ADHD and the Menstrual Cycle
ADHD in Women: The Impact of Hormonal Changes on Symptoms and Mood
Attention deficit hyperactivity disorder (ADHD) presents differently across individuals, and in girls and women (hereafter referred to as ‘women’, defined as those assigned female at birth and menstruating), research suggests these differences are associated with hormonal fluctuations, with emerging evidence indicating greater severity of hormone-related mood and cognitive experiences compared to women without ADHD (Broughton et al., 2025; Dorani et al., 2021; Kooij et al., 2025).
Hormonal fluctuations occur across key life stages, including the menstrual cycle, pregnancy, the postpartum period, perimenopause, and menopause. During these phases, ADHD individuals report increased intensity in both mood-related experiences and ADHD-related patterns (Broughton et al., 2025; Dorani et al., 2021).
One explanation for these changes involves dopamine regulation. ADHD is associated with differences in dopamine activity, and fluctuations in estrogen are thought to interact with dopamine systems in the brain (Broughton et al., 2025). Estrogen enhances dopamine and serotonin activity that support attention, cognition, and emotional regulation, with higher levels associated with greater cognitive clarity and emotional stability and lower or fluctuating levels linked to increased difficulty in these areas, while increases in progesterone have been associated with greater emotional sensitivity (Broughton et al., 2025; Osianlis et al., 2025).
Menstrual Cycle and ADHD Symptoms
Research examining psychiatric symptoms more broadly indicates that mental health experiences fluctuate across the menstrual cycle (Handy et al., 2022).
Menstrual Phase
During the menstrual phase, when estrogen and progesterone levels are relatively low, research indicates increased depressive experiences and emotional distress, and ADHD women may experience greater difficulty with attention, emotional regulation, and energy, although experiences vary.
Follicular Phase
During the follicular phase, as estrogen levels rise, estrogen-related increases in dopamine and serotonin activity are associated with attention, cognition, and mood processes, and ADHD women may experience relatively more stable attention, mood, and daily functioning, although experiences vary.
Ovulatory Phase
Around ovulation, when estrogen levels peak, estrogen-related activity in dopamine and serotonin systems is associated with cognitive clarity and emotional stability, and ADHD women may experience relatively improved attention and emotional regulation, although ADHD-specific evidence for this phase remains limited.
Luteal Phase
During the luteal phase, as estrogen declines and progesterone increases, research indicates increased anxiety, stress, and emotional changes, and ADHD women may experience greater difficulty with attention, emotional regulation, and task management, with evidence linking lower estradiol and higher progesterone to increased ADHD experiences, particularly among those with higher baseline impulsivity.
ADHD in Women Remains Under-recognised
Despite increased awareness, ADHD in women remains under-recognised and under-researched (Kooij et al., 2025).
A review of the literature highlights that:
ADHD experiences may vary across hormonal phases
Differences in presentation may contribute to delayed diagnosis
Sociocultural and diagnostic factors influence recognition
As a result, many ADHD individuals receive later diagnoses, often after extended periods of navigating these experiences without appropriate recognition.
Key Takeaway
Being an ADHD woman involves navigating the interaction between hormonal changes and brain-based processes, and understanding these patterns can support greater awareness of changes in attention, mood, and energy, which can be helpful in identifying and accessing appropriate support.
References
Broughton, T., Lambert, E., Wertz, J., & Agnew-Blais, J. (2025). Increased risk of provisional premenstrual dysphoric disorder (PMDD) among females with attention-deficit hyperactivity disorder (ADHD): Cross-sectional survey study. The British Journal of Psychiatry, 226(6), 410–417. https://doi.org/10.1192/bjp.2025.104
Dorani, F., Bijlenga, D., Beekman, A. T. F., van Someren, E. J. W., & Kooij, J. J. S. (2021). Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research, 133, 10–15. https://doi.org/10.1016/j.jpsychires.2020.12.005
Handy, A. B., Greenfield, S. F., Yonkers, K. A., & Payne, L. A. (2022). Psychiatric symptoms across the menstrual cycle in adult women: A comprehensive review. Harvard Review of Psychiatry, 30(2), 100–117. https://doi.org/10.1097/HRP.0000000000000329
Kooij, J. J. S., de Jong, M., Agnew-Blais, J., Amoretti, S., Bang Madsen, K., Barclay, I., Bölte, S., Borg Skoglund, C., Broughton, T., Carucci, S., van Dijken, D. K. E., Ernst, J., French, B., Frick, M. A., Galera, C., Groenman, A. P., Kopp Kallner, H., Kerner Auch Koerner, J., Kittel-Schneider, S., Manor, I., … Wynchank, D. (2025). Research advances and future directions in female ADHD: The lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women's Health, 6, Article e1613628. https://doi.org/10.3389/fgwh.2025.1613628
Osianlis, E., Thomas, E. H. X., Jenkins, L. M., & Gurvich, C. (2025). ADHD and sex hormones in females: A systematic review. Journal of Attention Disorders, 29(9), 706–723. https://doi.org/10.1177/10870547251332319
