Why is ADHD often undiagnosed in women?
Traditionally, ADHD has always been thought of as being a male dominated condition due to higher rates of diagnosis, however research suggests women struggle just as much with ADHD symptoms as men- they just present differently in terms of the symptoms.
Women seem to experience more internalising behaviour such as inattention, rather than externalising behaviour like hyperactivity (seen more in men) – because inattention is less noticeable than hyperactivity, it tends to get missed easily and thus contributes to under diagnosis in women.
The role of the menstrual cycle
Recently, a woman’s menstrual cycle has been shown to influence ADHD symptoms. This should not really be a surprise since it is well established that sex hormones such as oestrogen, progesterone and testosterone influence mood and cognition. The effect of these hormones on mood and cognition is multifaceted but involves regulation and modulation of neurotransmitters including serotonin, dopamine and noradrenaline.
Dopamine is of course the most well known neurotransmitter when it comes to ADHD. In preclinical studies, oestrogen has been shown to stimulate dopamine production and reduce reuptake and degradation at the synapse, highlighting just how important oestrogen is for optimising dopamine.
Can low or withdrawal of oestrogen make ADHD symptoms worse?
Yes.
- We see increased dopaminergic transmission in the late follicular phase of the menstrual cycle, which coincides with peak oestrogen, and seems to assist with better working memory and mood.
- We see decreased dopaminergic transmission in the early follicular phase (when women are bleeding and have low oestrogen) leads to worse brain fog and lowered motivation and concentration.
Does ADHD medication work differently during the menstrual cycle?
Women taking stimulant medication also report decreased perceived efficacy of stimulant medication premenstrually. While it is often suggested to increase medication at this time, it may be worth looking at your hormones and fixing these instead.
What can you do?
If you notice your ADHD symptoms are worse at different points in your cycle, then it may be worth booking a consult to work on your hormones, rather than simply increasing medication. Lisa is highly experienced Naturopath in Caringbah, situated in the Sutherland Shire, who specialises in Women’s Health and hormones.
