Do you have a vague feeling that your hormones affect how you feel and behave or even worsens your ADHD, but you have no idea how? Do theories about hormones or “hormonal imbalance” seems reasonable, but doesn’t quite fit into how you perceive things?
Let’s start by looking at how female sex hormones work in general and hopefully we can get closer to how things are for you as an individual.
The menstrual cycle can be divided into four different phases:
1) the menstruation phase when hormone level drops and the uterus lining is discharged in a menstrual bleeding,
2) the follicular phase during the first two weeks of the cycle with increasing estrogen levels,
3) ovulation with peak levels of estrogen around day 14, and
4) the luteal phase during the two last weeks of the cycle when the corpus luteum produces both estrogen and progesterone.
More specifically, during the follicular phase estrogen levels are rising in order to prepare the uterus to receive and implant a fertilized egg.
Estrogen levels peak, triggering the release of a mature egg, and then drops back to a lower level after ovulation. The luteal phase is characterized by increasing progesterone levels, as well as slightly increasing estrogen levels, both peaking in the middle of this phase. As many as 75% of all women report Premenstrual syndrome (PMS) in the luteal phase.
This may be displayed as a with wide variety of symptoms, such as mood swings, food or sugar cravings, fatigue, anxiety, irritability, or depression. Many women describe how their resilience towards rejection, worry or sadness dramatically decreases and that the smallest things can leave them sobbing like babies, yelling like maniacs, or looping around in endless ruminating over what others have said or done. About 10 % have so severe symptoms of anxiety, depression and mood changes that they are diagnosed with PMDD (Premenstrual Dysphoric Disorder).
Here hormonal birth control and antidepressants is often used to relieve symptoms. In fact, more and more research demonstrate that menstrual phase is important for understanding worsening of existing psychiatric symptoms such as anxiety, mania, depression, disordered eating, alcohol use and suicidal behaviors.1,2
The scientific landscape of female mental health has been a neglected area for far too long. However, recent research has started to show some very interesting associations between ADHD symptoms and hormones.
We know from animal research that estrogen and dopamine (the central neurotransmitter in our understanding of ADHD-symptoms and ADHD medication effect) interact and potentiate each other. However, it’s not as simple as the more estrogen, the less ADHD-symptoms. Rather, it seems like hormones may trigger or worsen different symptoms depending on menstrual cycle phase AND individual ADHD profile.2
Today we know that ADHD is a highly heterogeneous disorder. This means that ADHD affect different persons differently. Adding dramatically fluctuating hormones to the mix makes it even more complex and complicated.
Progesterone, rising after ovulation, is implicated in mood swings and emotional dysregulation that many women experience during the luteal phase and for women with ADHD, who already struggle with emotional regulation, additional hormonal effects during part of the menstrual cycle could possibly result in larger negative effects on daily life functioning.
Systemic hormonal contraception (the pill) containing both estrogen and progestins or only progastrin, that inhibit the ovulatory cycle and smoothens the hormonal profile (estrogen and progesterone levels remain the same, and there is no cycle).
For some women, with and without ADHD, this hormonal situation mimics the negative mood symptoms they experience from natural progesterone during the luteal phase of the menstrual cycle, and they end up in a “constant PMS-phase”. Interestingly though, most women don’t experience these negative mood effects and contraception works perfectly fine for them, providing a safe and effective protection from pregnancy, relieving them of the economic burden and sanitary hustle around menstruation and mitigate the negative health aspects from having a period such as having to stay home from school or work due to menstrual cramps, anemia due to heavy bleeding or missing practice due to fatigue or fear of bleeding through training cloths. For some women, quite counterintuitively, some progestins – even alleviate symptoms of PMS and PMDD.
So, unfortunately, it’s not as simple as just saying that you will feel better during follicular phase and worse in the luteal.
Or that the pill, a hormone IUD, or an estrogen gel will solve your problems. Rather you may respond differently to hormonal shifts depending on your individual ADHD profile. Say for example that your ADHD takes a more hyperactive and impulsive form. Then the days around ovulation, with estrogen peaking, potentially boosting your ADHD meds leaving you “overstimulated”, may be the days when you become more impulsive than usual, not because you feel bad about yourself but because you feel SO very good and high on life.
Maybe you suddenly feel f*ck consequences, drive too fast, drink to much, have unprotected sex, or take economic risks? Stakes are high and, in a millisecond, you might end up in situations you have to pay for weeks, months or years to come. Then again, if you have more of an ADHD-profile, defined more by inattention, lack of motivation and constant fatigue the
the energy boost around ovulation might provide an extremely welcome pause from the constant uphill struggle you feel most days.
Take home message is that we can’t tell how you or anyone else will react or feel just by looking at your diagnosis, medication, or hormonal status. We will have to map out and factor in many different variables. And to make it even more messy hormones have a delayed effect on the brain. So, the mood effects of PMDD for example often start a few days after ovulation and spill over into the first days of menstruation.
But it’s not impossible to figure out how things are for just you. It all starts with you tracking and following your hormones, connecting the dots, and gradually unravelling and understanding your own unique patterns. This is what precision health is all about!
1. Handy AB, Greenfield SF, Yonkers KA, Payne LA. Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review. Harvard review of psychiatry. 2022;30(2):100-17.
2. Eng AG, Nirjar U, Elkins AR, Sizemore YJ, Monticello KN, Petersen MK, et al. Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Horm Behav. 2024;158:105466.
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