PMDD: Why women with ADHD are 4x more likely to struggle

Hyperfocus listener Jenna Plonsky opens a raw conversation about ADHD, late diagnosis, and the mental health struggles many women face in silence. 

From postpartum depression to PMDD, this episode explores how hormonal shifts intersect with neurodivergence — and why so many go undiagnosed for decades. It’s an honest look at shame, self-perception, and the turning point that comes with finally understanding your brain.

• Watch: Did my ADHD make me more likely to have postpartum depression?

• Listen: ADHD and: Hormones

Rae Jacobson: The deep shame that comes with ADHD as a woman — it's just so deeply ingrained in you. Hearing the messages of people, like those intrusive thoughts of, "I can't do anything right. I'm dramatic. I'm too much. I'm not smart enough." Like all of that, I mean, it all hit me hard.

A few months ago, a listener named Jenna Plonsky wrote to us. Jenna told us she listened to "Hyperfocus" while she was, like, folding laundry or cooking or doing any of the other million tasks that you do when you are running a household with two children under five. And she decided to write to us.

Feeling both brave and vulnerable, Jenna wrote, "I'm a 34-year-old mom with ADHD/anxiety and PMDD. And I previously suffered from postpartum depression and anxiety." Jenna and I had a lot in common. I also have PMDD and went through postpartum depression. And like so many women with ADHD, we were both diagnosed later in life.

None of this is a coincidence. Women with ADHD are five times — five times — more likely to suffer from postpartum depression and between three to four times more likely to have Premenstrual Dysphoric Disorder, or PMDD. Just in case you're not familiar, PMDD is essentially a more serious and severe form of PMS.

Though these are experiences that so many women with ADHD share, when you're in them, it can feel really lonely. So I jumped at the chance to talk to Jenna about these things that so often we don't get to talk about. And just a heads-up: In this episode, we talk about some pretty heavy stuff, including suicidal ideation. So take care of yourself and skip this one if you need to.

I'm Rae Jacobson, and today on "Hyperfocus," a brave and vulnerable conversation with Jenna Plonsky.

I think one of the biggest questions in my mind afterward was, how did I get to be a 33-year-old woman without that diagnosis or support? That's a long time of your life to just kind of fly under the radar.

Jenna Plonsky: I had to do a lot of, like, self-reflection and self-work and journaling. And I still do, because this is, you know, it's still something that you carry. And I don't know if I'm ever going to be, like, 100% healed from not having the support.

In order to get the support, you need the label. Especially for, like, school and everything like that. You know, who wouldn't want to achieve more or do better in school and their studies? And like, I just remember it being a lot harder for me than everybody else.

And you know, during this time of, like, diagnosis, too, we were moving out of state — like, from Georgia to Pennsylvania. Big move. My husband found my high school diploma and like, I'm, you know, looking through it.

And you know how people get recognized for, you know, being an honor student, valedictorian, and all of these clubs, all of these sports, all of this, all of that? And like, little stars next to their name. And I had nothing next to my name.

Rae: If it's any comfort, I once won an award when everybody else got awards for, like, "Best at Spanish," "Best at Math." I won "Most Spaced Out." That's a true story! Because they had to give me something. Like, "Here, you get — you get this. This is a good one."

Jenna: Oh my god! "Here's a piece of paper." Oh my gosh, that's so ridiculous. Oh my goodness. It's a journey, and it continues to be a journey is the best answer I've got.

(03:51) The emotional struggle of navigating her daughter's diagnosis while undiagnosed herself.

Rae: It is a journey, especially when you're diagnosed at 33 like Jenna was. Like a lot of other women, Jenna began to suspect she might have ADHD when she was trying to help her kid. Now, her daughter has a diagnosis of ADHD and anxiety, but back then, they were both white-knuckling it as Jenna tried to figure out what was going on with her daughter and with herself — a process that was as brutal as it was eventually, at least, enlightening.

Jenna: When these big outbursts and emotional dysregulation moments happened, that feeling of failure — yeah, that was really all-consuming and really hard to get through.

Rae: So all of this was going on, you're trying to figure out what's going on with your daughter. What was going on with you?

Jenna: Just blindly going through life, trying my best, not diagnosed, and feeling like my best always fell short. Yeah, super emotional time for me because, you know, we're both — her and I — were navigating emotional dysregulation without really knowing what was going on. It would be like just hitting a wall constantly with one another.

I often call my daughter my mirror. I really don't like the phrase "mini me" — I don't like it. But like, "the mirror," I think, is a good way to describe it because a lot of her quirks are similar to mine: the behaviors, even the anxiety part. At this time, I did not have, like, an official diagnosis, but I thought it was postpartum anxiety and depression.

And that was kind of like my tunnel, you know? And I started to do all of, like, the right things. I was exercising and paying attention to my diet. And then I'm like, "Something's still not right." Like, with me. I just noticed there was a piece — a big, giant piece of the puzzle missing.

Rae: I'm so struck by when you say, "I felt like I was doing all of the right things." Because I can relate to that very much as somebody who also went through postpartum depression. And when those right things don't lead you where you need to go, it can feel sort of overwhelming in a whole other way.

So as you're experiencing this thing where you're putting in the right things, you're doing all of this work, and you're starting to see things that feel familiar to you in the mirror of your daughter, what was going through your head? Where were you going in that?

Jenna: Where wasn't I going? That's such an ADHD answer to that question. It really didn't all start clicking for me until she got her diagnosis. And to me, I think I knew — that was just when I knew. I was like, "Okay, so she — she has ADHD."

Like, this is a real thing. We're going — we're going to learn more about it, read more about it. I started listening to podcasts. "Climbing the Walls" — listening to that was — there were so many amazing female stories in that that I just resonated with.

Like, the deep shame that comes with ADHD as a woman. It's just so deeply ingrained in you. Hearing the messages of people, like those intrusive thoughts of, "I can't do anything right. I'm dramatic. I'm too much. I'm not smart enough." Like all of that, I mean, it all hit me hard.

And I was like, "Oh man." But it moved me to the right direction of like, "Okay, I'm going to get myself evaluated and diagnosed so that I can better support myself." Because it just started to dawn on me like, if you can't support yourself as an individual and if you are a parent, you're not really going to be able to support your kid in the best way.

(09:49) The intense emotional lows and suicidal ideation experienced during their darkest periods.

Rae: So Jenna, who if you can't tell by now, is a resourceful, impressively positive person, threw herself into learning more. And as she began to understand her ADHD, she also started wondering more about some of the other challenges that she'd experienced.

Two of those were things Jenna had written to us about in her email: postpartum depression and PMDD, Premenstrual Dysphoric Disorder. Now, we all have our "we do not talk about this enough" soapbox topics, and these are mine.

Now, I know I said this before, but I'm going to say it again because as I said, this is my thing. Women with ADHD are five times more likely to have postpartum depression or another perinatal mood disorder and three to four times more likely to have Premenstrual Dysphoric Disorder, or PMDD. These are life-altering and at times life-threatening conditions. And soapbox time: We do not talk about them enough.

So when Jenna mentioned in her email that she had postpartum depression and PMDD, I was, like, "excited" is probably not the word, but grateful. Yes, let's go with grateful that I was going to finally get the chance to talk about these things, these conversations we so rarely get to have. That said, just a warning: This is where things get kind of heavy.

What was your postpartum depression experience like?

Jenna: Oh, grueling. Gruesome. Sad. I mean, there were, like, thoughts of, like, suicidal ideation. Yeah, a lot of, "I shouldn't be here. I'm not helpful. Like, I'm not doing enough." Yeah, just a ton of intrusive thoughts.

And then your body, when you're thinking these things, your body reacts to that. And I — I got weaker, I was gaining more weight. You like, lose control of how to help yourself and how to stay healthy for you, for your kids.

Like, yeah, it's a time that I definitely don't want to relive. At the same token, like, I went through it so that I could get the answers that I now have. And you know, it's almost like you have to hit rock bottom in order to get back to the top and like, you know, appreciate where you're at with loads of self-compassion practice. Yeah, it was a dark, dark time.

Rae: I think it's like so — I mean, probably indicative of, like, the kind of person that you are that you're like, "Okay, this had a value and a purpose." I admit I have a hard time finding that in it for myself.

To the suicidal ideation and dark times piece, I have a vivid memory — I live in New York City — of standing on the side of a subway, you know, I was on a subway platform. And the train was coming and I had this brief, like — and I'll be interested if you had these, too. They felt like visions.

Like, it was more than a thought. It wasn't quite a hallucination or anything like that, but this, like, almost real mental image of just throwing myself on the tracks.

Jenna: Yeah.

Rae: And I remember walking to the middle of the platform, like, shaking physically, and just sitting down and thinking like, "What was that? Like, this is not right." And to this day, it's the kind of thing where I look back on it and I'm like, "Was that my brain?" Like, it feels so alien.

Jenna: Yeah.

Rae: As we've talked about on the show before, ADHD symptoms vary pretty widely. And for women, they are very impacted by hormonal shifts, which means that things like pregnancy or menstruation can wreak serious havoc. The postpartum mood disorders that Jenna and I both experienced were serious, but luckily in our cases, time-limited.

But those feelings that Jenna describes having — anxiety, intrusive thoughts, depression — are also symptoms of PMDD, a cyclical mood disorder that corresponds to the luteal phase of your menstrual cycle. This monthly suckfest also includes rage, disorganization, tender boobs, exhaustion, changes in appetite, and a big spike in ADHD symptoms.

(13:02) A PMDD persona and the intense sensory and emotional shifts it causes.

Rae: What is PMDD like for you? Like what — not just what is it like, but like what does it do to your life?

Jenna: Oh! Well, I've named her. Her name is Esther. Yeah, her name is Esther. So I got that — I picked that up from a Wanda Sykes stand-up from years and years ago. You can tell I'm a millennial. But um, yeah, she has like this little skit of like, "Esther wants cheesecake."

Rae: Something about personifying, it's helpful.

Jenna: It is, because the — the thing that I connected was that, like, that depression piece was only ever involved whenever it was, you know, well, basically like two weeks out of every month.

Rae: So that's a lot of time!

Jenna: It's a lot of time. But that's not me. Like, it's something that happens to me, but like, that's not me. Because — and it's odd, but the person who truly pointed this out to me was my husband.

Rae: Mine too! He just knows. He's like — he knows the window. He's like, "Oh, you're getting your period."

Jenna: Yes!

Rae: And it's — I feel like because of how we're trained to kind of think about men speaking to us about our menstrual cycle as always being like, "Oh, you're on your period." Like, it's helpful to have, like, someone who's, like, a partner say that to you and be like, "You're not doing great."

Jenna: Yeah.

Rae: The other people who might, like, call you on it or be able to, like, comment on it aren't necessarily in a position to observe it.

Jenna: Right.

Rae: So what is it like for you? Like, when that time hits, those two weeks out of the month or however long it lasts for you, what happens? You go from being the Jenna that I see before me — delightful, lovely, warm, capable person — to — who is she? Who's Esther?

Jenna: Oh, Esther is a raging capital B. She gets angry at, like, the slightest things. The sensory overwhelm, like, things taste different, things sound different, things feel different. Just shorter patience. It really does feel like you're a different person whenever that time is going on.

It feels like somebody else is, like, driving the car. Like, I can feel myself in the back being like, "Oh no, don't do — no, that's not a normal reaction to that. We shouldn't be saying that. That's — that's not how we respond to this." Even my voice doesn't sound like myself.

Yeah, I realized, like, the toll that it was taking on me mostly because, like, of my husband saying things, like he notices my behaviors and my moods changing and like, like growing up, I'm the first in my family to have all of these diagnoses. And like, that's a hard thing to carry. Yeah, I'm steering the ship and it can be lonely and hard.

But growing up, two older brothers, I got my first period when I was 12. I remember that shift of like, "Whoa, why is everything pissing me off?" "Why — why do I suddenly suck now?" "Why am I crying?" "Why am I crying? Why do I want to put the — the blanket over my head and just rock back and forth?"

The thing about all this is, like, you can only make fun of it. Because when it's, like, not happening, you're like, "This is ridiculous." Yeah. But like, I don't know about you, but the — the impact that it has where you're like, "So I'm just going to lose, like, half my time to feeling like an alien who hates everything?"

(16:14) Mindset reframing to manage ADHD and emotional challenges.

Rae: PMDD can be hard to treat, and what works for one person might not work for another. But since no one likes being an alien who hates everything for a week out of every month, I was curious what, if anything, Jenna had found that helped treat her PMDD symptoms.

Jenna: I take hormonal birth control.

Rae: Does that help you?

Jenna: It has helped me. And I know that that — that may not be the cure — all for other women and there's a lot of, you know, different avenues with this. But again, I — I think a combination approach — you kind of have to do a little bit of everything. Like a little CBT, hormone therapy, little maybe antidepressants?

Yeah, and I haven't tried hormone therapy other than, you know, birth control. But yeah. Um, I don't take any other medication, though.

Rae: You don't take ADHD medication?

Jenna: No, I'm raw dogging.

Rae: Interesting! Yeah. Can I ask why or why not? What were your pros and cons there?

Jenna: Well, when I started to take birth control recently, I noticed enough progress and to a point where I felt like, "Okay, like I can — I feel like I can handle the other symptoms that have — like my ADHD symptoms."

Regular exercise has been really huge. Birth control, practicing mindfulness. You do have to train your brain to think of yourself in a better way, or else you're not going to.

Rae: Well, like all those things from before, what you're carrying in with you — "I'm not smart, I'm not good enough, I'm too much, I'm this and that" — those things, like we said, they're not going away on their own. You have to do something with them, teach your brain to see you as something different.

Jenna: And I do that with my daughter, too, because I just — I already started to see that, like, internal dialogue and that super negative mindset of, like, "Like, I hate this, and I can't do this, and I'm so bad" or this and that.

And like, I've noticed since I've started to make the genuine effort of, you know, reframing and, like, positive phrasing of things — I mean, we're — we're still working on it, but she's started to, and like now her big one is, "I'm learning."

Rae: Oh! Oh, I love that so much.

Jenna: I know, because that — that is, like, that's a big thing that I say to her often.

Rae: That's — like — a glow in my chest is what that feels like. Me too! But you're so right. How you speak about yourself has such an impact on how your child learns to speak about themselves, to themselves. Do you ever find when the PMDD is strong that it's harder to do those things that you've taught yourself as a parent?

Jenna: Mm-hmm.

Rae: I think that's one of the big challenges to me is, like a parent with PMDD, is that that's when those systems seem to fail.

Jenna: Yeah. The biggest thing for me is, like, adjusting the expectations. Like, during this time, Mommy feels really terrible. Mommy's energy's really low. Um, we're going to watch movies. So many movies! So many movies and so much — "Do you want to take a bath? You should take a bath."

But it's true. All of the — the times where you have to be like, "Okay, normal rules cannot apply right now." That's a big one. That has helped me so much.

Rae: But you know, I think you're right to be like, "Yeah, let's talk about it. Let's not make any of these things feel hidden." Because like, I think about what you said about being the first. You know, you're kind of making that not have to happen for your daughter by being so open, by sharing your experience. And it doesn't sound like you're doing it in a way that's asking too much of her.

Jenna: I like that. That's, like, a very — I don't know, it's like the thing that we can do for ourselves. Yeah. Yeah. To be like, "I'm a human. I'm going to be okay some days and not others."

Rae: Exactly.

Jenna: "And I'm going to do a better job this day than that day." Exactly. Yeah, especially whenever you have ADHD. It's just — like, really knowing yourself and really tuning into it is really the only way to, you know, navigate it.

I'm just so thankful that I know what I know now. The labels and all of that, it — it's helped me and it's only going to help her, too, going forward in the future. And in with PMDD, too, I mean — I'm — I'm going to be on high alert for that with her.

Rae: Yes! With all of these things, like the work that you've done to educate yourself, to learn about, like, all the things that you need — those are gifts that you're giving not just to yourself but to your daughter. Who knows, maybe — maybe our daughters will be lucky enough to get their periods and breeze through.

Jenna: Yeah!

Rae: But you know, if they don't have that unlikely luck, we'll be much more ready for it than we were.

Jenna: Yeah. Exactly. And again, it just — like, it's great to know that we're — we're going to be there for them. They're not going to be alone. Yeah. And we're going to figure it out.

Rae: Thank you so much for listening to this awesome conversation, and thank you so much to Jenna for writing in and for coming on the show. If you ever want to write in and you think you might be a great guest for us, please don't hesitate. We love hearing from our listeners.

And if you're interested in learning more about PMDD or postpartum depression and ADHD, check out our episode with Dr. Catherine Birndorf, co-founder of The Motherhood Center and a reproductive psychiatrist. We'll link to it in the show notes.

"Hyperfocus" is made by me, Rae Jacobson, and Cody Nelson.

Our music comes from Blue Dot Sessions. Our research correspondent is Dr. KJ Wynne. Video is produced by Calvin Knie and edited by Alyssa Shea.

Briana Berry is our production director. Neil Drumming is our editorial director. Production support provided by Andrew Rector.

If you have any questions for us or ideas for future episodes, write me an email or send a voice memo to hyperfocus@understood.org. 

This show is brought to you by Understood.org. Our executive directors are Laura Key, Scott Cocchiere, and Jordan Davidson.

Understood is a nonprofit organization dedicated to empowering people with learning and thinking differences, like ADHD and dyslexia. If you want to help us continue this work, donate at understood.org/give.