January 8, 2025
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How periods can affect ADHD symptoms and treatment
Attention deficit hyperactivity disorder symptoms worsen before and during a period, a new study has found, which may have implications for treatment.
Researchers once thought that attention deficit hyperactivity disorder (ADHD) was an immutable condition: you either have it or you don’t, end of story. But it has become clear that ADHD symptoms can change throughout a person’s life, and new research shows that symptoms can also change during the menstrual cycle.
The new findings, presented at the US Congress of Psychiatry and Mental Health in October but not yet published in a peer-reviewed journal, provide the strongest evidence yet that ADHD symptoms can change with hormonal changes.
“It gives us a personalized view of what is happening to many women with ADHD,” says Dora Wynchank, a psychiatrist and ADHD researcher at the Dutch mental health organization PsyQ, who was not involved in the study. “Because ADHD has historically been studied in boys and men, we have missed this important aspect.”
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Michelle Martel, 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 cycle. Almost all participants had a formal ADHD diagnosis, and approximately half took psychostimulants for treatment. Each day, Martel’s team measured the participants’ hormone levels and assessed their ADHD symptoms with questionnaires and cognitive tests.
Martel and her colleagues found that participants reported worse ADHD symptoms, such as inattention and impulsivity, before and at the beginning of their period and, to a lesser extent, around ovulation. This matched the results of the cognitive tasks, and echoes what many psychologists, including Martel and Wynchank, have heard from their patients.
“‘Something happens the week before my period where all hell breaks loose,'” Wynchank says she’s heard from clients. “‘A couple of days into my month, I look back and I don’t recognize myself. And this comes back every month.’
Martel says these changes are largely caused by drops in estradiol, the most potent form of estrogen. Estrogen is the best known sex hormone, but it is also active in the brain, helping to stabilize attention, memory and mood. It also helps your body 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,” Wynchank says. “That combination of malfunctioning dopamine and low estrogen levels is just a double whammy that makes the cognitive symptoms much worse.” This may explain why studies show higher rates of premenstrual dysphoric disorder in people with ADHD, as well as a higher likelihood of worsening postpartum depression and perimenopausal symptoms. Estrogen levels are known to drop before menstruation, after childbirth, and around menopause.
Martel’s latest results show the same effect as a previous study of 32 participants Published in 2018. “It’s really just validating everything we found before,” says Martel, “It really allows us to make sure these results are accurate, that we’re getting something real.”
The findings may have implications for the diagnosis and treatment of ADHD. In Martel’s preliminary study, some participants only met criteria for ADHD at certain points in the menstrual cycle, which may have affected the ability to diagnose it. And Martel wants to study whether some people would benefit from a cyclical adjustment of ADHD medication.
Wynchank and his collaborators published a case study which supports this idea of a cycle-specific recipe in 2023. Researchers prescribed an increased pre-monthly dose of ADHD medication to nine patients and followed them for six months to two years. All participants experienced improvement in symptoms without increased side effects and planned to continue with the titrated dose. But Wynchank says there are other things, such as psychotherapy and hormonal birth control, that haven’t been thoroughly studied yet that can make premenstrual ADHD symptoms worse.
There is much work to be done in this area, both Wynchank and Martel agree. “ADHD in girls and women is certainly understudied,” says Martel.
To address this disparity, Wynchank and his collaborators are leading the way A worldwide survey of women with ADHD Until March 1, 2025. “We want to know what the lived experience of women with ADHD is and what the research priorities are,” says Wynchank. “It’s not about researching what interests us. We want that to come from women.”
