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Introduction
ADHD is often understood through a narrow childhood lens, focusing on hyperactivity, impulsivity, and executive function challenges. However, for those assigned female at birth (AFAB) and others who experience menstrual cycles, ADHD is dynamic, shifting in response to hormonal fluctuations across the lifespan.
Growing research highlights how oestrogen and progesterone influence dopamine and serotonin regulation—two key neurotransmitters already working differently in ADHD brains (de Jong et al., 2023; Dorani et al., 2021; Eng et al., 2024; Lin et al., 2024). As hormone levels fluctuate throughout the menstrual cycle, many ADHDers experience increased inattention, emotional intensity, and executive function challenges.
For some, these shifts can be so profound that they meet the criteria for Premenstrual Dysphoric Disorder (PMDD) - a condition that deeply affects mental health, energy levels, daily functioning, and overall wellbeing. Yet, despite clear evidence linking hormonal changes to ADHD symptom variation, medical and research communities have largely overlooked this intersection, leaving many individuals misdiagnosed, under-supported, or struggling to self-advocate (de Jong et al., 2023; Dorani et al., 2021; Eng et al., 2024; Lin et al., 2024).
This article explores the interplay between ADHD, PMDD, and hormonal cycles, unpacking the neurobiological, psychological, social, and cultural layers of this experience, while offering evidence-based, neurodivergent-affirming strategies for navigating these fluctuations with greater self-understanding and support.
How the Menstrual Cycle Affects ADHD Symptoms
The Role of Estrogen, Progesterone, and Dopamine Regulation
ADHD is inherently dynamic, with dopamine regulation playing a key role in attention, motivation, impulse control, and mood regulation. For those who experience menstrual cycles, hormonal fluctuations influence dopamine activity, directly impacting cognitive function and emotional wellbeing. Oestrogen, a key hormone in the menstrual cycle, has a powerful effect on dopamine availability. When oestrogen levels are high, executive function and emotional regulation tend to improve; when they drop, ADHD-related challenges often intensify (Eng et al., 2024).
How the Menstrual Cycle Impacts ADHD Symptoms
Follicular Phase (Days 1–14, beginning with menstruation)
Oestrogen levels rise, increasing dopamine availability resulting in improved focus, emotional regulation, and executive function.
Many ADHDers feel more productive, motivated, and mentally clear in this phase.
Luteal Phase (Days 15–28, post-ovulation to menstruation)
Oestrogen drops while progesterone rises, dampening dopamine function.
Progesterone has a sedative effect, often leading to brain fog, fatigue, and sluggish thinking.
Reduced impulse control, increased emotional intensity and difficulties with executive function.
For those who also experience PMDD, these fluctuations can intensify ADHD-related challenges, triggering severe mood swings and even suicidal thoughts (Lin et al., 2024).
PMDD and Its Intersection with ADHD
27.6% of individuals with PMDD also meet the criteria for ADHD—a much higher rate than in the general population (Lin et al., 2024). PMDD is a hormone-related mood disorder where symptoms escalate in the late luteal phase, significantly impacting:
Emotional wellbeing: Extreme irritability, anxiety, depression, and mood swings.
Cognitive function: Brain fog, memory lapses, and difficulties concentrating.
Behaviour: Impulsivity, frustration intolerance, and heightened rejection sensitivity.
Research suggests the reason that ADHD and PMDD co-occur is due to shared neurobiological factors (Dorani et al., 2021; Eng et al., 2024), including:
Dopamine depletion during oestrogen withdrawal resulting in challenges with attention and executive function.
Serotonin fluctuations contributing to challenges with emotional regulation.
GABA imbalances reducing the brain’s ability to inhibit impulsivity.
For neurodivergent individuals navigating both ADHD and PMDD, the late luteal phase can feel completely debilitating, impacting daily functioning, relationships, and self-perception. Without recognition and appropriate supports, this cycle can lead to distress, burnout, and a sense of disempowerment. Understanding this intersection between ADHD, PMDD, and hormone shifts is a crucial step towards self-advocacy and personalised support.
Psychological, Social, and Cultural Impacts of ADHD and PMDD
The Emotional Toll of Hormonal Fluctuations
For many neurodivergent individuals, the interaction between ADHD and PMDD can create intense emotional and cognitive fluctuations throughout the menstrual cycle. The unpredictability of symptoms can lead to frustration, self-doubt, and exhaustion, as one week may bring focus and productivity, while the next brings brain fog, overwhelm, and challenges with emotional regulation.
This inconsistency can contribute to imposter syndrome, with many individuals questioning their capabilities when symptoms intensify. The cyclical nature of challenges can reinforce negative self-perceptions, especially in environments that value consistency and linear progress. Emotional sensitivity is also heightened, making it more difficult to regulate stress and interpersonal challenges.
Unfortunately, because ADHD and PMDD are often misdiagnosed as anxiety or depression, many individuals are placed on treatments that fail to address the root cause. This can result in further distress, as standard treatments for anxiety or depression may not adequately support the executive function challenges and dopamine regulation differences at play (Dorani et al., 2021).
Workplace and Social Challenges
The fluctuating nature of ADHD symptoms in response to hormonal shifts can make it difficult to maintain consistency at work, in relationships, and in daily responsibilities. Many individuals experience periods of high energy and motivation, followed by sudden crashes in focus, emotional regulation, and executive function. These fluctuations often lead to:
Increased absenteeism, particularly during the late luteal phase when PMDD symptoms peak.
Difficulty meeting deadlines and maintaining productivity due to unpredictable cognitive shifts.
Workplace stigma, as menstrual health and ADHD remain poorly understood, leading to dismissal of struggles or lack of accommodations.
Masking symptoms, which can result in burnout, chronic stress, and a heightened risk of mental health difficulties.
In personal relationships, these challenges can create communication barriers, misunderstandings, and feelings of shame, particularly when emotional regulation challenges are misinterpreted as intentional behaviour rather than a neurobiological response. Without awareness and accommodations, many individuals feel unsupported and pressured to push through their symptoms, often at the cost of their wellbeing.
The Gender Bias in ADHD Research
Historically, ADHD research and diagnostic criteria have been based on male-presenting traits, with little attention given to how hormonal fluctuations impact executive function and emotional regulation (Eng et al., 2024). This bias has led to:
Women and AFAB individuals being underdiagnosed, particularly if their ADHD presents as inattentive, fluctuating, or emotion-driven.
The dismissal of hormonal influences on ADHD symptoms in medical and clinical settings, leaving individuals without appropriate treatment adjustments.
Limited research on female-specific ADHD treatments, meaning most available interventions are not designed with hormonal variations in mind.
There is an urgent need for gender-inclusive ADHD research that recognises and validates the impact of hormonal cycles on executive function, mental health, and daily life. Without this recognition, individuals will continue to face barriers to diagnosis, misattributed symptoms, and inadequate support, reinforcing a system that fails to account for the lived realities of ADHDers with menstrual cycles.
Managing ADHD and PMDD: Neurodivergent-Affirming Strategies
Finding ways to navigate the fluctuations in ADHD symptoms across the menstrual cycle can be challenging, but evidence-based strategies can help reduce overwhelm and improve overall wellbeing. Managing ADHD and PMDD requires an approach that acknowledges hormonal shifts, prioritises self-compassion, and allows for flexibility.
Medication Adjustments
IMPORTANT: Consult your treating doctor prior to making any changes to your medication.
Adjusting stimulant dosage premenstrually may help counteract challenges with attention, executive function, and emotional regulation as hormone levels shift (de Jong et al., 2023).
Some people find that SSRIs (Selective Serotonin Reuptake Inhibitors), when taken only during the luteal phase, can support mood regulation and reduce PMDD-related distress (Lin et al., 2024).
Tracking symptom fluctuations can help determine whether medication adjustments might be helpful. If this is something you’re considering, bringing this data to your treating doctor can support conversations about individualised treatment options.
Tracking Symptoms and Hormonal Patterns
Menstrual tracking apps can help identify patterns in cognitive and emotional fluctuations across the cycle.
Recognising when ADHD symptoms are likely to intensify allows for proactive adjustments in medication, therapy, workload, and self-care.
Tracking also helps with self-validation—noticing patterns in symptoms can reduce frustration and self-blame, making it easier to practise self-compassion during more challenging phases.
Therapeutic Approaches
Cognitive Behaviour Therapy (CBT) and Dialectical Behaviour Therapy (DBT) can help build self-awareness and emotional regulation skills to navigate hormonal shifts.
Mindfulness can reduce emotional reactivity and overwhelm, particularly during the late luteal phase when executive function tends to drop.
Allowing for a flexible approach—some strategies will work well during one phase of the cycle but not another. It’s okay to adapt, adjust, and experiment to find what works best for you.
Nutrition and Lifestyle
Magnesium, omega-3 fatty acids, and vitamin B6 have been shown to support hormonal regulation and mood stability, potentially reducing PMDD symptoms (Dorani et al., 2021).
Movement and exercise (e.g., stretching, walking or strength training) can help with executive function and mood regulation.
Ensuring you get enough sleep can support your energy levels, cognitive clarity, and emotional balance.
Workplace and Educational Accommodations
Neurodivergent-friendly workplaces and study environments recognise that consistency is not always possible, particularly when symptoms fluctuate across the cycle.
Advocating for flexible deadlines, remote work options, or alternative work schedules can help reduce burnout and executive function crashes.
Normalising discussions around menstrual health, ADHD, and fluctuating executive function is essential for reducing stigma and increasing support in workplaces and education.
Conclusion
The interaction between ADHD, PMDD, and hormonal fluctuations has been understudied and unrecognised for far too long. Many ADHDers experience cyclical shifts in cognitive function, emotional regulation, and energy levels, yet medical systems, workplaces, educational systems and broader society often fail to recognise or accommodate these realities. Understanding this connection is essential for improving both self-advocacy and systemic change.
Recognising the impact of hormonal fluctuations on ADHD symptoms is a critical step in:
Improving ADHD diagnosis and treatment for individuals with menstrual cycles.
Developing targeted interventions that address hormonal influences on executive function and emotional wellbeing.
Advocating for workplace and societal accommodations that acknowledge the real impact of these conditions on daily life.
By pushing for gender-inclusive ADHD research and treatment approaches, we can work towards more affirming, informed, and accessible care. This includes better education for healthcare providers, the integration of hormonal cycle awareness in ADHD management, and the normalisation of flexible support structures in workplaces and schools.
There is no single ‘right’ way to support ADHD and PMDD, and what works will look different for everyone. The goal is not to force ourselves into rigid expectations, but to honour our fluctuating needs, seek support where possible, and advocate for a world that understands and accommodates neurodivergent experiences.
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References
de Jong, M., Wynchank, D. S. M. R., van Andel, E., Beekman, A. T. F., & Kooij, J. J. S. (2023). Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage. Frontiers in Psychiatry, 14, 1306194–1306194. https://doi.org/10.3389/fpsyt.2023.1306194
Dorani, F., Bijlenga, D., Beekman, A. T. F., van Someren, E. J. W., & Kooij, J. J. S. (2021). Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research, 133, 10–15. https://doi.org/10.1016/j.jpsychires.2020.12.005
Eng, A. G., Nirjar, U., Elkins, A. R., Sizemore, Y. J., Monticello, K. N., Petersen, M. K., Miller, S. A., Barone, J., Eisenlohr-Moul, T. A., & Martel, M. M. (2024). Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and Behavior, 158, 105466-. https://doi.org/10.1016/j.yhbeh.2023.105466
Lin, P.-C., Long, C.-Y., Ko, C.-H., & Yen, J.-Y. (2024). Comorbid Attention Deficit Hyperactivity Disorder in Women with Premenstrual Dysphoric Disorder. Journal of Women’s Health (Larchmont, N.Y. 2002), 33(9), 1267–1275. https://doi.org/10.1089/jwh.2023.0907
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