ADHD in adult women has increased dramatically over the last couple of years. Sometimes the diagnosis is missed when a woman is young, and she’s diagnosed later in life. Other times ADHD is misdiagnosed as anxiety, depression, PMS. Or symptoms are simply overlooked because ADHD presents differently in women compared with men.
In addition, symptoms of ADHD in women might exacerbate during times of hormonal fluctuation, either throughout the monthly cycle or during a particular life phase such as puberty, pregnancy, or menopause.
If you have ADHD, or have a woman in your life who does, you may have asked these questions:
- Why is my ADHD worse on some days?
- Why is my ADHD worse on my period?
- Can ADHD medication affect your period?
- How does estrogen affect ADHD?
We will answer these questions and so much more in this article. Once we understand our hormones, and the changes they undergo, we begin to see the connection with our symptoms. This is an empowering place from which to make lifestyle change.
How Does ADHD Affect Women Differently?
Attention deficit hyperactivity disorder, commonly known as ADHD, is a neurobehavior disorder that affects cognitive functions and is characterized by inattention and/or hyperactivity.
Growing research shows ADHD affects women differently. The average age of adult diagnosis in women is 36 to 38, whereas men are three times more likely to be diagnosed, and typically in childhood.
Boys and men are more likely to appear disruptive, impulsive, and hyperactive, what we classically think of as symptoms of ADHD. This is a more external presentation of the disorder.
It turns out women with ADHD are more likely to have an internal presentation of ADHD, where inattentiveness is the predominant symptom. Girls also tend to learn better coping-strategies and ways to mask their symptoms. For these reasons doctors tend to be less suspicious of ADHD and women, resulting in missed diagnoses and misdiagnoses.
Left untreated, ADHD may lead to poor academic performance, behavioral issues, and other problems later in life, such as substance abuse, anti-social behavior and psychological comorbidities including anxiety and depression. For women, these may be exacerbated by hormonal changes.
Can Sex Hormones Affect ADHD Symptoms?
Do hormones affect ADHD? The short answer is yes. Sex hormones shape the brain, influence neurotransmitters, and impact learning, memory, emotion, cognition, and motivation.
Estrogen, a main female reproductive hormone, exerts great influence on the brain. There are high levels of estrogen receptors in areas of the brain related to cognition and emotion.
Estrogen also raises neurotransmitter levels, including dopamine that supports focus, motivation, and attention, as well as serotonin that supports mood. One possible root cause of ADHD is low levels of these neurotransmitters.
This means that changes in estrogen influence ADHD symptoms.
Women with ADHD are particularly sensitive to lower levels of estrogen and may experience increased symptoms, including:
- Sleep difficulty
- Decreased concentration
- Fatigue
- Anxiety
- Irritability
- Depression
In addition, changes in sex hormones, influence the effectiveness of ADHD medication, including Ritalin and Adderall.
These medications work by blocking dopamine reuptake, therefore causing dopamine levels to rise. Estrogen may aid in its effectiveness, but low estrogen levels may make these medications less effective. Higher levels of progesterone may also decrease medication effectiveness.
ADHD medication may become less effective during times of hormonal fluctuation, including the luteal phase of the cycle, postpartum, and perimenopause.
Let’s discuss changing hormones throughout a woman’s life and how this may affect ADHD.
ADHD And Puberty
Puberty is a difficult time for anyone, but it can have a severely negative impact on girls. Massive hormonal fluctuations affect every aspect of life.
Through puberty, both estrogen and progesterone levels rise. It may become more challenging to manage ADHD symptoms and the effectiveness of the medication may diminish.
Remember that girls may respond differently by internalizing problems and won’t necessarily “act out” as boys are more likely to.
An exacerbation of ADHD during puberty may look like:
- Forgetfulness
- Irritability
- Aggression
- Recklessness
- Risk-taking
- Anxiety
- Depression
- Mood swings
- Academic problems
- Decreased focus
Understanding the change in ADHD symptoms you (or your daughter) might experience will help to prepare you for this hormonal transition.
ADHD, Periods and PMS
After puberty, women experience more subtle hormonal changes throughout the menstrual cycle. During the follicular phase, or the first half of the cycle, estrogen levels rise and neurotransmitters are more balanced. Women with ADHD tend to feel better.
During the luteal phase, or the second half of the cycle after ovulation, progesterone levels rise which can make ADHD symptoms worse. Women may feel more hyper or restless and have a harder time focusing and accomplishing tasks before their period. This may be exacerbated for a woman who has both ADHD and irregular periods, since the hormone fluctuations may be more severe or less predictable.
ADHD and PMS often go hand-in-hand leading up to her period. Symptoms may last for a few days, a week, or more. It’s helpful to add extra ADHD support during this time as well as work to address the root causes of hormonal imbalances to improve PMS and ADHD period management.
Although the pill can have negative side effects, some women with ADHD report experiencing benefit with regards medication effectiveness, which may be because it eliminates hormone fluctuations.
It is worth noting that a small association between pill use in mother and a subsequent diagnosis of ADHD in her children has been observed. Currently we lack significant data to advise on pill use as a potential therapy for ADHD and have yet to fully understand its role in the development of ADHD in children of mothers who have used it.
ADHD and Pregnancy
Due to increased estrogen, and therefore higher levels of some neurotransmitters, many people find their ADHD “disappears” during pregnancy. After some adjustments to rising progesterone in early pregnancy, they continue to feel better as their pregnancy progresses.
Some are advised or choose to stop ADHD medication, finding they don’t need it during pregnancy. But note that not every woman will react the same to pregnancy. Be sure to consult with your doctor about any changes in medication or if you take medication and are planning a pregnancy.
It’s important to discuss with your doctor prior to pregnancy (if possible) what medications are safe for pregnancy and breastfeeding. Adderall, a common ADHD medication, for example, has very limited data for use in pregnancy and is not advised during breastfeeding as it does enter the breastmilk.
While ADHD pregnancy management typically goes smoothly, postpartum is another story. Estrogen levels decrease 100 to 1000-fold in just a few days after giving birth, affecting the brain.
Combine this rapid hormonal change with lack of sleep, stress, and other challenges of having a new infant, and women with ADHD may find symptoms return or worsen. They may also be more susceptible to postpartum depression.
The postpartum period may be extremely difficult. Consider putting a plan in place ahead of time for support. This may include low-level mood stabilizers, therapy, or other measures that you discuss with your provider.
ADHD and Perimenopause/Menopause
Perimenopause is another period of hormonal fluctuation in a woman's life. While overall hormone levels are declining, perimenopause is marked by large swings in hormones and is sometimes referred to as “reverse puberty.” Irregular cycles make it challenging to predict the effect of these hormone swings on ADHD symptoms.
Over time, the decline in ovarian function leads to the end of ovulation and progesterone surges. Estrogen also declines, settling at a lower, yet more stable, level when periods cease. Menopause is defined as beginning one year after the last period.
Given what we know about how estrogen supports the brain, it’s not surprising that many women experience changes in brain function through the perimenopause and post-menopausal years.
Low estrogen in menopause may contribute to:
- Memory loss
- Brain fog
- Mood issues
- Decreased attention
- Changes in reasoning and cognitive performance
Many of these symptoms may overlap with ADHD symptoms and are the result of low estrogen affecting neurotransmitters and brain function. Hormone replacement therapy may be something to consider discussing with your doctor.
What You Can Do to Help
Hormonal changes through the menstrual cycle and phases of life may be particularly hard for women with ADHD. However, understanding how these hormonal fluctuations affect symptoms can help you put strategies in place to improve ADHD management. Here are some ways to do so.
Adjust Your Medication
If you notice changes in ADHD symptoms that correlate with hormonal fluctuations, adjusting medication may be supportive.
Some women have found success with increased doses of or a change in ADHD medication during high symptom days of their cycle, or when entering a new phase of life, such as puberty, postpartum, or menopause. There may be other times, such as during pregnancy, when decreasing or discontinuing medication makes sense.
Always discuss medication changes with your doctor.
Omega-3 Fatty Acids
Fish oil, a source of omega-3 fatty acids, could help with ADHD symptoms. The omega-3 fats in fish oil, DHA and EPA, support cell membranes and neurotransmitters while decreasing inflammation. This helps with mood and overall brain function and may even help to improve behavior in children with ADHD.
Omega-3 fatty acids are found in cold water fish like salmon and sardines, as well as nuts and seeds like walnuts and hemp seeds.
You can learn more about the benefits of omega-3 fatty acids here. If you’re looking for a high quality, tested omega-3 supplement, look at our Omega Plus.
Vitamin D
Vitamin D is another supplement that may improve ADHD symptoms, particularly inattention. Vitamin D is made when we are exposed to the sun. If you find you spend a lot of time indoors or live somewhere without sun exposure, it may be best to supplement.
Those with ADHD and vitamin D deficiency may see the most benefit from supplementation. I recommend a combination of vitamin D3 and vitamin K2 because the addition of K2 can be protective against some of the issues that can arise with supplementation.
Hormone Supportive Nutrients
In addition, supplements aimed at improving hormonal balance may indirectly support ADHD too. Vitamin B6, folate, DIM, sulforaphane (from broccoli seeds), calcium D-glucarate, black cohosh, and Vitex are some of the herbs and nutrients that can help support healthy estrogen, progesterone, and testosterone levels. You’ll find all of these in our Balance Women's Hormone Support supplement.
Supplements needs in perimenopause, may differ from supplements taken during other life phases and should be tailored for each individual. Work with your provider for the proper testing and guidance.
Some options to consider might be:
Get More Sleep
Sleep is one of the most important factors when it comes to general cognitive function and wellbeing. When you feel the symptoms of your ADHD are worse, this is time to get more sleep. In addition, prioritizing sleep may help minimize the fluctuations in symptoms that correspond with hormone change.
In adults, ADHD correlates with delayed sleep phase disorder, a circadian rhythm disorder where one falls asleep later (by at least two hours) and wakes up later compared to a normal pattern.
Staying up late, the use of screens at night, and sleep deprivation may negatively impact ADHD symptoms.
If you have a hard time winding down at night and getting consistent sleep, here are some ideas:
- Set a regular bedtime and stick to it!
- Limit screen use before bed or use blue light blocking glasses
- Make sure your room is comfortable, cool, and dark
- Take a bath, journal, or meditate in the evening
Melatonin, the sleep hormone, helps to set the circadian rhythm and can be supported through good sleep hygiene and supplementation. L-theanine is another supplement option that may improve sleep quality in those with ADHD.
Regular Exercise
Being active is good for your brain and promotes sleep. Exercise is an especially effective lifestyle tool for ADHD as it refreshes the mind, burns off excess energy, and supports hormone balance.
Studies show both short – and long-term benefits to exercise for brain health and symptoms in children and adults with ADHD. Exercise leads to structural changes in the central nervous system, improves brain activity, and enhances dopamine, which improves attention and cognitive performance.
While all exercise is supportive, cardiovascular activity may be particularly beneficial for reducing impulsivity, attention, and behavior.
Understand Your Cycle
When it comes to your hormones, you may not see patterns until you start tracking your symptoms. Understanding your cycle and how your body reacts to various factors means that you can better anticipate how to care for yourself.
The first step is to keep a journal. Track your cycle, along with ADHD symptoms. You can also make notes about sleep, exercise, diet, and other lifestyle factors. To make it easy, use an app like Clue or Flo.
When you notice patterns, you can target specific interventions and evaluate how the interventions work. You’ll be able to anticipate bad days and have an emergency plan in place.
If you are ready to dive deeper into understanding your cycle, your hormones, and how to create more balance, check out my free Hormone Starter Kit.
As if ADHD isn’t challenging enough; women have the added challenge of navigating ADHD through hormonal changes. Understanding your body is empowering. This knowledge will help you to feel more grounded and thrive through your cycle and through life.
References
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- NIH National Institute of Mental Health. Attention-Deficit/Hyperactivity Disorder (ADHD). NIH.
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- Barth, C, Villringer, A, Sacher, J. Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Frontiers in Neuroscience. 2015. 9.
- Banaschewski, T, Belsham, B, Bloch, M. Supplementation with polyunsaturated fatty acids (PUFAs) in the management of attention deficit hyperactivity disorder (ADHD). Sage Nutrition and Health. 2018. 24. 279–284.
- Dehbokri N, Noorazar G, Ghaffari A, Mehdizadeh G, Sarbakhsh P, Ghaffary S. Effect of vitamin D treatment in children with attention-deficit hyperactivity disorder. World J Pediatr. 2019. 15. 78-84.
- Lyon MR, Kapoor MP, Juneja LR. The effects of L-theanine (Suntheanine®) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial. Altern Med Rev. 2011. 16. 348-354.
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