ADHD and periods

If you have ADHD and haven’t reached menopause, you might notice that your ADHD symptoms change during the month. You’re not imagining it — your menstrual cycle and the hormones that go with it can affect your ADHD.

Most people who menstruate begin having periods around age 12 and stop (reach menopause) around age 51. ADHD is a lifelong condition, but you may experience changes in your symptoms during the years that you have periods. 

Managing both periods and ADHD symptoms can be tricky. But learning about your menstrual cycle and how it affects your ADHD can help you find strategies to help you cope.

The menstrual cycle is a natural process during which hormones like progesterone and estrogen help prepare your uterus for pregnancy. If you don’t become pregnant, the uterine lining sheds and menstruation (your period) begins. It’s worth noting that you can still experience these hormonal changes if you have ovaries but don’t have a uterus. You just won’t bleed. 

The menstrual cycle is guided by hormones and has three main stages: 

1. Follicular phase: This starts at the same time as your period and continues after it ends. Estrogen and progesterone are lowest at the start of your period. The brain then sends out a hormone called follicle-stimulating hormone (FSH), which helps egg-containing follicles in the ovaries grow. Estrogen levels rise, preparing the uterus for pregnancy.

2. Ovulation: Estrogen peaks around the middle of your cycle, causing the release of a mature egg. This is when you’re most likely to get pregnant.

3. Luteal phase: After ovulation, estrogen increases to help prepare the uterus for pregnancy. If the egg isn’t fertilized by sperm, estrogen and progesterone drop and your period begins.

The menstrual cycle typically lasts around 28 days, but it can vary from person to person. Hormones control each stage and shape how your body prepares for pregnancy or resets for the next cycle.

Symptoms of ADHD can include trouble with focus and organization and, for some, hyperactivity or impulsivity. But researchers are only now learning more about the causes of ADHD and how it affects the body at large. So far, we know that ADHD is related to differences in the brain chemicals dopamine and norepinephrine. Dopamine affects the feelings of motivation, reward, and emotional control.¹ These can be challenging areas for people with ADHD.² 

We also know that hormones play a role in ADHD symptoms. Estrogen is related to dopamine levels in the brain. When estrogen levels go up or down during your cycle, so does your dopamine level.³ When your estrogen and dopamine levels are low, your ADHD symptoms like inattention and impulsivity may be worse.⁴ 

Estrogen levels naturally rise and fall throughout your cycle. When your estrogen is higher during the second half of the follicular phase, ovulation, and the first half of your luteal phase, your dopamine level is higher. ADHD symptoms like inattention and impulsivity may feel milder.³

When your estrogen is lower during the second half of the luteal phase and the first half of the follicular phase — the week before and week of your period — dopamine and serotonin levels drop.³ Your ADHD symptoms may get worse. You might have more trouble focusing, feel less motivated, or struggle with impulsivity. You could also feel more withdrawn or emotionally low.⁴ This is because when estrogen is low, so is your serotonin level, which can lead to depression, mood swings, and low sex drive. 

Tracking your period can help you get ahead of symptom changes. You can download Understood’s printable period tracker, find an app online, or use a calendar to help keep track of your cycle. Understanding when your symptoms may be more intense can make it easier to manage them. 

Here’s what you can expect from each phase and some tips that may help: 

Estrogen is at its lowest during your period, the start of this phase, which can make focusing hard. You might also feel like spending more time alone.⁴ Plan easier social activities, like watching a movie with a friend, and stick to your schedule as best you can. Plan out your medications for this week to help you focus. You may feel moodier due to low serotonin levels. Knowing that low motivation and mood are due to low serotonin levels can help you put your low mood into perspective. It can help to know that your feelings are temporary, and that you’ll feel better the following week.

As your period ends, estrogen starts to rise, so ADHD symptoms may improve. The second half of your follicular phase is a great time to plan events or tackle important assignments.

Estrogen peaks right before ovulation and drops once the ovary releases an egg. You might notice more trouble with impulse control after ovulation.⁴ Plan your days and the timing of major decisions before ovulation to avoid impulsive choices. 

After ovulation, estrogen rises slightly, and then drops again if pregnancy does not occur. As estrogen drops, you might feel less focused.⁴ Use tools like alarms, reminders, and planners to stay on top of tasks. If you take medication, make sure it’s planned out for this week. Research indicates that many women benefit from a higher level of stimulant medication during this week. We get more into that below. 

People with ADHD are more likely to experience premenstrual mood changes. This is partially because the organizational, emotional, and behavioral challenges that come with ADHD can make dealing with premenstrual symptoms even more challenging. Many people who menstruate experience premenstrual syndrome (PMS) during the luteal phase — the last week of their cycle.⁵ Symptoms typically include:

• Trouble concentrating or brain fog

• Feeling extra sensitive

• Moodiness and irritability

• Feeling tired or bloated

• Increased appetite (because estrogen plays a key role in hunger signals)

For a smaller percentage of people, these symptoms can be severe. This is called premenstrual dysphoric disorder (PMDD).⁶ Symptoms of PMDD can include:

• Mood swings — for example, bouts of extreme anger or sadness

• Feeling out of control

• Depression

• Anxiety or panic attacks

• Thoughts of suicide or self-harm

• Intense sensitivity

• Trouble with sleep

• Difficulty concentrating 

• Physical symptoms, such as breast tenderness, headaches, weight changes, and clumsiness

People with ADHD are at higher risk for PMS and PMDD.⁷ Both conditions can make ADHD symptoms harder to manage. Keep track of how you’re feeling around your period. And talk to your health care provider if you think you may need help.

If your menstrual cycle affects your day-to-day life with ADHD, schedule an appointment with your health care provider. Track your menstrual cycle and your ADHD symptoms each day and bring the information to your provider. They may have suggestions for changes in your medication schedule based on your symptoms. 

Options might include:

• Increasing your stimulant medication in the week leading up to your period to help manage symptoms

• Taking hormonal birth control, which can help smooth out the hormonal fluctuations that cause increased symptoms 

• Taking an SSRI or other antidepressant or anxiety medication regularly or during the week leading up to your period

Managing both ADHD and periods can be challenging. But knowing how your ADHD reacts to different stages of your cycle can help you and your health care provider come up with strategies that can improve your life. 

If you have ADHD and get periods, your symptoms may change throughout your menstrual cycle because of shifts in your hormones. Estrogen, which affects dopamine and serotonin in the brain, rises toward the midpoint of your cycle. Estrogen helps improve focus and emotional control. However, as estrogen levels drop during the week before your period and remain low during your period, dopamine and serotonin levels drop. During this time, your ADHD symptoms like inattention, impulsivity, and emotional regulation and withdrawal may be worse. 

Tracking your cycle can help you prepare for these changes. Try to schedule important tasks and events during high-estrogen phases. Use reminders or adjust your schedule during low-estrogen phases. If symptoms feel overwhelming, consult your health care provider about adjusting your treatment plan.