From monthly menstrual cycles that can leave you feeling exhausted, achy, and irritable to the hot flashes and mood swings brought on by menopause, many challenges and discomforts women experience can be blamed partially on hormones.

Hormonal changes can present difficulties for all women, but for those with ADHD, it can be even more challenging.

Language matters

We use “women/girls” and “men/boys” in this article to reflect the terms that have been historically used to identify a person’s sex or gender. But your identity may not align with how your body responds to this condition. Your doctor can better help you understand how your specific circumstances will translate into diagnosis, symptoms, and treatment.

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Attention deficit hyperactivity disorder (ADHD) is a neurological disorder characterized by impulsivity, hyperactivity, and difficulty focusing.

According to the DSM-5, there are three distinct types of ADHD:

  • Predominantly inattentive: This type is characterized by difficulty with organization, paying attention, and staying on task.
  • Predominantly hyperactive-impulsive: This type is characterized by high levels of energy, fidgeting, and impulsivity.
  • Combined: This type is characterized by both inattentiveness and hyperactivity.

Symptoms will vary depending on the subtype and a person’s age, personality, and — you guessed it — sex.

Boys who are diagnosed with ADHD are more likely to have the combined or hyperactive-impulsive subtype. So they tend to have more overt symptoms, such as hyperactivity, aggression, and impulsivity.

For girls diagnosed with ADHD, though, it’s often subtler. Girls typically display more internalized ADHD symptoms, such as inattention and forgetfulness. As a result, many girls go years without proper diagnosis or treatment. After all, it may be easier to overlook a child who’s daydreaming as opposed to one who can’t sit still.

Estrogen, the primary sex hormone in those assigned female at birth, is a key component in the reproductive system. But there’s also a link between estrogen and various cognitive functions. Specifically, estrogen can affect dopamine, serotonin, and norepinephrine. These neurotransmitters play a role in ADHD as they have a strong impact on memory, focus, and mood.

Of course, estrogen doesn’t cause or cure ADHD, but it can certainly have an impact on symptoms. Research from 2017 suggested attention and executive thinking skills can improve when estrogen levels are higher. On the other hand, ADHD symptoms can worsen when estrogen levels are lower.

Throughout a woman’s lifetime, estrogen levels are constantly in flux. On top of that, during the reproductive years, estrogen levels rise and fall monthly. That means, for women with ADHD, these hormonal changes can play a big role in how symptoms are experienced and managed.

Puberty is a time filled with abundant change and emotional irregularity as hormones take over.

For girls, puberty typically hits between the ages of 9 and 13, and it comes with both physical and emotional changes. There’s also a marked increase in estrogen and progesterone hormones.

It might be easy to assume that, with higher levels of estrogen, girls with ADHD would have an easier time during puberty. However, the opposite tends to be true. That’s because, while estrogen can improve ADHD symptoms, progesterone does not.

There’s also the issue of medication. ADHD is most commonly treated with stimulant medications (such as Adderall or Ritalin), but these medications can be less effective during puberty.

For this reason, it may be helpful to keep a symptom diary and discuss changes or challenges with your doctor.

Women menstruate each month from puberty until perimenopause (roughly 30 to 40 years). During this 28-day menstrual cycle, estrogen and progesterone levels fluctuate. Although these fluctuations are not nearly as dramatic as they are during puberty, they do still affect ADHD symptoms.

According to an article by Marcy Caldwell, a licensed clinical psychologist specializing in ADHD, women often experience more or worsening symptoms during the last 2 weeks of their cycle as progesterone levels rise.

And, as if that weren’t bad enough, it’s also been suggested that premenstrual syndrome (PMS) is more common in women with ADHD.

Just like with puberty and periods, pregnancy brings a substantial shift in hormone levels. For many women, Caldwell explains, ADHD symptoms get worse during the first trimester.

This could be due to the increased progesterone, but medication also plays a role. Many women stop taking their stimulant medication during pregnancy, so the first trimester can be a major adjustment.

There’s limited research regarding medication use and ADHD during pregnancy. A small 2022 study found that, among those who discontinued, maintained, or adjusted their ADHD medication during pregnancy, there were no significant changes in symptoms.

However, there was a difference between those who discontinued medication and those who continued or adjusted medications regarding their moods and family functioning. More research is needed to explore the connections.

Around the age of 40, women start to experience what’s known as perimenopause. During this time, estrogen levels begin declining and menstruation becomes more irregular. This stage can last up to 10 years until menopause, which is when menstruation stops altogether.

Along with hot flashes, menopause often brings memory fog and difficulty focusing. Unsurprisingly, this can be even more difficult for women with ADHD, who already face challenges in the area of focus and attention.

For women with ADHD, hormonal changes can lead to additional challenges. But simply understanding how hormonal changes can impact your symptoms can go a long way in managing symptoms and addressing needs over time.