“The average age of diagnosis for women with ADHD, who weren’t diagnosed as children, is 36 to 38 years old,” says Patricia Quinn, M.D., director of the National Center for Girls and Women with ADHD, and author of Understanding Women with ADHD. “Before that time, girls and women are often misdiagnosed as having a mood disorder or an anxiety disorder. Even if these are secondary conditions, treating them does not get to the root of the problem, which is ADHD.”
The Influence of Hormones on ADHD across the Lifespan
Understanding the link between hormones and ADHD is a fairly new topic of research. Recent studies have found that depending on the stage of development, hormones can impact a woman’s experience of attention deficit disorder. The influence of this relationship not only impacts women monthly, but over their entire lifetime. Put simply, ADHD looks different in women because a large part of a woman’s ADHD presentation can be attributed to fluctuation in hormones: Specifically, sex hormones, like estrogen and progesterone. Experts are suspecting a connection between ADHD and sex hormones after studies have already discovered how estrogen levels can impact mood and behavior in women. Sex hormones specifically carry messages from to our body and are known to turn off and turn on various traits during different developmental miles stones (i.e. puberty and pregnancy). These hormones also play a part in turning off and turning on chemical processes in our brain as well that can change a woman’s mood, energy, and even ADHD behaviors. To understand what hormones do for women with ADHD, we first need to understand the impact of estrogen and progesterone, the two most important hormones in the female body.
Estrogens are broken down into three separate subgroups:
- Estrone (E1) produced after a woman undergoes menopause
- Estradiol (E2) common in women of childbearing age
- Estriol (E3) primary estrogen during pregnancy
These hormones work together to insure healthy development in females, particularly female sex characteristics. Estrogen also manages healthy cholesterol levels, ensures bone health, and impacts the brain (i.e. mood), heart, skin, and other tissues. Estrogen is key to “unlocking happiness” as it triggers the release of Dopamine, Serotonin, and Norepinephrine that aids in overall individual satisfaction and cognitive ability.
In contrast to estrogen, progesterone is a different kind of hormone: a steroid hormone, from the hormone class progestogens that is secreted by the Corpus Luteum. Progesterone comes from a temporary endocrine gland that is produced by the female body during the menstrual cycle. It triggers the release of Gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the human cortex. GABA acts as a calming agent for the brain and while this might sound appealing for the ADHD brain, GABA can cause a depressing effect. In turn this effect can inhibit the positive effects of estrogen and cause a woman to feel an increase of inattention, fatigue, brain fog, irritability, and/or sadness.
Over a woman’s lifetime, her hormone levels fluctuate naturally during different developmental periods, and this can cause estrogen and progesterone levels to change dramatically. This ultimately can impact a woman’s mood, energy levels, and her presenting ADHD symptoms.
How hormones impact ADHD over the lifespan
Hormones: Childhood and ADHD
When a female is born, estrogen and progesterone levels are at an all-time high. Within a few months, hormone levels drop to a much lower and more consistent space. This fluctuation in hormones can cause ADHD symptoms to become apparent at a young age. Additionally, at this time, the consistency in hormones produces a regularity of symptoms. This makes treatment easier for girls as it looks similar to the treatment for boys, which ADHD treatment is often normed on. Â
Hormones: Puberty and ADHD
During puberty is when sex hormones begin to surge and girls experience an increase in progesterone and estradiol, a from of estrogen. Due to the sharp increase of these hormones, progesterone often moderates estrogen’s positive emotional and cognitive benefits. Consequently, high levels of progesterone prime a girl’s amygdala (the emotion center of the brain) for a reaction. Increased activity in the amygdala can cause symptoms of depression, anxiety, irritability, and impulsivity and ultimately make ADHD symptoms harder to manage.
Additionally, rise in female hormones can cause an adolescent girl to metabolize her medication at a faster rate, and make the dosage less effective. Increasing a girl’s medication dosage isn’t always beneficial due to the high levels of progesterone that negate positive emotional and cognitive benefits, leaving a girl to feel emotional and irritable. Alternatively, boys during this developmental age experience an increase in testosterone production, which can affect brain circuits and consequently cause more externalized ADHD-like symptoms. This might lead to boys being diagnosed with ADHD more than girls at the same age, as female ADHD behavior presentation is often internalized.
“We found that girls with ADHD in their early teens have more academic problems, more aggressive behavior, earlier signs of substance-related problems, and higher rates of depression than girls who don’t have the condition,” says Stephen Hinshaw, Ph.D., professor and chair of the department of psychology at the University of California/Berkeley, who has been studying girls with ADHD for more than 10 years.
Hormones: PMS and ADHD
Estrogen and progesterone levels continue to rise and begin to peak when a woman is in her 20s. However, female hormone levels don’t only change as women age; they also fluctuate monthly. The constant change in hormones can ultimately impact a woman’s mood, energy levels, and other ADHD-like symptoms. The first two weeks of a monthly cycle, will cause estrogen levels to increase and mood to heighten, which consequently makes ADHD symptoms more manageable. This occurs due to the increased level of estrogen that releases more “feel-good neurotransmitters” (e.g., dopamine and serotonin) in the brain. However, once a woman ovulates, her mood often decreases and ADHD symptoms worsen as estrogen levels decrease and progesterone levels increase. During the luteal phase, the third and fourth weeks, progesterone reduces the positive impact of estrogen and possibly even reduces the effectiveness of stimulant medications. Finally, once menstruation begins, both estrogen and progesterone levels fall and the cycle begins again. This change in hormone levels not only evolves through the lifespan but monthly due to one’s menstrual cycle which can ultimately dictate the fluctuation of ADHD behaviors.
Hormones: Pregnancy and ADHD
A woman’s body undergoes another hormone change if she becomes pregnant. During the first trimester, there is a rapid increase in estrogen and progesterone due to the placenta producing hormones itself and stimulating other glands (i.e., adrenals and the thyroid). This process can lead to a significant rise in ADHD behaviors as well as fatigue, changes in mood, and anxious symptoms. Additionally, it isn’t uncommon for women to be advised to stop taking their stimulant medication to protect their baby’s development, which can make a woman’s ADHD symptoms feel unbearable. However, during the second and third trimester of pregnancy, a woman’s hormone levels begin to steady. Estrogen levels at this time often decrease symptoms and ease mood, allowing ADHD symptoms to be more manageable. Nevertheless, once a woman gives birth, her estrogen and progesterone levels again drop significantly. This fluctuation in hormone secretion can ultimately lead to an increase in depression, anxiety, and ADHD symptoms.
Hormones: Perimenopause and Menopause and ADHD
Menopause is the time signifying the end of a woman’s menstrual cycle and occurs 12 months after a woman’s last period. Estrogen levels drop about 65 percent by the time a woman reaches menopause and the decrease in hormone production can begin at least 10 years prior, during the time known as perimenopause. Because of the decrease of estrogen, women also experience a loss of dopamine and serotonin in the brain. This can cause women to experience changes in mood, increase in fatigue, difficulty thinking, and memory challenges. These symptoms appear to be especially escalated in women who already have ADHD. However, the benefit during this stage is that progesterone has also decreased. With the decrease of progesterone, the small levels of estrogen that are present can be adaptive for the female body. Additionally, hormones stop cycling at this period and ADHD treatment can be easier and more consistent, as symptoms don’t fluctuate as frequently.
“Given a brain that, in effect, has less cognitive energy to begin with, it can be especially hard for women with ADHD at this time in their life to concentrate and to make good decisions,” says Patricia Quinn, M.D., director of the National Center for Girls and Women with ADHD.
What’s a Woman to Do?
There are a handful of beneficial strategies for women to utilize when hormone changes impact ADHD symptom presentation. One effective approach is hormone level tracking (i.e., period tracker). Understanding what a woman’s individual hormones are doing, can help make sense of when symptoms will be better or worse.
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Diet, exercise, therapy, and meditation can all be helpful tools when addressing the biological and environmental impact of hormones on mood and a woman’s executive functioning system. Having both preventative tools and after-care treatment can help accommodate for ADHD challenges that might arise.
Treatment might look like…
- Hormone replacement therapy (i.e., estrogen patch)
- Atomoxetine, an ADHD drug that can improve concentration and memory loss
- Antidepressants, can regulate mood
- Oral contraceptives taken during perimenopause, can stabilize hormone levels and improve brain function
- Talk therapy, to build emotional insight and awareness as well as positive coping skills
Get tested for ADHD
For those local to the Seattle area who want to learn more about if ADHD testing is right for you, please feel free to reach out to Relational Psych. We have a team of licensed psychologists and post-doctoral residents that specialize in helping people like you understand your functioning (and potentially your ADHD) so you can thrive in life. We offer comprehensive assessments to gather in-depth data about your experiences and integrate these into a holistic understanding of your sense of self with practical recommendations and a thorough report. We also have a team of therapists that can help support you after the evaluation if therapy is a recommended portion of your treatment.
Learn more about how to get tested for ADHD here, and if you’re ready to get help and are an adult in the Seattle area, schedule a free consultation today!
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References
Caldwell, M. (2021). Hormones and ADHD: The Missing Key. ADDept. Retrieved from https://www.addept.org/living-with-adult-add-adhd/homones-and-adhd
Cristol, H. & Bhandarie, S., (2020). The Link Between Hormones and ADHD. WebMD. Retrieved from https://www.webmd.com/add-adhd/hormones-adhd-connection
McCarthy, L. & Novotni, M. (2022). Woman, Hormones, and ADHD. ADDitude. Retrieved from https://www.additudemag.com/women-hormones-and-adhd/
