For women with ADHD this may not come as a surprise – female hormones seem to impact attention levels.

Some people report ADHD symptoms being harder to manage at different times of the menstrual cycle and after reviewing the literature researchers agree. Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence – PubMed (nih.gov)

Not a lot is known about the link between hormones and executive function – there is little research out there. But what information there is suggests some interesting patterns.

Women with ADHD may find it even harder to plan, focus and prioritise at times of great change in hormone levels. So the menstrual cycle, puberty, pregnancy and the menopause could each impact how symptoms show up for some individuals.
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Some people do not register as even having clinical ADHD until they reach one of those life stages. It is not uncommon for women to stay below the clinical threshold until they reach menopause – when fluctuating levels of oestrogen and progesterone suddenly tip them into full-blown ADHD.

To muddy the waters further, many women without ADHD experience ‘preg head’, ‘meno brain’ or mood changes during menses. However, for those with a diagnosis symptoms are more likely to be severe and to interfere with daily life.

That could be the reason boys with ADHD outnumber girls by 3:1 but by the time of adulthood that has evened out. Women are being diagnosed when they reach menarche, pregnancy or menopause and their symptoms become more pronounced.
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Changing levels of oestrogen, progesterone and their impact on neurotransmitters seem to be behind it.

A review of research literature found evidence that falling levels of the oestrogen type estradiol E2 could be linked to an increase in hyperactivity and inattentivity. E2 is the form of oestrogen present during reproductive years. It’s suggested that rising levels of this hormone at puberty may play a role in activating ADHD.

During the menstrual cycle different affects are suggested as progesterone and oestrogen rise and fall.

At mid-cycle, as oestregen falls – around the time of ovulation – women may notice a rise in hyperactivity, impulsivity, executive deficit and changes in emotional regulation. This could lead to greater risk-taking as well as greater alcohol consumption.

In the second part of the cycle there may be an increase in inattention, irritability and depressive symptoms. Again, these affects may be present in women without ADHD but more pronounced for those with the condition.

Some clinicians adjust medication throughout the menstrual cycle to get the best results for clients. But there is very little research to turn to and more concrete information is sorely needed.
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Written by Dr Diana Goldsmith
Clinical Psychologist