ADHD in adult women is emerging as a focus of increased research, and women are being assessed for Attention Deficit Hyperactivity Disorder more commonly than in the past. This blog series addresses ADHD in adult women. In this sixth post in the series, Attention Deficit Hyperactivity Disorder is examined in women; specifically, the role of hormones.
Hormonal Impact:
Attention Deficit Hyperactivity Disorder symptom severity varies in response to hormonal fluctuations. Girls experience enhanced cognitive abilities, mood, motivation, verbal memory, and sleep when estrogen and corresponding dopamine levels are high. However, during low-estrogen/low-dopamine states, girls are likely to experience exacerbated ADHD symptoms and comorbid internalizing symptoms, including premenstrual mood symptoms. Compared to their neurotypical peers, women with Attention Deficit Hyperactivity Disorder experience higher rates of premenstrual syndrome, premenstrual dysphoric disorder, postpartum depression, and symptoms associated with menopause. This cumulative symptom burden can destabilize even the highest-functioning females (which can also lead to later identification and diagnosis of ADHD). Awareness of hormone levels can enhance diagnostic accuracy. Given that women spend more than one third of their lives in menopause, it is essential that we understand that older women can experience exacerbated climacteric symptoms (symptoms of menopause) and Attention Deficit Hyperactivity Disorder symptoms.
Ovarian hormones interact with almost every system in the body, and are essential components of physical, social, and emotional health for women. Estrogen protects the brain by enhancing neurotransmitter activity, which then affects executive functioning, attention, motivation, verbal memory, sleep, and concentration. Estrogen levels, which fluctuate in individuals throughout the month as well as across the lifespan, affect the expression of ADHD symptoms in women. ADHD is largely thought of as a condition with symptoms that are stable across time, but this is not the case for women and their bodies. In fact:
- ADHD Symptoms Vary with Hormone Fluctuations. ADHD symptoms increase as estrogen decreases. Estrogen decreases after ovulation, in the middle of the menstrual cycle, and even further near the start of menstruation. The combination of low estrogen and high progesterone exacerbates ADHD symptoms. It also means symptoms can vary day-to-day. Some women may be even more sensitive to these fluctuations than others.
- Estrogen Increases During Puberty, around the time when ADHD symptoms become more prominent in girls. These hormonal changes can also lead to anxiety and emotional volatility, which can lead to girls being misdiagnosed with anxiety or a mood disorder, and treated insufficiently when Attention Deficit Hyperactivity Disorder is not accurately diagnosed.
The content for this article was derived in part from the following sources:
- Littman and Wagenberg, Gender Differences in ADHD and Their Clinical Implications, Psychiatric Times, 2023. https://www.psychiatrictimes.com/view/gender-differences-in-adhd-and-their-clinical-implications
- ADDitude: https://www.additudemag.com/adhd-in-women-misunderstood-symptoms-treatment/?srsltid=AfmBOoqVeQiluZLnL2VZ9dL99n_3OQR04nvRstgSpni6yH5zZi353zXB, reviewed by Ellen Littman, Ph.D., 2021.
- https://www.autism.org.uk/advice-and-guidance/topics/physical-health/menopause#:~:text=Some%20autistic%20people%20report%20that,strategies%20that%20work%20for%20them
If you would like to learn more about Attention Deficit Hyperactivity Disorder, you may want to explore additional posts on my Neuronews Blog. If you are interested in assessment for Attention Deficit Hyperactivity Disorder and are age 16 or older, you can learn more on my page about, Neuropsychological Assessment. Please feel free to contact me from that page or by email at amy@amyblackmonphd.com.