Women and ADHD

Hormones and brain function

Reproductive hormones such as oestrogen and progesterone influence multiple brain systems involved in attention, emotional regulation, motivation, energy levels, and stress tolerance. These same systems are often areas of difficulty for women with ADHD.

Fluctuations in these hormones across the cycle and at different life stages can therefore amplify or quieten ADHD-related difficulties, even when day‑to‑day demands remain unchanged.

Menstrual cycle effects

Across the menstrual cycle, hormone levels naturally rise and fall. Women with ADHD can notice a cyclical pattern to their symptoms, even if they do not initially connect this to hormones.

• Within the follicular phase, occurring from day one to around day 14, ovulation, of the cycle oestrogen levels are higher. This can bring about improved focus, motivation, mood and ability to manage tasks requiring improved executive functioning more easily.
• Once in the luteal phase, which occurs following ovulation and leads up to the commencement of the menstrual period, oestrogens levels drop and progesterone starts to rise. This can have a more dampening or sedating effect resulting in increased fatigue, low motivation, reduce mental clarity and feelings of brain fog and poor memory. Mood changes can occur with increased irritability and emotional dysregulation (difficulties managing fluctuation in mood and reactions), leading to greater feelings of overwhelm or exhaustion. These changes can result in typical symptoms of PMS (pre-menstrual syndrome) or PMT (pre-menstrual tension).

PMDD - Premenstrual Dysphoric Disorder

Women with ADHD are significantly more likely to experience PMDD. Studies have shown that approximately two in every five (40%) of women with a diagnosis of ADHD meet the criteria for PMDD compared to around 5-10% of women without. This increased risk is thought to be due to an increased sensitivity to hormonal changes during the menstrual cycle.

PMDD is not caused by having “abnormal” hormone levels. Instead, it happens because some people’s brains are more sensitive to the normal hormonal changes that occur across the menstrual cycle.

ADHD is linked to increased sensitivity in parts of the brain that help manage emotions, cope with stress, and regulate important brain chemicals such as dopamine and serotonin.

As a result, many women notice stronger changes in mood, thinking, and emotional balance during this time, even though these challenges improve once their period starts.

ADHD is a significant risk factor for a diagnosis of PMDD, and this association is now well supported by high‑quality research.

Women concerned they may have PMDD should track their cycle, keeping a record of mood changes and symptoms experienced throughout the month, ideally building up a history of symptoms over three months can help when seeking a referral. You should speak to your GP if you’re concerned you may have PMDD.

PCOS – Polycystic Ovary Syndrome

PCOS is more common in women with ADHD than those without.

PCOS is a common condition that affects how a woman’s ovaries work. It can result in irregular periods, excess androgen (a higher level of male hormones in the body that can result in physical signs of PCOS such as increased facial and body hair), and polycystic ovaries, where the ovaries become enlarged and contain fluid-filled sacs called follicles that surround the eggs. Women with PCOS can also experience difficulties with becoming pregnant, weight gain, oily skin or acne, and thinning hair.

Hormones can play an important role in the development of the brain, particularly in areas linked to attention, motivation, and emotional regulation. Differences in these during early development may increase the risk of a baby going on to develop ADHD.

Insulin resistance is common in PCOS and affects how the brain uses energy. ADHD is also associated with differences in brain energy regulation and dopamine signalling (which relates to focus, motivation, and reward). When blood sugar levels fluctuate, concentration, motivation, and emotional control can worsen, which may intensify ADHD‑like symptoms.

Many symptoms overlap and may be explained away as “hormonal”:

• Brain fog and poor concentration
• Chronic fatigue
• Emotional sensitivity or irritability
• Poor planning, organisation, and follow‑through of tasks and activities.
• Low self‑confidence.

ADHD can often be missed in women with PCOS due to overlap of symptoms, particularly those around inattention, and a focus on the physical effects of the conditions such as fertility, insulin resistance and weight gain.

Perimenopause and menopause

Perimenopause is a common time for ADHD symptoms to worsen or become newly noticeable. Fluctuating and ultimately declining oestrogen levels can affect attention, working memory, emotional regulation, and stress tolerance.

Individuals may report:

• Reduced ability to multitask or cope with pressure
• Increased forgetfulness or mental fatigue
• Heightened emotional sensitivity or irritability
• A sense that previous effective coping strategies no longer work

These changes can be deeply unsettling, particularly if ADHD has not previously been identified.

Women who are already taking medication to help manage their ADHD symptoms may find these becomes less reliable during this stage, even if it worked well for many years previously.

Stabilising hormones first, where appropriate and safe to do so, with HRT (hormone replaced) can help to improve cognitive symptoms and enhance the response to ADHD treatment.

This can prevent unnecessary medication changes or overstimulation from high doses, to manage symptoms. Where difficulties due to perimenopause and menopause further increase, changes to ADHD treatment are unlikely to bring about desired improvements. Once hormone levels are better managed, changes to ADHD medications can be explored, if indicated, safely and more effectively.

It is important to remember that while perimenopause and menopause can be a time when undiagnosed ADHD symptoms come to light and are more noticeable due to the overlap of symptoms, the additional challenge of existing coping strategies and routines becoming less effective, ADHD is a lifelong condition.

Individuals with ADHD will have experienced similar changes at different stages of their life, either without initially realising the reason for this, or due to having these related to other difficulties, for example, stress, anxiety, or depression, or because of good support and protective factors in their life at those times that may have meant the impact of their ADHD symptoms was less problematic.