January 8, 2025
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How menstruation affects ADHD symptoms and treatment
New study finds symptoms of attention-deficit hyperactivity disorder worsen just before and during menstruation, which could impact treatment
Researchers once thought that attention-deficit hyperactivity disorder (ADHD) was a fixed condition. Either you have ADHD or you don’t have ADHD, that’s the end of the story. However, it turns out that ADHD symptoms can change throughout the lifespan, and new research shows that symptoms can also change across the menstrual cycle.
The new study, presented at the American Congress on Psychiatry and Mental Health in October but not yet published in a peer-reviewed journal, suggests that ADHD symptoms may fluctuate with hormonal changes. This provides the strongest evidence to date.
“This gives us a personalized insight into what is happening to many women with ADHD,” says Dora Winchank, a psychiatrist and ADHD researcher at the Dutch mental health organization PsyQ. says. He was not involved in this study. “Because ADHD has historically been studied in boys and men, we have missed this very important aspect.”
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Michelle Martell, a clinical psychologist and chair of the psychology department at the University of Kentucky, led the new study, which followed 97 female college students throughout their menstrual cycles. Almost all participants had a formal ADHD diagnosis, and about half were taking psychostimulant medications for treatment. Martell’s team measured the participants’ hormone levels daily and assessed ADHD symptoms with questionnaires and cognitive tests.
Martel and her colleagues found that participants reported worsening symptoms of ADHD, such as inattention and impulsivity, just before and at the beginning of their period, and to a lesser extent around ovulation. This is consistent with the results of cognitive tasks and what many psychologists, including Martell and Winchank, have already heard from their patients.
“‘Something happens the week before your period and all hell breaks loose,'” Winchank has heard from clients. “A few days after your period starts, you look back and realize you’re I don’t recognize it. And this comes back every month.”
Martell said these changes appear to be primarily caused by a drop in estradiol, the most potent form of estrogen. Estrogen is best known as a sex hormone, but it is also active in the brain, helping with attention, memory, and mood stability. Additionally, it helps produce and maintain levels of dopamine, an important brain signaling chemical that plays a central role in ADHD.
“It’s about sensitivity to hormonal fluctuations,” Winchank hypothesizes. “The combination of poor dopamine and low estrogen levels is kind of a double whammy that makes cognitive symptoms even worse.” This may explain why studies show a higher incidence of postpartum depression and worsening of perimenopausal symptoms. Estrogen levels are known to decrease before menstruation, after childbirth, and around menopause.
Martell’s latest results show the same effect as a pilot study she published in 2018 with 32 participants. “It’s really just validating everything that was previously discovered,” Martell said. I’m starting to understand something real. ”
This finding may have implications for the diagnosis and treatment of ADHD. Martel’s preliminary study found that some participants met criteria for ADHD only at certain points in the menstrual cycle, which could affect diagnostic ability. And Martell wants to find out whether some people might benefit from having their ADHD medications adjusted periodically.
Winchank and colleagues published a case study in 2023 supporting this idea of cycle-specific prescriptions. The researchers prescribed premenstrual doses of ADHD medication to nine patients and followed them for six months to two years. All participants reported improvement in symptoms with no increase in side effects and planned to continue with increasing doses. But Winchank points out that there are other things that may help worsen premenstrual ADHD symptoms, such as psychotherapy and hormonal birth control, but they haven’t been studied in detail.
Both Winchank and Martel agree that there is much work to be done in this area. “There’s no question that ADHD is significantly under-researched in girls and women,” Martel says.
To combat this disparity, Winchank and colleagues are conducting a global study of women with ADHD through March 1, 2025. “We want to understand what the lived experiences of women with ADHD are and what their research priorities are,” Winchank says. “It’s not something we’re interested in researching. We want it to come from the women themselves.”
