Times when your hormones fluctuate, such as puberty, menopause, pregnancy, and even your monthly cycle, may increase symptoms of ADHD.

Throughout a woman’s lifetime, estrogen levels are constantly in flux. Additionally, during the reproductive years, estrogen levels rise and fall monthly.

For women with ADHD, these hormonal changes can play a big role in how symptoms are experienced and managed.

Estrogen is the primary sex hormone in those assigned female at birth. It is a key component in the reproductive system.

There is a link between estrogen and various cognitive functions. Specifically, estrogen can affect dopamine and serotonin. These neurotransmitters play a role in ADHD as they can affect focus and mood.

On the other hand, ADHD symptoms may become more severe when estrogen levels are lower.

For girls, puberty typically occurs between the ages of 8 and 13, and it comes with both physical and emotional changes. There’s also a marked increase in estrogen and progesterone hormones.

It might be easy to assume that, with higher levels of estrogen, girls with ADHD would have an easier time during puberty. However, the opposite tends to be true.

While estrogen may improve ADHD symptoms, progesterone does not. Higher levels of progesterone during the third and fourth weeks may decrease the effectiveness of ADHD medications.

For this reason, it may be helpful to keep a symptom journal and discuss changes or challenges with your doctor.

How to keep a symptom journal

A symptom journal is a written daily record of symptoms you experience. It includes information about daily habits and medication use that may affect these symptoms.

A symptom journal can be a tool that can help you recognize triggers and patterns. This can be especially helpful when talking with your doctor.

You can use a notebook or a notes application on an electronic device to keep your symptom journal. Include information such as:

  • the dates and times where you notice increased symptoms
  • when you take medications
  • mood changes
  • sleep length and quality
  • what and when you eat and drink
  • about where you are in your cycle, if applicable
  • other symptoms (even if they seem unrelated)

Women menstruate each month from puberty until perimenopause (roughly 30 to 40 years). During this 28-day menstrual cycle, estrogen and progesterone levels fluctuate. Although these fluctuations are not nearly as dramatic as they are during puberty, they do still affect ADHD symptoms.

According to an article by Marcy Caldwell, a licensed clinical psychologist specializing in ADHD, women often experience more or worsening symptoms during the last 2 weeks of their cycle as progesterone levels rise.

A 2023 study found that women may experience exacerbated ADHD symptoms. Decreased effectiveness of ADHD medication was also reported.

Another 2023 study found that risk-taking behaviors may increase mid-cycle, and inattention symptoms may increase right before the menstrual cycle.

Additionally, premenstrual syndrome (PMS) may also be more common in women with ADHD. Combined with ADHD, PMS can compound symptoms such as brain fog and forgetfulness.

If you feel that your cycle is impacting your ADHD symptoms, talk with your doctor. They may be able to adjust your medication if needed.

Just like with puberty and periods, pregnancy brings a substantial shift in hormone levels. For many women, Caldwell explains, ADHD symptoms get worse during the first trimester.

There’s limited research regarding medication use and ADHD during pregnancy. A small 2022 study found that, among those who discontinued, maintained, or adjusted their ADHD medication during pregnancy, there were no significant changes in symptoms.

However, there was a difference between those who discontinued medication and those who continued or adjusted medications regarding their moods and family functioning. More research is needed to explore the connections.

If you have ADHD and are planning on becoming pregnant, speak with your doctor about your medication. Do not stop taking your medication unless your doctor has specifically advised you to.

Around the age of 40, women start to experience what’s known as perimenopause. This is the transitional period into menopause.

During this time, estrogen levels begin declining, and menstruation becomes more irregular. This stage lasts an average of four years until menopause, which is when menstruation stops altogether.

A 2021 study found that decreasing levels of estrogen and progesterone during perimenopause can cause ADHD symptoms to become more severe.

Dopamine and serotonin, two brain chemicals that are known to play a role in ADHD, can be affected during perimenopause. This may lead to worsening of ADHD symptoms.

Along with hot flashes, menopause often brings symptoms such as memory fog and difficulty focusing. This can be even more difficult for women with ADHD, who already face challenges in the area of focus and attention.

Estrogen therapy is sometimes prescribed to treat the symptoms of menopause. This may also help manage some newly worsened ADHD symptoms. However, estrogen therapy is not prescribed for ADHD alone.

For women with ADHD, hormonal changes can lead to additional challenges. Understanding how hormonal changes can impact your symptoms can go a long way in managing symptoms and addressing needs over time.

If you feel that puberty, pregnancy, or menopause are affecting your ADHD symptoms, it is important to talk with your doctor. They can help you manage any new or exacerbated symptoms while keeping your individual needs in mind.