PMDD and ADHD

‍

Introduction

For many women, Premenstrual Dysphoric Disorder (PMDD) and Attention-Deficit/Hyperactivity Disorder (ADHD) can be a challenging combination. Both conditions on their own can significantly impact day-to-day functioning, but together, they create unique challenges. PMDD is a severe form of premenstrual syndrome (PMS) that causes intense emotional and physical symptoms before menstruation, such as mood swings, irritability, and depression. ADHD, meanwhile, is a neurodevelopmental disorder known for its effects on attention, impulsivity, and emotional regulation.

Studies show that the overlap of PMDD and ADHD is substantial. Research suggests that around 45% of women with ADHD also experience PMDD, far exceeding the rates seen in the general population. This high rate of co-occurrence suggests a unique interplay between these conditions, shaped by hormonal changes and other factors. Understanding this connection is critical for women looking to manage symptoms effectively and live fulfilling lives.

How Hormones Influence ADHD Symptoms

The Impact of the Menstrual Cycle on ADHD

The menstrual cycle has a powerful impact on ADHD symptoms, with hormonal fluctuations affecting focus, energy levels, and mood stability. Throughout the cycle, estrogen and progesterone levels rise and fall. In the follicular phase (beginning with menstruation), estrogen gradually increases, leading to greater focus and mental clarity for many. However, as the cycle progresses into the luteal phase (after ovulation), estrogen drops, and progesterone rises.

This hormonal shift can amplify ADHD symptoms. Research shows that ADHD symptoms such as inattention, impulsivity, and emotional sensitivity often worsen during this phase. The decline in estrogen, which supports dopamine and serotonin activity, is particularly challenging for those with ADHD, as it can reduce focus and emotional stability​​.

Hormones, Neurotransmitters, and ADHD

Estrogen and progesterone both play a role in ADHD symptoms. Estrogen helps regulate neurotransmitters like dopamine and serotonin, which are essential for attention, mood, and motivation. When estrogen levels are low, as in the late luteal phase, the resulting neurotransmitter deficiency can exacerbate ADHD symptoms.

Progesterone, which peaks before menstruation, also affects emotional regulation. Higher levels of progesterone can increase sensitivity to stress and lead to emotional dysregulation, such as irritability and impulsivity—both hallmark symptoms in ADHD.

How PMDD Affects ADHD Symptoms

Symptom Overlap and Worsening During the Luteal Phase

Many PMDD symptoms align closely with ADHD symptoms, including cognitive challenges like brain fog, difficulty focusing, and emotional volatility. These issues tend to worsen during the luteal phase, particularly in women with ADHD. For example, symptoms such as forgetfulness, lack of focus, and impulsivity are common to both ADHD and PMDD. During the premenstrual phase, women with both conditions may experience amplified struggles with these symptoms, resulting in significant impairment in daily functioning​​.

Quality of Life and Daily Impact

Living with both ADHD and PMDD can disrupt multiple areas of life, from work performance to personal relationships. Many women report feeling unmotivated, reactive, or even despondent in the days leading up to their period. This cycle can impact productivity, create relationship strain, and diminish self-esteem. The high rates of co-occurrence underscore the need for more awareness, as around 45% of women with ADHD experience PMDD compared to about 3-9% of women in the general population​​.

Addressing PMDD and ADHD Together: Effective Approaches

1. Adjusting ADHD Medications Pre-Menstrually

Increasing the dosage of stimulant medications during the luteal phase has shown promise in managing ADHD symptoms that worsen before menstruation. A recent study revealed that women who increased their stimulant dose premenstrually experienced improved attention, reduced irritability, and greater energy. However, this approach requires close supervision to avoid potential side effects, and each patient may respond differently to these adjustments​.

2. SSRIs for Mood Stabilization

Selective serotonin reuptake inhibitors (SSRIs), often prescribed for PMDD, may offer dual benefits by alleviating both PMDD-related mood swings and the emotional volatility associated with ADHD. Taking SSRIs only during the luteal phase is an option for those looking to manage premenstrual symptoms without continuous medication​.

3. Lifestyle and Non-Medical Interventions

A range of lifestyle changes can help support mood stability and cognitive function for those with PMDD and ADHD:

• Nutritional Support: Diets rich in magnesium, vitamin B6, and omega-3 fatty acids can help support neurotransmitter function, potentially easing both PMDD and ADHD symptoms. Reducing sugar and caffeine may also improve mood stability and reduce fatigue​​.
• Exercise and Sleep Routines: Regular physical activity and a consistent sleep routine can enhance mood, improve focus, and reduce stress. Sleep and exercise can be particularly impactful during the luteal phase.
• Cognitive Behavioral Therapy (CBT): CBT techniques are effective for managing emotional responses, stress, and impulsivity, making them valuable tools for individuals managing both PMDD and ADHD​.

Real-Life Tips for Managing PMDD and ADHD

Tracking Symptoms and Planning Ahead

Tracking the menstrual cycle with a dedicated app can help anticipate when PMDD and ADHD symptoms may worsen, allowing individuals to prepare and plan around those days. Recognizing symptom patterns can also help in discussing treatment options with healthcare providers.

Building Supportive Routines

Creating a simple, consistent routine—using checklists, alarms, or task reminders—can help counter brain fog and maintain focus during challenging times. For instance, breaking tasks into smaller steps may make them more manageable when energy and focus are low.

Prioritizing Self-Care

Allow for self-care and avoid overcommitting during high-symptom days. Taking time to rest, practice mindfulness, or engage in gentle activities can help reduce stress and make symptom management more manageable​​.

Communicating with Healthcare Providers

Advocating for one’s own care is essential. Sharing symptom patterns and menstrual cycle information with healthcare providers can help tailor treatment, ensuring better support for both PMDD and ADHD symptoms.

Moving Forward: Research Needs and Raising Awareness

Gaps in Research and Clinical Care

Despite the high rates of co-occurrence, PMDD remains underdiagnosed in individuals with ADHD. More research into how cyclical hormones influence ADHD is essential, as is developing personalized treatment strategies. There is a need for studies on female-specific ADHD treatments that consider hormonal fluctuations​​.

The Importance of Collaborative Care

A multidisciplinary approach involving endocrinologists, psychiatrists, and ADHD specialists can help provide a more holistic treatment plan. This approach considers hormonal influences and addresses both PMDD and ADHD comprehensively.

The Role of Advocacy and Education

Educating the public, healthcare providers, and even educators about the link between PMDD and ADHD is vital. With greater awareness, those affected by both conditions can find more effective support and care, reducing stigma and encouraging early intervention.

Conclusion: Managing PMDD and ADHD with Knowledge and Support

By understanding the interplay between PMDD and ADHD, women can take a proactive role in managing symptoms. Recognizing the impact of hormonal cycles and considering tailored treatment options can lead to improved quality of life. While the journey may be challenging, with the right support and resources, individuals can successfully navigate the complexities of PMDD and ADHD.

For those experiencing similar symptoms, resources like support groups, mental health services, and online tools for tracking cycles can provide valuable support, helping women find strategies that work for them and improve their ability to manage both PMDD and ADHD.

‍

FAQ about ADHD and PMDD:

What are the 11 symptoms of PMDD?

PMDD includes symptoms like intense irritability, mood swings, anger, feelings of sadness or hopelessness, anxiety, fatigue, trouble concentrating, physical symptoms such as bloating and breast tenderness, changes in appetite, sleep disturbances, and a feeling of being overwhelmed or out of control. These symptoms typically peak during the late luteal phase, just before menstruation begins.

Do ADHD symptoms get worse on your period?

Yes, many people with ADHD report that their symptoms become more challenging during the premenstrual phase of their cycle. This can include greater difficulty with focus, heightened impulsivity, increased emotional sensitivity, and struggles with mood regulation. Hormonal fluctuations, especially a drop in estrogen, are thought to exacerbate ADHD symptoms in the days leading up to menstruation.

Are people with ADHD more prone to PMDD?

Yes, research shows that people with ADHD who menstruate have a significantly higher risk of experiencing PMDD. In fact, a study from 2020 reported that around 45.5% of women with ADHD also had PMDD, compared to only 28.7% in the general population. This increased prevalence highlights the importance of managing both conditions together for those affected.

Is PMDD neurodivergent?

While PMDD itself isn’t classified as neurodivergent, it can co-occur with neurodivergent conditions like ADHD and autism. The overlap between PMDD and ADHD symptoms, such as emotional regulation challenges and mood instability, suggests a potential link. However, more research is needed to understand the relationship fully.

What is the best medication for PMDD and ADHD?

For PMDD, selective serotonin reuptake inhibitors (SSRIs) like sertraline, fluoxetine, and citalopram are commonly prescribed. These medications help stabilize mood and manage PMDD symptoms. For ADHD, stimulant medications are standard, and some healthcare providers may adjust the dosage premenstrually to better manage symptom spikes. A healthcare provider can help determine the best combination or adjustments needed for individual cases.

Is PMDD common with ADHD?

Yes, PMDD is more common in individuals with ADHD. Studies indicate that women with ADHD are at a higher risk for PMDD compared to the general population, with nearly half experiencing PMDD symptoms.

‍

References

1. Dorani, Farangis, et al. "Prevalence of Hormone-Related Mood Disorder Symptoms in Women with ADHD." Journal of Psychiatric Research, vol. 133, 2021, pp. 10–15. doi:10.1016/j.jpsychires.2020.12.005.
2. Lin, Pai-Cheng, et al. "Insomnia, Inattention, and Fatigue Symptoms of Women with Premenstrual Dysphoric Disorder." International Journal of Environmental Research and Public Health, vol. 18, no. 6192, 2021, pp. 1–11. doi:10.3390/ijerph18126192.
3. de Jong, M., et al. "Female-Specific Pharmacotherapy in ADHD: Premenstrual Adjustment of Psychostimulant Dosage." Frontiers in Psychiatry, vol. 14, 2023, article 1306194. doi:10.3389/fpsyt.2023.1306194.
4. Morales, Tori. "PMDD, Autism, and ADHD: The Hushed Comorbidity." ADDitude Magazine, 9 Feb. 2024, www.additudemag.com/pmdd-autism-adhd/.
5. Nonacs, Ruta. "In Women with ADHD, Should We Adjust Stimulant Dosage Premenstrually?" MGH Center for Women’s Mental Health, 8 May 2024, womensmentalhealth.org/posts/should-we-adjust-stimulant-dosage-premenstrually/.
6. Brighten, Jolene. "ADHD and PMDD Hormone Connection." Dr. Jolene Brighten, 3 Oct. 2024, drbrighten.com/adhd-and-pmdd-hormone-connection/.
7. Halbreich, Uriel, et al. "The Prevalence, Impairment, Impact, and Burden of Premenstrual Dysphoric Disorder (PMS/PMDD)." Psychoneuroendocrinology, vol. 28, 2003, pp. 1–23.
8. Bürger, Isabel, et al. "Perceived Associations Between the Menstrual Cycle and ADHD: A Qualitative Interview Study Exploring Lived Experiences." Sexual & Reproductive Healthcare, vol. 40, 2024, article 100975. doi:10.1016/j.srhc.2024.100975.
9. Dorani, Farangis, et al. "Comorbid ADHD in PMDD: Challenges and Treatment Approaches." Journal of Women's Health, vol. 30, no. 9, 2021, pp. 1325–1332.