Sex Hormone Pitfalls and ADHD: Four Smart Ways to Empower Women with ADHD

Do you encounter increasing brain fog and irritability during your period, but find you’re more focused and less distracted mid-cycle? 

Sex hormones, from puberty to menopause, can aggravate ADHD over a woman’s lifetime.

ADHD symptoms tend to be variable for women with ADHD. They fluctuate across the menstrual cycle and along the life span and are impacted by variations in sex hormones and ADHD medications, all influencing executive functioning. 

This article is about how to manage the pitfalls of all these changes across the life span. To appreciate what occurs in women with ADHD it's helpful to first look at sex hormone fluctuations in all women across the life span. We'll then look at the most compelling new research on women with ADHD and how to manage these variations as they impact performance. My hope is to empower you and the woman you love to live a healthier, calmer, and more enjoyable life with ADHD. Let's get started! 

Hormones and the Menstrual Cycle  

 Sex hormone fluctuations are necessary for a healthful cycle; at the same time, these changes cause variations in behavior and performance in many women.

The reproductive system is influenced by two hormones, the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH) which travel from the brain to the ovaries. In the ovaries, these hormones impact the production of estrogen and progesterone.

During the follicular phase, the first 10-16 days of the menstrual cycle, many follicles are growing in the ovaries, causing estrogen levels to increase. A dominant mature follicle emerges producing more estrogen and more luteinizing hormone. At this stage, there are low levels of progesterone. 

After ovulation, the luteinizing hormone and estrogen hormone levels fall. The dominant follicle transforms into a corpus luteum, which acts as a temporary organ that mainly releases progesterone and prepares the uterus for embedding an egg. Progesterone levels then begin to rise as the mature follicle drops off. About 7 days after ovulation, estrogen levels start to rise as well, but not as high as progesterone levels.

In the perimenopause stage, the follicle-stimulating hormone levels in the brain fluctuate, impacting estrogen fluctuation, and causing mood swings, insomnia, weight gain, and memory challenges. While estrogen levels are not eliminated, the ovaries can spring into gear every so often. 

A 2021 study of 2400 women aged 35 -55 years reported they were having perimenopausal symptoms even though they didn’t expect perimenopause to interfere with their lives until age 50. Perimenopause can last months, or years. (Streicher, Lauren, Hot Flash Hell)

“During perimenopause, the only thing predictable is that your period generally arrives as you get on a plane wearing white with no tampons... Once a woman enters menopause, the ovaries have permanently stopped producing estrogen and your 'tank is on empty,'" says Streicher.

As you can see, even without ADHD, fluctuations in sex hormones are normal for a healthy cycle. Still, these fluctuations can impact changes in behavior and performance.  

ADHD, Estrogen, and Dopamine  

For individuals with ADHD, minor variations in dopamine in the prefrontal cortex can impact memory, motivation, focus, and mood.

The prefrontal cortex is also a region with high amounts of estrogen compared to other areas of the brain. It is extremely sensitive to the neurochemicals in its environment and any changes in these neurochemicals. 

Explore Sleep Challenges 

Wavering levels of hormones during your cycle affect your ability to fall and stay asleep. According to a 2007 National Sleep Foundation poll, 33% of women say their sleep is disturbed during their menstrual cycles. Estrogen helps metabolize neurotransmitters that regulate the sleep cycle. Estrogen also keeps your body temperature low at night and can act as a mood stabilizer. 

In their study on patients with ADHD and sleep, researchers Wajszilber and Gruber recommend a baseline sleep study during the assessment of ADHD, and intermittent evaluation of sleep over the life span. They suggest treating the sleep problem might be an ideal first step prior to or in addition to prescribing stimulant medication.