ADHD and the Menstrual Cycle: How Your Cycle Affects Your Symptoms
Many people with ADHD find that their symptoms get worse before menstruation. This is due to hormonal changes in the luteal phase, where estrogen decreases and affects including dopamine and serotonin in the brain.
If you have ADHD, you're probably used to a daily life where impulses have to be kept in check, your head sometimes feels like a ten-lane highway with heavy traffic and varying success in staying focused. As a late-diagnosed woman - I know this, even though my choice to take medication has helped me tremendously with focus and calm.
But in my own research, I have also found that our menstrual cycle plays a fairly large role in how ADHD symptoms are experienced over the course of a month and thus also how good an effect we may experience from our possible medication.
And this is an important insight for you with ADHD to gain. Because based on the feedback I get from you, not all psychiatrists yet make menstruating women aware of the interaction between hormones and ADHD symptoms or tailor the treatment to the menstrual cycle.
So let's take it piece by piece, so that you with ADHD can gain a little more insight into both your body and your mind. It's worth its weight in gold.
The article is written by Cathrine Wichmand, founder of Flow, diagnosed with ADHD in 2024
Why does ADHD get worse before menstruation?
Briefly explained: Many menstruating women with ADHD experience their symptoms worsening in the days before menstruation. This is due, among other things, to hormonal changes shortly after ovulation and into the luteal phase, when estrogen levels drop. Estrogen supports focus and cognitive processes and works together with neurotransmitters such as dopamine and serotonin.
Dopamine is important for, for example, your executive functions, and this is also where you are affected when you have ADHD. Your brain does not have enough dopamine when you have ADHD, and therefore you can also take medication to regulate the level of dopamine.
Therefore, you may find that your ADHD medication does not quite work as well as usual, or that the racing thoughts and mental chaos return a little.
How hormones affect your ADHD symptoms - throughout the cycle
Let's go a little deeper into what hormonal changes happen during your cycle and how it affects the brain. ADHD and hormones are closely related because estrogen affects dopamine in the brain.
👉 If you want to geek out about your cycle and get to know the phases better, read the article here
1. The menstrual phase (approximately days 1–5)
Menstruation begins because both estrogen (the lowest level of your entire cycle) and progesterone have dropped - the egg has not been fertilized. The body sheds the uterine lining, and most of us experience fatigue or menstrual cramps.
Hormones
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Estrogen: low
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Progesterone: low
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Testosterone: low to moderate
How can it affect ADHD?
When estrogen is low, dopamine activity may also be lower. This can lead to:
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low motivation
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mental fatigue
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difficulty concentrating
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greater need for rest
At the same time, some may experience some mental clarity because progesterone is also low.
2. Follicular phase (approximately days 6–14)
Since the first day of bleeding, the body is already slowly preparing for the next ovulation, and estrogen levels gradually increase. Estrogen supports focus and cognitive processes and, supported by dopamine and serotonin, many people generally experience increased energy and vitality.
Hormones
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Estrogen: increasing
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Progesterone: low
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Testosterone: slightly increasing
How can it affect ADHD?
Estrogen can increase dopamine activity in the brain , which can make ADHD symptoms easier to manage. As a result, many people experience:
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better focus
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higher motivation
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more energy
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easier planning and organization
For some, this is the phase in the cycle where ADHD feels most manageable.
3. Ovulation (approximately day 14–16)
Now the hormones reach their highest level and ovulation takes place.
Hormones
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Estrogen: peaks
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Testosterone: peaks
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Progesterone: begins to rise
How can it affect ADHD?
Many people with ADHD experience:
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high energy
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increased self-confidence
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better social profit
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stronger motivation
The combination of high estrogen and testosterone can support dopamine and make the brain more "awake", this is also where you "get the most out of" your medication if you take medication.
4. The luteal phase (approx. days 17–28)
After ovulation, progesterone rises sharply, while estrogen falls relatively sharply. Progesterone has a more calming and sedating effect on the nervous system , but it also minimizes the positive effect of estrogen and helps to influence both attention and mood. Shortly before your period, progesterone drops sharply. Many menstruating women generally experience that they are more tired, bloated, a little more mentally unprepared - this is when PMS sets in.
Hormones
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Estrogen: decreases
-
Progesterone: increases
-
Testosterone: decreases
How can it affect ADHD?
For many with ADHD, this is the most challenging phase . You may find that your medication is not working as well as it used to, and you may experience increased:
- More difficulty regulating your mood
- Poorer focus
- More difficult to plan and structure tasks and time
- More difficult to make decisions
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Lower motivation
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Increased impulsivity
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Greater emotional vulnerability
It is also during this phase that some people experience PMS or PMDD , which can exacerbate emotional symptoms. In fact, recent research from Cambridge shows that women with ADHD are three times more likely to experience PMDD than menstruating women without ADHD.
Briefly explained:
High levels of estrogen = higher levels of dopamine and serotonin
High levels of progesterone = estrogen's beneficial effects are blocked, so lower dopamine and serotonin – lower stress tolerance.
Low levels of estrogen = lowest levels of dopamine and serotonin.
Does that sound familiar? Of course, symptoms can vary from person to person, but many describe that small, easy everyday tasks feel significantly more difficult during this part of the cycle, even if they take medication.
ADHD symptoms that may get worse before menstruation
Many people with ADHD experience a worsening of symptoms during the luteal phase. This can be felt as, among other things:
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more inner turmoil
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greater impulsivity
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lower motivation
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difficulty concentrating
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increased emotional sensitivity
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fatigue and brain fog
Symptoms can vary from person to person, but many describe that even small everyday tasks feel significantly more difficult during this part of the cycle. Does this apply to you too?
Is it PMDD, PMS – or just ADHD x hormones?
We need to dwell on PMDD - this is important for you with ADHD. Up to 80% of all menstruating women experience PMS - premenstrual symptoms ( PMS you can read much more about here ). PMDD is the somewhat more severe degree of PMS.
It is estimated that up to 8% of all menstruating women suffer from PMDD - but if you have ADHD, the risk is three times greater. And PMDD is not a question of being a little tired. PMDD, premenstrual dysphoria, is manifested, among other things, by depressive thought patterns, and with PMDD you are so affected that it affects your relationships, work conditions, self-image and level of functioning. And it can hit every single cycle - month after month. It is extremely hard, and it can be serious.
👉 Here you can read in depth about PMDD - both symptoms and treatment options.
And that's why it's really important that you take it seriously, because there is something to do if you have ADHD.
How is PMDD treated?
The general treatment approaches if menstruating women experience PMDD are:
- SSRI (antidepressant treatment) – often first choice
- Hormonal treatment
- Therapy and support
- Lifestyle (as a supplement – not as a “solve it yourself”)
- HRT - Hormonal Replacement Therapy
- Diary
- Antihistamines
- Dietary supplements
- GLP1 (although newer and more experimental treatment)
We go into more depth about the treatments in the article about PMDD here.
But when you have ADHD, there may also be a very good reason to adjust your medication according to your cycle. This may mean a higher dose in the period between your ovulation and the first day of your bleeding, for example, what we call the luteal phase.
Talk to your psychiatrist about this particular option if you find that your medication is not working as well as usual.
And now that I'm writing from a place of personal experience, I can add that I take magnesium glycenate throughout my cycle, I drink a glass of water with creatine every morning. And then I eat as much protein as I can.
To stay personal: Does the thought of SSRIs make you nervous? I had a period where I took SSRIs - what is called antidepressant treatment for PMDD. It is nothing to be ashamed of, and it can be a really good help for some.
I have ADHD - what can I do to get through my cycle better?
Even though you can't change your cycle, there are small things that can help you get through your luteal phase a little better:
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Track your cycle and note when your symptoms worsen. This will give you an understanding of the pattern and give you a better chance of taking care of yourself in the next cycle. Then your period won't catch you off guard to the same extent.
That's the sneaky thing about PMDD, it kind of creeps up on you. -
Talk to your doctor ... about possible adjustment of medication leading up to menstruation. It may be that you need a higher dose? Or maybe it is relevant to look at mood-stabilizing medication to best support you? Or melatonin to sleep more soundly? There are several options, but only you and your psychiatrist know the right solution for you.
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Give yourself more slack during this period ... If you know you're really affected after your ovulation, plan your calendar accordingly. Fewer tasks, fewer appointments, more of what can increase dopamine. And: Down with self-criticism. It's not you who is wrong, it's you who is affected by the development of hormones.
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Get enough sleep ... And I mean that seriously. Sleep is extra important for you with ADHD and especially in your luteal phase, when your brain and body need extra recovery. Even a few days of poor sleep hits me extremely hard.
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Eat consistently throughout the day ... And preferably high in protein! Several studies show that protein stimulates neurotransmitters in the brain that increase alertness, while carbohydrates promote fatigue. This supports the widespread belief that people with ADHD perform better after a high-protein breakfast and lunch.
(Hint: I eat eggs + cottage cheese EVERY morning).
The extra spice for ADHD: Postpartum and perimenopause
Now that you know that the drop in estrogen affects everything from your well-being, your energy, your executive abilities, etc., it's worth keeping in mind during other periods of life when estrogen also drops - for example, after giving birth or during perimenopause.
During your pregnancy, estrogen levels have increased and peaked - shortly after birth, they drop dramatically. This is one of the factors that increases the risk of postpartum reactions - and this estrogen drop is worth paying attention to if you have ADHD.
And then comes perimenopause - the long period leading up to menopause, when your menstrual cycle finally stops. During this time, estrogen levels are also unstable, and menstruating people with ADHD may therefore experience even more severe perimenopausal (yes, that's a word) symptoms compared to people without ADHD.
👉 Not sure if you're in perimenopause? Here are the most common symptoms.
You are not alone – and it is not your fault.
Finally, I want to give both you and myself a big hug. From a late-diagnosed woman with ADHD who has really been down and out many times because of (undiagnosed) ADHD, it's so hard that we can experience our cycle in a much higher and harder way.
Know that you are not alone. You are not wrong either. Everyone's brain is very much influenced by hormones, and when it is also affected by an attention disorder like ADHD and therefore even more sensitive to hormonal fluctuations, it comes at a cost to us.
The best thing you can do for yourself is to gain knowledge in the field and be your own best advocate. You have room to maneuver, and you also have a psychiatrist or doctor who will take you seriously.
From one curly brain to another: Good luck!
FAQ: ADHD and the menstrual cycle
Why does ADHD get worse before menstruation?
Because estrogen drops in the luteal phase, which can affect dopamine in the brain and thus focus and impulse control.
Can ADHD medication work less well before menstruation?
Some people find that the medication feels less effective in the days before menstruation due to hormonal changes.
Can cycle tracking help with ADHD?
Yes, many people find that cycle tracking gives them a better understanding of when symptoms worsen. Find our guide to tracking your cycle here.
Can ADHD be affected by hormones?
Yes. Hormones like estrogen affect dopamine in the brain, which can affect ADHD symptoms.
Is ADHD worse during the luteal phase?
Many people experience worsening symptoms during the luteal phase because estrogen decreases and progesterone increases.
Sources:
- How Nutrition harmonizes the ADHD Brain by ADDitude Magazine - Richard Wurtman, Ph.D., of the Massachusetts Institute of Technology
- Hormones and Behavior by Ashley G. Eng, Urveesha Nirjar, Anjeli R. Elkins, Yancey J. Sizemore, Krystina N. Monticello, Madeline K. Petersen, Sarah A. Miller, Jordan Barone, Tory A. Eisenlohr-Moul, Michelle M. Martel,
- Increased risk of provisional premenstrual dysphoric disorder (PMDD) among females with attention-deficit hyperactivity disorder (ADHD) : cross-sectional survey study by Thomas Broughton, Ellen Lambert, Jasmin Wertz, Jessica Agnew-Blais
