ADHD and the menstrual cycle: When hormones put a strain on 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.
But did you know that your menstrual cycle plays a big role in how you experience your symptoms? Not all therapists make menstruating women aware of the connection between hormones and ADHD symptoms, but because the impact can actually be quite large, we think it's worth delving into. So let's take it piece by piece, so that you with ADHD get a little more insight into how you are affected during your menstrual cycle.

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The Luteal Phase: Hormonal Chaos After Ovulation

In the week or weeks between ovulation and your period, your body undergoes a natural hormonal shift. Estrogen levels, which otherwise have an invigorating, energizing effect and can improve dopamine function in the brain, drop significantly. At the same time, progesterone – a hormone that has a more calming and sedating effect – increases.

For people with ADHD, it can be a tough cocktail, in short:

• Low estrogen = less dopamine → poorer focus, memory and motivation.
  
  

• More progesterone → increased fatigue, lower stress tolerance and more emotional reactivity.
  
  

The result? Many people experience a worsening of their ADHD symptoms in the days before their period. And it's not just something you "imagine" – it's biologically rooted.

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Symptoms that often worsen in the luteal phase (after ovulation):

Maybe you can nod in recognition of some of the symptoms below?

• Increased inner turmoil or restlessness
  
  

• More impulsive or irritable behavior
  
  

• Difficulty organizing and planning
  
  

• Brain fog and low motivation
  
  

• More emotional vulnerability or depression
  
  

Some describe that it can feel as if their medication suddenly doesn't work - it's often about the brain working under completely different conditions in this particular phase compared to the follicular phase. And you should talk to your doctor about this if you are given medication to support you in your everyday life.

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Is it PMDD, PMS – or just ADHD x hormones?

“I just feel so exhausted… Almost completely depressed.” Is that a sentence you recognize? The vast majority of us can feel the energy and energy draining away as we approach our first day of bleeding.

But for people with ADHD, the cognitive and emotional symptoms of the luteal phase can be particularly pronounced, making daily tasks overwhelming. It can feel like you're "losing yourself" for one to two weeks each month. There is significant overlap between hormone-exacerbated ADHD and PMS/PMDD - and this can make it difficult to distinguish between the two.

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What can help you with ADHD better throughout your cycle?

Even though you can't change your cycle, there are small things that can help you get through your luteal phase a little better:

1. Track your cycle ... and note when symptoms worsen. This will give you an understanding of patterns and give you better opportunities to take care of yourself in the next cycle.

2. 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.

3. Give yourself more slack during this period ... And schedule fewer tasks, and turn down the self-criticism. Know that it's your hormones and ADHD brain that's at play - it's not you.

4. Get enough sleep ... And we mean that seriously. Sleep is extra important for you with ADHD and especially during your luteal phase, when your brain and body need extra recovery.

5. 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.

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You are not alone – and it is not your fault.

If you don't feel like your medication is working for about half of the month, then there's a good explanation for when you have a cycle. You're not alone - and there's nothing wrong with you. Your brain is largely hormonally influenced.

Unfortunately, psychiatry, like so many other areas of medicine, is still lagging behind when it comes to female-specific symptoms, and unfortunately, there is not much focus yet on how a menstrual cycle is affected by ADHD. It is unlikely that your therapist has asked you about how you experience, for example, the luteal phase. But now you hopefully know a little more about how you may be affected, and you are therefore better equipped to have the conversation with your doctor.

We can only recommend that you start keeping a cycle diary so that you can start to see the connection between your symptoms and your cycle. The hormonal fluctuations that you will naturally experience during a cycle regardless of ADHD can significantly worsen your ADHD symptoms – but there is help available so that you can be better supported throughout your cycle.

Sources: Massachusetts Institute of Technology brain scientist Richard Wurtman, Ph.D. How Nutrition harmonizes the ADHD Brain by ADDitude Magazine, 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