Key Takeaways
- ADHD is often underdiagnosed in women because symptoms can present differently than in men.
- Women are more likely to experience inattentive symptoms rather than hyperactivity.
- Hormonal fluctuations throughout the menstrual cycle may influence ADHD symptoms.
- Oestrogen plays an important role in dopamine regulation, which is closely linked to ADHD.
- Some women notice worsening brain fog, concentration difficulties and emotional symptoms at certain stages of their cycle.
Why is ADHD often undiagnosed in women?
For many years, Attention Deficit Hyperactivity Disorder (ADHD) was considered a predominantly male condition. This perception largely stemmed from higher diagnosis rates in boys and men. However, research now suggests that women experience ADHD at similar rates but are often diagnosed later in life or overlooked altogether.
One reason ADHD is frequently missed in women is that symptoms tend to present differently.
While boys are more likely to display externalising behaviours such as hyperactivity, impulsivity and disruptive behaviour, women are more likely to experience internalising symptoms, including:
- Inattention
- Daydreaming
- Difficulty concentrating
- Mental overwhelm
- Emotional dysregulation
- Executive functioning challenges
- Forgetfulness
Because these symptoms are often less visible, many girls and women learn to mask their struggles, contributing to delayed diagnosis and treatment.
The role of the menstrual cycle
Recently, research has highlighted that 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. Research suggests that oestrogen may support dopamine activity by:
*Decreasing dopamine reuptake at the synapse
*Increasing dopamine production
*Reducing dopamine breakdown
Can Low 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?
Some women taking stimulant medication report that their medication feels less effective in the days leading up to their period.
Researchers are increasingly exploring the interaction between hormones and ADHD medication response. While some women may discuss medication adjustments with their prescribing doctor, it may also be valuable to investigate underlying hormonal factors that could be contributing to symptom fluctuations.
Addressing hormone imbalances, stress, sleep quality, nutrition and overall health may form an important part of a comprehensive ADHD management strategy.
Supporting ADHD Through a Hormonal Health Approach
If you notice that your ADHD symptoms worsen at specific times during your menstrual cycle, it may be worth exploring your hormonal health alongside conventional treatment.
Potential areas to investigate include:
- Oestrogen and progesterone balance
- Nutritional deficiencies
- Stress and cortisol levels
- Sleep quality
- Blood sugar regulation
- Gut health
- Perimenopause-related hormone changes
A personalised approach can help identify factors that may be influencing cognitive function, mood and attention throughout the month.
Frequently Asked Questions
Why is ADHD harder to diagnose in women?
Women are more likely to experience inattentive symptoms rather than obvious hyperactivity. These symptoms are often less visible and may be mistaken for anxiety, stress or personality traits.
Can hormones make ADHD symptoms worse?
Research suggests that hormonal fluctuations throughout the menstrual cycle may influence neurotransmitters such as dopamine, potentially affecting focus, motivation and mood.
Does ADHD get worse before a period?
Many women report worsening ADHD symptoms before menstruation when hormone levels begin to decline. Symptoms may include brain fog, poor concentration, emotional sensitivity and reduced motivation.
Can perimenopause affect ADHD?
Yes. Declining and fluctuating oestrogen levels during perimenopause may contribute to worsening ADHD symptoms in some women.
Seeking Support for ADHD and Hormonal Health?
If you’ve noticed that your ADHD symptoms fluctuate throughout your menstrual cycle, hormonal health may be an important piece of the puzzle.
As a naturopath and nutritionist based in Caringbah in the Sutherland Shire, I support women from Sydney, Melbourne and across Australia via telehealth with ADHD, hormone health, perimenopause, gut health and nutritional medicine.
Book a consultation to explore how your hormones, nutrition and lifestyle factors may be influencing your ADHD symptoms.
