ADHD and the Reproductive Years
"Hormonal fluctuations definitely affect my ADHD symptoms,” says 41-year-old Jamie Suzanne Saunders, an office manager in Louisville, Kentucky. "About three days before I get my period, and continuing through it, I feel hyper, inattentive, and restless. It’s like I’m driving down a superhighway, and, instead of going straight, I veer off onto an exit, only to find myself on another highway with equally interesting exits. I lose my focus and can’t get anything done." Newly diagnosed, Saunders hopes that her ADHD specialist will help her take control of her symptoms, especially as she heads into perimenopause.
Hormonal Effects on ADHD
The average menstrual cycle is about 28 days, counting from the first day of your period. During the first two weeks, known as the follicular phase, levels of estrogen rise steadily, while progesterone levels are low.
Estrogen promotes the release of the feel-good neurotransmitters, serotonin and dopamine, in the brain. Not surprisingly, studies suggest that the first two weeks of the cycle go more smoothly for women with ADHD than the second two weeks, when progesterone levels rise. During the third and fourth weeks, called the luteal phase, progesterone diminishes the beneficial effects of estrogen on the brain, possibly reducing the effectiveness of stimulant medications.
Quinn believes that women with ADHD experience premenstrual syndrome (PMS) more acutely than women who don’t have the condition. "Feelings of depression and anxiety typically worsen in women with ADHD during this time," says Quinn. The good news? Treating ADHD can improve PMS symptoms, too.
Solutions: Keep a log of your ADHD symptoms for three months — charting when they occur and worsen during the menstrual cycle — and try to identify a pattern. Some women have problems only one or two days of the month, the week before their periods begin. Other women’s ADHD symptoms worsen for 10 days or so during the luteal phase.
"I never understood how hormonal fluctuations affected my ADHD symptoms until I kept a journal," says Lori Scarmardo, age 34, mother of two, in Austin, Texas. Lori was diagnosed with ADHD six years ago. "Every month, in the week before my period, I would make entries like, 'I’m back in the fog' or 'I can’t get anything done.' Noticing when my ADHD symptoms were severe helped me go easier on myself — I realized that my behaviors were due to hormonal changes — and caused me to develop strategies to minimize those symptoms. I cut back on caffeine and sugar in the week before my period, and I exercised regularly."
Medication can help. Taking a low-dose antidepressant or anti-anxiety medication one or two days before your period helps many women manage emotional highs and lows. Others find that upping their ADHD medication slightly, a few days before, makes them feel they’re in control. Oral contraceptives improve ADHD symptoms in many women by minimizing hormonal fluctuations. Three weeks of pills that are formulated with estrogen alone, followed by one week of progesterone alone, seem to be especially helpful.
Next: ADHD and Childbirth