From monthly periods that leave you tired and achy, to postpartum anxiety, to night sweats and mood swings brought on by menopause, hormones can be partially to blame for a lot of discomfort women face.
And while women going through hormonal transitions can have a difficult time adjusting, research shows that for women with attention-deficit/hyperactivity disorder (ADHD), it is more challenging.
In fact, women with ADHD experience a two- to three-fold increase in mood and ADHD symptoms during hormonal transitions, and 58% of women with ADHD report experiencing postnatal depression, compared to just 19% in the general population.
Despite affecting millions of women worldwide, ADHD in females often goes undiagnosed or misunderstood, with many women struggling silently with symptoms that fluctuate with hormonal changes, impacting their daily lives, relationships and overall well-being.
Sandra Kooij, MD,PhD, a professor on adult ADHD at Amsterdam University Medical Center and researcher on ADHD and hormones across the female lifespan, breaks down just how much estrogen plays a role in worsening ADHD symptoms and what women can do to help alleviate symptoms.
The role of estrogen in hormonal transitions
ADHD is a neurodevelopmental disorder that affects a person’s ability to pay attention, control impulses and be active. Symptoms can start in childhood and persist through adulthood, impacting daily life and way of functioning.
Symptoms can include having trouble staying focused or on task, having too much energy or struggling to sit still. Symptoms will also vary depending on a person’s age, personality and gender.
Girls typically display more internalized ADHD symptoms, such as inattention and forgetfulness, and as a result, it’s not uncommon for them to go years without a proper diagnosis or treatment.
As girls age, it’s natural for their body to develop more estrogen. Studies have shown higher levels of estrogen are linked to enhanced executive function and attention, while low or fluctuating estrogen levels are associated with various cognitive deficits. Meaning as estrogen levels fluctuate throughout a woman’s life, so can her ADHD symptoms.
“During these episodes hormone levels drop, of which perimenopause lasts longest; hormones will never return afterwards,” Kooij said. “It is especially estrogen that impacts mood and cognition. In women with ADHD, who are believed to have low brain levels of the neurotransmitter dopamine, this drop of estrogen hits them twice.”
Dopamine and estrogen happen to work closely together in the brain, improving mood, memory and decision making. When lacking both, women with ADHD face a harder time when it comes to regulating behavior, she adds.
What women can do to better help their ADHD symptoms
Screening at any stage of life can help.
If you’re unsure about any symptoms you are having, speaking with a licensed healthcare professional who can offer a referral to a specialist is a great place to start, regardless of what age or life stage you are in.
While symptoms might be brushed off or seen as normal, Kooji advises to continue to seek medical care until you feel your symptoms are manageable.
“Treatment of ADHD might also improve cognitive and depressive perimenopausal symptoms,” Kooij said. “We found a positive effect of an increased dosage of stimulant ADHD medication for premenstrual depression, and hormone replacement therapy can improve the mood swings and hot flashes, meanwhile also protecting bone and heart health.”
In addition to pharmaceutical treatment for ADHD symptoms, optimizing brain function that involves basic behavioral and lifestyle changes is key. Getting adequate sleep can help cognitive function and help regulate emotions. Exercise is another key element. This boosts blood flow which can increase serotonin and dopamine.
Of note, ADHD during perimenopause can be differentiated from menopausal symptoms by screening for when symptoms began in childhood and what the lifetime persistence of ADHD symptoms have been for the patient.
And while knowledge about the interaction of dopamine and estrogen is still scarce in mental health care, progress is being made. Research is slowly expanding, and more resources are becoming available.
If you have questions about your ADHD symptoms or are curious if you have ADHD, Kooji advises to speak with your doctor.