A guide to hormones and ADHD

Hormones play a powerful role in all of our lives. For women, chemicals like estrogen can influence everything from how you develop into adulthood to how clearly you think and function. And the way hormones affect you can vary depending on what stage of life you’re in, or where you are in your menstrual cycle.

A growing body of research suggests that there may be a connection between changes in hormone levels and ADHD.¹ This might not surprise you if you live with ADHD. But getting some facts to back up what you may have long suspected can put your mind at ease.

Estrogen, progesterone, and ADHD

The amount of estrogen and progesterone your body produces depends on where you are in your menstrual cycle, pregnancy, or stage of life. If you don’t get your period regularly, due to a medical condition, birth control, or menopause, your hormones may not change as much — or as predictably.

Let’s talk about estrogen first. When estrogen levels rise, the amount of dopamine available for your body to use increases. Dopamine is one of several “feel good” chemicals in the brain. The more dopamine you have, the more energized and focused you might feel. The catch? When estrogen levels drop, so does dopamine function. That means how you feel can take a dive, too.²

Some research suggests that the brains of people with ADHD don’t process dopamine as well as non-ADHD brains.³ So, when your estrogen levels dip, how much dopamine your brain has and can use may dip even more. This drop may make certain ADHD symptoms worse. It can also make hormone-related mood changes or irritability worse.

Keep in mind

Research suggests that a decline in estrogen levels, rather than the absolute amount of estrogen, can lead to worse ADHD symptoms in women. Even physicians may not be aware of this and may tell a woman in perimenopause that her estrogen levels are “fine,” not understanding that it’s the decline in estrogen, not the level of estrogen, that is impacting her anxiety, depression, or ADHD symptoms.

— Kathleen Nadeau, PhD, Understood Expert

Another key hormone is progesterone. Progesterone increases after ovulation and during pregnancy. A high progesterone level can make you feel relaxed. But it can also lower your mood and leave you feeling drained.⁴

How your hormones affect your ADHD symptoms will change throughout your life. Knowing what life stage you’re in, and what hormones are at play, can help you better understand your ADHD — and yourself.

Puberty

ADHD can seem milder as boys reach their teens because they may appear less hyperactive.⁵ Teenage boys may still struggle with their emotions and with attention and organization. But less disruptive behavior can sometimes make ADHD symptoms less noticeable to others.

With girls, it’s the opposite.⁵ Girls are more likely to get an ADHD diagnosis during puberty because their symptoms become more obvious due to fluctuating hormones.

Younger girls tend to struggle quietly with attention and focus. Hyperactivity in girls can also show up differently. Compared to boys, whose hyperactivity gets flagged as “disruptive,” girls are often told that they’re “chatty.” And few teachers recognize being overly talkative as a sign of ADHD. 

At puberty, fluctuating hormones can trigger new and more obvious ADHD symptoms.⁶ Preteen and teenage girls may start having intense mood swings and anxiety. They may suddenly struggle in school. (Think back to your own experience.) At the same time, girls with ADHD tend to withdraw during puberty. This can make their troubles easier to miss.

If you have a daughter with ADHD who’s in or nearing puberty, keep a careful eye out for mood or behavior changes. Reach out to her health care provider if you see that she’s struggling. Keep her teachers in the loop, too.

The menstrual cycle

Your ADHD symptoms may change significantly depending on where you are in your menstrual cycle.

Tracking your cycle and comparing it to how challenging your ADHD symptoms are can help you identify trends. If you notice that your mood and ability to focus are better or worse at certain points in your cycle, plan accordingly. For example, leave tougher projects for the weeks during and after your period. And save lighter jobs that take less concentration for the second half of your cycle.

If you need help tracking your menstrual cycle, download Understood’s printable period tracker. Use it to compare your ADHD symptoms to where you are in your cycle.

Read on to better understand how and why your cycle can affect your ADHD symptoms.

Follicular phase

This phase of the menstrual cycle begins on the first day of your period and lasts from 14 to 21 days. It’s called the follicular phase because a sac — called a follicle — grows within the ovary as it prepares to release an egg. During this phase, estrogen climbs. You may feel more alert, energetic, and better able to handle attention-related tasks.⁷ You may notice more hyperactivity-related symptoms around this time, too.⁸

Ovulation

Ovulation occurs shortly after two hormones, estrogen and luteinizing hormone (LH), peak. Within 24 to 36 hours of this peak, your ovary releases an egg. Right after ovulation, estrogen levels start to fall. At the same time, levels of progesterone start to rise. Ovulation typically falls in the middle of your menstrual cycle, unless you have irregular or long cycles.

There are many ways to track ovulation if you’re trying to learn more about your cycle. After you ovulate, your body temperature increases slightly. Checking and tracking your temperature first thing in the morning can help identify ovulation. But you have to track your temperature every day. And it can take a while to identify trends. Some fitness trackers include temperature monitoring and predict ovulation. You have to wear them to bed every night for accurate readings.

You can also buy ovulation tests. These are paper strips that you dip in urine to find out when your LH is high. Or you can pay attention to your vaginal discharge. Before you ovulate, discharge becomes thin and watery. Some people say it looks like egg whites.

Luteal phase

Your luteal phase begins right after ovulation and ends the day before your period starts. This phase is typically about two weeks long. During the first week, progesterone levels rise and estrogen levels stay stable. If you get pregnant, your progesterone levels will continue to rise. If you don’t become pregnant, progesterone and estrogen levels will decrease during the second week of your luteal phase. Because of this decrease in hormones, you may have a harder time managing ADHD symptoms.⁷

Period

The first day of your period marks the start of the follicular phase. This is also the time when estrogen levels start climbing. Some women, with and without ADHD, feel a sense of ease and relief as soon as they start bleeding. Others feel bloated, achy, irritable, and distracted. They may only feel better once their period ends.

Some women with ADHD feel like their medications don’t work as well leading up to and during their period.⁹ And certain ADHD medications may worsen menstrual cramps¹⁰ and cause heavier bleeding.¹¹ Talk to your health care provider about changing or adjusting your ADHD meds if they don’t feel as helpful during your period.

PMS and PMDD

If you think there’s a connection between your ADHD and how miserable you feel before your period, you’re not imagining it!

There’s evidence that women with ADHD are more likely to have premenstrual syndrome (PMS).¹² If you have PMS, you’ll notice symptoms about a week before your period, lasting up until a few days after your period starts. Typical symptoms of PMS include irritability, mood swings, bloating, headaches, fatigue, and breast tenderness.

Women with ADHD are also more likely to have premenstrual dysphoric disorder (PMDD), a more severe form of PMS.¹³ Making things tougher: Certain ADHD medications may not work well toward the end of your cycle.⁷

Talk to a mental health professional if you’re struggling. It may be worth changing or increasing your ADHD medication if they don’t feel as effective. Your health care provider may also suggest taking an antidepressant or anti-anxiety medication several days before your period starts.⁹ In some cases, using birth control pills to regulate estrogen and progesterone levels may be the way to go.¹⁴ Keeping your hormones from rising and dipping may help lessen ADHD symptoms.

Pregnancy

The hormones in your brain and body skyrocket when you’re expecting. This includes specific hormones you only make while you’re pregnant. Estrogen and progesterone levels also increase dramatically during pregnancy.

Many women, with and without ADHD, report having “pregnancy brain” during this time. They find it difficult to concentrate, stay organized, remember things, and stay on task.

Research on this subject has mixed findings.¹⁵ One study found no connection between hormonal changes during pregnancy and mental functioning. But it did link higher levels of progesterone to feeling depressed.

Another study found evidence of issues related to thinking, but only during late pregnancy. And a study of pregnant women with ADHD found that their symptoms stayed relatively stable.

Overall, changes in mental functioning may affect some pregnancies and not others. But pregnant women with ADHD may be more sensitive to these hormonal changes.¹⁵

One of the biggest questions women with ADHD have during pregnancy is whether they can continue taking ADHD medications. There is data showing that stimulants are safe to take while pregnant.¹⁵ But some doctors still advise against it, and prefer not to expose an unborn child to medication when possible.¹⁶ This is especially true for women with milder ADHD symptoms.

Your best option is to talk to your health care provider and weigh the risks and benefits of being on or off your meds. Together, you can make a choice that’s best for both you and your future child.

If you want to try going off meds, it may help to ask for accommodations at work. Your employer may be able to cut back or adjust your workload, based on your pregnancy and ADHD diagnosis.¹⁵

Postpartum

As soon as you give birth, your estrogen and dopamine levels drop. Low estrogen levels can last for at least six months after giving birth, and for some women, as long as they are breastfeeding. 

Low estrogen levels may cause your ADHD symptoms to worsen. Lack of sleep while caring for a newborn can also worsen ADHD symptoms.¹⁷ On top of this, women with ADHD are five times more likely to have postpartum depression and anxiety disorders than women without ADHD.¹⁸

If you’re pregnant or are thinking about getting pregnant, make a plan to identify and address signs of postpartum depression and anxiety early. Share your concerns with your partner or family members and ask them to keep an eye out for worrisome changes in your mood or behavior. Asking for support is crucial during this time.

As part of your plan, talk to your health care provider about restarting or adjusting your ADHD drugs. If you want to nurse your baby, discuss the risks and benefits of starting or staying off your meds while breastfeeding.⁷

Finally, don’t be a hero. Caring for a newborn is one of the most rewarding things in life. But it’s also among the most challenging and chaotic. This is especially true if you have ADHD. Accept help when it’s offered. And don’t be afraid to ask for support early, even before your baby is born.

Perimenopause and menopause

The transition from your fertile years to menopause is typically gradual. This stage is called perimenopause.

During perimenopause, estrogen and other hormone levels begin to drop. When that happens, levels of dopamine and other chemicals that affect mood also dip. For most women, perimenopause starts in their late 30s and continues over the next four to eight years. The transition to menopause is complete once you go a year without getting your period.

Perimenopause and menopause can come with physical symptoms like weight gain and hot flashes. You may also notice changes in your thinking and emotions. Classic menopause symptoms like moodiness, irritability, difficulty concentrating, and poor memory can be confused with ADHD symptoms.¹⁹

There isn’t a lot of research about how menopause specifically affects women with ADHD. But it’s possible that women with ADHD may have more severe perimenopause and menopause symptoms than women without ADHD. This may be because you start out with lower dopamine levels than other women — and your levels dip even lower as menopause nears.⁷ You may feel increasingly anxious, depressed, moody, agitated, and distracted.

You may also find it harder to focus, stay on task, keep organized, and remember things as your dopamine levels continue to drop and you go through menopause.

Medication can help if you feel like your ADHD and menopause symptoms are too hard to manage. Raising the dosage of your ADHD meds may also be an option. Your health care provider might prescribe a medication known as a selective serotonin reuptake inhibitor (SSRI) to help with anxiety and depression. Hormone replacement therapy is another option and can relieve menopause symptoms for women with and without ADHD.

After menopause

Once you’ve gone 12 months without a period, you’re considered postmenopausal. You’ll be in this phase for the rest of your life.

Some women say they feel better once their bodies adjust to the change and their hormones aren’t in flux anymore. Unfortunately, ADHD in postmenopausal women has not been studied very much. But some women with ADHD say that memory problems become their primary symptom at this stage in life.

Keep in mind

Hormone replacement therapy (HRT) can be very helpful in the 10 years following menopause. Very few physicians have been trained in HRT for cognitive or emotional regulation issues and falsely believe that if hormone levels are at an adequate level during perimenopause, there is no problem. There is growing evidence that HRT in the decade following menopause can be extremely helpful for women in a number of ways, including helping with cognitive issues.

— Kathleen Nadeau, PhD, Understood Expert

ADHD and hormonal changes can make for a wild ride. But knowing what to expect can be empowering. Knowing what to watch for as you go through each stage can help you better prepare. And you may feel more confident about reaching out for help.

Summary

Hormones are important chemicals that coordinate important functions in your body. They play an especially powerful role in women’s lives, from birth to puberty to menopause and beyond.

The rise and fall of these hormone levels during certain times of the month or phases of your life can affect how you feel, how clearly you think, and how well you function.

Research suggests that changes in hormone levels likely affect ADHD symptoms in girls and women. Women with ADHD may also be more likely to have hormone-related mood disorders like premenstrual syndrome, depression after giving birth, and memory issues before and during menopause.

Knowing what to expect as a woman with ADHD can be empowering. Not just because you’ll know what to watch for as you go through various cycles and stages of your life. But because you’ll know when and where you might want to reach out for help.