Scientists have discovered yet another fun perk that comes along with fluctuating female sex hormones. No, we’re not talking about PMS this time, or bloating, or even that sudden desire to subsist entirely off of chocolate and sea salt; we’re talking about ADHD symptoms. More specifically, how hormones seem to impact ADHD symptoms.
In a recent study, researchers described the “double whammy” (their words, and we agree) that women who have ADHD face throughout the month and throughout their lifetime. We’ll get into the details of this research below, but the TL;DR version is this: Some ADHD symptoms seem to increase when estrogen rapidly declines… but other symptoms go up when estrogen increases. Since women are in a constant flux of hormonal changes throughout the month– and throughout our lifetimes– rising and falling ADHD symptoms may feel like another internal rollercoaster to navigate for ladies.
Hence the “double whammy.”
How ADHD Affects the Sexes Differently
Before we discuss how hormones impact ADHD symptoms, let’s take a quick look at how ADHD shows up differently in males and females.
About 8.1 percent of adults between the ages of 18 and 44 in the U.S. have been diagnosed with ADHD. 5.4 percent of those people are male, and 3.2 percent, female.
Now this doesn’t exactly mean that more males have ADHD than females; just that more of them are diagnosed. Some think this is because they are more likely to show outward signs of ADHD like hyperactivity, impulsivity, or aggression; where females are more likely to exhibit internal ADHD behaviors, like inattention or forgetfulness.
Additionally, people who are socialized as women are typically taught to “sit still,” “be polite,” and may just be better at internalizing and hiding ADHD symptoms. As a result, girls and women with ADHD are often underdiagnosed and misdiagnosed with other conditions like mood disorders.
ADHD symptoms seem to remain pretty consistent for boys and men, but for girls and women, symptoms tend to change throughout the month, or during different life phases like puberty, pregnancy, or perimenopause. Because hormones.
Estrogen and ADHD
Estrogen is the primary sex hormone for those assigned female at birth. And, estrogen has been shown to affect dopamine, serotonin, and norepinephrine. Basically, when estrogen levels are on the rise, so too are levels of these three neurotransmitters. This happens for women during puberty, and every month during the follicular stage of the menstrual cycle, before ovulation.
When estrogen levels fall, so too do levels of dopamine, serotonin, and norepinephrine. This happens every month during the luteal phase– after ovulation and before your period. It also happens during perimenopause and after pregnancy.
Here’s where ADHD symptoms come in. To really oversimplify things here, ADHD has been linked to low levels of neurotransmitters like dopamine, serotonin, and norepinephrine. So when estrogen falls, ADHD symptoms tend to get worse.
When estrogen levels rise, women with ADHD may find it easier to concentrate.
But because we can’t just have nice things, there is a catch, and it really is a “double whammy.”
When estrogen levels rise, women with ADHD may find it easier to concentrate– however, if their symptoms also tend to include fidgeting, hyperactivity, or impulsiveness, these behaviors will be at their highest when estrogen levels are highest.
To recap:
- Whenever estrogen falls, women with ADHD may find it more difficult to concentrate and stay focused. This happens every month after ovulation, during menopause, and post pregnancy.
- Whenever estrogen rises, women with ADHD may find it easier to concentrate, but may find it harder to sit still or control impulsive behavior. This happens during puberty, before ovulation each month, and during pregnancy.
ADHD Hormone Deficiency
Some people (who aren’t currently going through menopause) may also have chronically low levels of estrogen. This may be because of an eating disorder, genetic conditions like Turner Syndrome, autoimmune disorders, certain cancer treatments that affect the ovaries, a hysterectomy, conditions that affect the pituitary gland, or just prolonged stress. For those with ADHD, this baseline estrogen deficiency may make ADHD symptoms worse.
The relationship seems bidirectional
It seems that not only can hormones make women’s ADHD symptoms worse, but ADHD can make women’s hormonal symptoms worse, too.
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Women with ADHD are more likely to have premenstrual dysphoric disorder (PMDD), a debilitating monthly response that includes painful physical, psychological, and cognitive symptoms. This is because dopamine plays a role in regulating pain as well as mood, and people with ADHD are thought to already have lower levels of dopamine.
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Women with ADHD are more likely to experience postpartum depression after their first child. This is because estrogen– and so dopamine– levels plummet after delivery.
- Women with ADHD report more symptoms of perimenopause, like hot flashes.
ADHD and Other Hormones
Progesterone: During the menstrual cycle, when estrogen goes low, progesterone goes high. While this sort of sounds like a campaign slogan for hormones, it’s actually just what happens every month during the luteal phase for menstruating women. Unfortunately, research shows that this combination of decreased estrogen and higher levels of progesterone can cause ADHD symptoms to be at their worst.
Testosterone: You might think that since boys are more often diagnosed with ADHD, testosterone might play some role. However, studies don’t point to this.
Thyroid hormones: It seems people with high levels of thyroid-stimulating hormone (TSH) are more likely to show ADHD symptoms.
Best Birth Control for ADHD
If you have ADHD and you’re in your fertile years, it might seem tempting to just get on hormonal birth control to mitigate symptoms. After all, increasing estrogen typically means better concentration, right? Unfortunately, it’s a little more complicated than that.
Hormonal birth control pills come in two forms: Combination pills, which contain both estrogen and progestin, and the “mini pill” which contains just progestin.
As we’ve seen by now, though, raising progesterone levels is not great for ADHD–and there is no hormonal pill that won’t do this, even if it also raises estrogen. Though some people on Reddit seem to favor a combination pill taken consistently, with no break for placebo pills. This means there would be no plummeting levels of estrogen and it may mitigate some ADHD symptoms.
But, as we all know, these people on Reddit are not doctors or experts. So if you have ADHD and you notice a difference in symptoms throughout your cycle, post-pregnancy, or during perimenopause, please talk to your doctor about whether or not hormonal treatment is right for you.
