The Hormonal Link Between Premenstrual Dysphoric Disorder and ADHD

Though the two may seem disparate, there is a definite link between premenstrual dysphoric disorder (PMDD) and attention-deficit/hyperactivity disorder (ADHD). Hormonal imbalances or, more commonly, sensitivity to normal hormonal fluctuations are partly to blame for both conditions. 

The main difference between these disorders lies in the timing and onset of symptoms. Females suffering from PMDD have symptoms only during or before menstruation. In contrast, individuals who have ADHD will experience symptoms at all times, regardless of what phase of their menstrual cycle they are currently residing in. 

What is Premenstrual Dysphoric Disorder (PMDD): 

PMDD is a cyclical mood disorder, affecting up to 8 percent of women, that occurs in the days leading up to menstruation. It is characterized by symptoms such as depression, anxiety, irritability, fatigue, changes in appetite, difficulties with focus, and trouble sleeping. These symptoms typically go away once menstruation begins. Although researchers aren't exactly sure what causes PMDD, many experts believe there may be a link between this condition and other mental health disorders like ADHD. Studies have found that women with premenstrual dysphoria exhibit many of the same symptoms as those with ADHD, such as losing focus and emotional dysregulation.

What Is Attention Deficit-Hyperactivity disorder (ADHD):

ADHD is a mental disorder that makes it difficult for people to focus and inhibits their ability to control their impulses. Many adults with ADHD go undiagnosed and struggle silently in their daily lives. But if left untreated, ADHD can cause problems in school, work, social relationships, and most daily activities. 

Hormonal Effects on PMDD:

The exact cause of PMDD is unknown, but it is thought to be related to a sensitivity to normal cyclical hormonal fluctuations throughout the menstrual cycle. This sensitivity may be due to a genetic predisposition or an imbalance in neurotransmitters, such as serotonin. Serotonin is a neurotransmitter that plays a role in mood regulation. Women with PMDD may have a defect in how their brains metabolize serotonin or other neurotransmitters. This defect causes symptoms, such as depression and anxiety, which worsen just before menstruation and improve once menstruation starts. 

Hormonal Effects on ADHD:

Hormonal changes at puberty — especially the higher levels of estrogen and progesterone — can cause ADHD medications that have worked for years in childhood to become less effective during adolescence. Studies have shown that estrogen may enhance a woman’s response to amphetamine medications, but this effect may be diminished in the presence of progesterone. 

Estrogen promotes the release of the feel-good neurotransmitters serotonin and dopamine in the brain. Studies also indicate that the first two weeks of the cycle go more smoothly for women with ADHD than the second two weeks when progesterone levels rise. During the third and fourth weeks, called the luteal phase, progesterone diminishes the beneficial effects of estrogen on the brain, possibly reducing the effectiveness of stimulant medications. Progesterone also increases levels of norepinephrine, a stress hormone that can worsen anxiety. Not surprisingly, this is when symptoms of ADHD tend to deteriorate for many women. 

It should be noted that not all women with ADHD experience such pronounced fluctuations in symptoms during their menstrual cycle. However, for those who do, understanding how hormones affect ADHD symptoms can help manage them. 

Treatment Options:

Fortunately, there are treatments available for both PMDD and ADHD. For PMDD, treatment can involve either taking birth control pills, which help to regulate hormone levels and therefore are only effective for an actual hormone imbalance and not the more common scenario, which is sensitivity to normal hormonal fluctuations, or antidepressants, which help to balance serotonin levels.  

For ADHD, treatment typically involves medication such as Ritalin or Adderall, which help increase dopamine, positively affecting focus, concentration, and even emotional regulation. 

While PMDD and ADHD may seem like two completely different conditions, they share a lot in common—namely, hormonal sensitivity. Treating ADHD can improve PMDD symptoms and vice versa. Given the increasing prevalence of both diseases, additional work in this area could help lead to better treatments, especially for PMDD and its associated symptoms.