows, so does our understanding of how best to support girls and women with ADHD. An important recent shift has been the adoption of the concept of neurodiversity. Neurodiversity aims to view diagnoses such as ADHD as brain differences rather than illnesses or problems to fix. Embracing neurodiversity means recognising and affirming these differences, focusing on harnessing individual strengths and celebrating neurodiverse identities, rather than focusing on deficits.
One significant area of research has identified the impact of the female hormonal cycle on ADHD symptoms and management. Hormonal fluctuations significantly impact all girls and women, but due to brain chemistry differences, these fluctuations can particularly impact those with ADHD.
The Female Hormonal Cycle
The female hormonal cycle, or menstrual cycle, typically lasts about 28 days and involves a series of hormonal changes preparing the body for potential pregnancy. The cycle is divided into four main phases: the menstrual phase, the follicular phase, ovulation, and the luteal phase. Three key hormones play a role: estrogen, progesterone, and testosterone. While men have these hormones too, the levels and fluctuations differ.
The Hormonal Cycle and ADHD Symptoms
Estrogen plays a critical role in regulating and producing dopamine, a neurotransmitter linked to attention, focus, and mood. People with ADHD are said to have differences in brain functioning which results in low dopamine levels. Therefore, fluctuations in estrogen, which affect dopamine regulation and production, can cause ADHD symptoms to fluctuate.
ADHD symptoms in women can fluctuate significantly across the menstrual cycle due to the influence of hormonal changes. Here’s how different phases of the cycle can affect ADHD symptoms:
Menstrual Phase (Days 1-5)
- Hormonal Changes: Estrogen and progesterone levels are at their lowest.
- Symptom Impact: Women may experience heightened ADHD symptoms such as increased distractibility, mood swings, and irritability. Low estrogen levels can lead to reduced dopamine production, exacerbating attention and focus issues.
Follicular Phase (Days 6-14)
- Hormonal Changes: Estrogen levels gradually increase, peaking just before ovulation.
- Symptom Impact: Rising estrogen levels can improve dopamine production, improving focus, attention, and mood. This phase might be when women feel most balanced and capable of managing ADHD symptoms.
Ovulation (Around Day 14)
- Hormonal Changes: Estrogen reaches its peak, and testosterone levels also increase.
- Symptom Impact: The peak in estrogen and testosterone can enhance cognitive functions, mood, and energy levels. ADHD symptoms are often less pronounced during this time.
Luteal Phase (Days 15-28)
- Hormonal Changes: Estrogen levels drop, and progesterone levels rise.
- Symptom Impact: The decrease in estrogen can reduce dopamine production, leading to a resurgence of ADHD symptoms. Women may experience increased distractibility, emotional sensitivity, and difficulty with executive functions like planning and organisation. As progesterone levels rise, some women may also experience premenstrual syndrome (PMS) symptoms, such as mood swings and fatigue, which can further complicate ADHD management.
Late Luteal Phase/Pre-Menstrual Phase (Final Days Before Menstruation)
- Hormonal Changes: Both estrogen and progesterone levels fall sharply.
- Symptom Impact: This phase often brings the most significant increase in ADHD symptoms. Women might experience severe mood swings, irritability, anxiety, and cognitive fog. These changes can make managing daily tasks particularly challenging.
Fluctuations Across the Lifespan
These hormones and cycles may change throughout different stages of a woman’s life, starting from puberty. Some considerations may include:
- Puberty: Increasing estrogen levels can intensify ADHD symptoms. Girls who previously masked or compensated for symptoms may struggle more during this time. Emotional dysregulation can also increase.
- Pregnancy: During pregnancy, higher estrogen levels might improve ADHD symptoms, but planning and organisational challenges can arise. For women who were previously using hormonal contraception, ceasing use may lead to an increase in symptoms as a result of experiencing the hormonal cycle again.
- Post-Natal: The rapid drop in estrogen after childbirth can impact women with ADHD more significantly, increasing the risk of post-natal depression and exacerbating planning and organisational demands.
- Perimenopause and Menopause: Declining estrogen levels during this period can increase ADHD symptoms. Many women report “brain fog” and struggle with attention, planning, and decision-making.
Managing ADHD Symptom Fluctuations
- Awareness: Although there may be a “typical” cycle, hormonal cycles can vary from person to person. Building awareness of your specific cycle and noticing changes in your mood, energy and attention can help you to prepare for the week and month ahead. Knowledge and awareness can reduce feeling blindsided by changes in mood, concentration or energy and help to regain some control in the face of these challenges. There are a range of tracking apps available now to make it easier to keep up to date, or you could use a calendar or diary.
- Self-compassion and self-care: Practicing self-compassion involves treating yourself kindly during periods of symptom fluctuation, and understanding that these variations are normal. Engaging in self-care routines such as mindfulness, adequate rest and exercise, and balanced nutrition can help mitigate stress and stabilise mood, which in turn can support more consistent management of ADHD symptoms.
- Professional Support: Consult with your GP or your psychiatrist about hormonal impacts on ADHD symptoms. Psychologists can assist in navigating these changes and building awareness of symptom fluctuations. If this is something you have noticed having an impact on your life, you could reach out to our team of psychologists at Centre for Effective Living who can support you in understanding and managing these changes.
Article supplied with thanks to The Centre for Effective Living.
Feature image: Photo by Carolina Heza on Unsplash