Estrogen and ADHD
Science class refresher! Estrogen is a hormone present in all bodies and at higher levels in female bodies. It regulates the female reproductive system and supports various parts of the body including skin, bones, heart health, and brain function. Women’s estrogen fluctuates throughout the month and across the life course.
What does this have to do with ADHD? One of the main characteristics of an ADHD brain is lower levels of dopamine; estrogen helps boost dopamine production and functioning in the brain. So, as estrogen levels (and therefore dopamine levels) fluctuate throughout a woman’s life, the symptoms and severity of her ADHD may change as well. Instead of a “set it and forget it” approach to their ADHD, women may need more awareness of what’s going on in their bodies, more tools, and more proactive ADHD management.
Here is a quick look at the interaction between estrogen and ADHD at different stages of a woman’s life.
Childhood
Before puberty, socialization seems to play a bigger role than hormones in the way ADHD presents in girls. Social expectations of girls — which are conveyed to children in myriad ways at home, at school, through peers and media, etc. — condition many girls with ADHD to manage hyperactivity and impulsivity through fidgeting, nail picking, hair-twirling, etc., in contrast to the more disruptive behaviors expected of boys. And because girls learn to conform to these societal expectations, they are less likely than boys to be identified for assessment and diagnosed with ADHD in childhood, resulting in years of unnecessary struggling and suffering.
Puberty and Beyond
The onset of puberty often intensifies or worsens ADHD symptoms for girls, as hormone production ramps up and fluctuations begin. Thus puberty is when girls are more likely be diagnosed with ADHD; this is also in part because the most recent revision to the diagnostic criteria raised the age of onset from 7 to 12. Prior to that, girls were often excluded from diagnosis because they hadn’t been bouncing off the walls in kindergarten.
Monthly variations in estrogen levels also mean that girls and women may not get all the benefits from their ADHD medication. For decades, stimulant ADHD medications were thought to work the same way in male and female bodies. However, after years of women’s complaints, recent research has found that stimulant medications can be less effective for girls and women when estrogen production decreases during the premenstrual phase (the week before she gets her period). New guidance indicates that women may need to increase their ADHD medication dosage during that week in order to maintain its effectiveness.
Postpartum
During pregnancy, estrogen levels spike and some pregnant women report an easing of their ADHD symptoms. But after delivery, it’s a whole different story. Having a new baby is intensely demanding and can be profoundly disorienting, and for birthing moms with ADHD, the dramatic drop in estrogen postpartum can mean a significant worsening of ADHD symptoms. (All this at the same time that changes in routine, caregiving demands, sleep, and identity may be rocking her to her core.) Further, breastfeeding moms may choose to change or discontinue their ADHD medication due to concerns about transfer via breastmilk; this means that when women need the support of medication the most, they may acutally be downshifting their medication and/or adopting other, nonmedication approaches.
Perimenopause and Menopause
Perimenopause — the process of hormonal change that can last as long as 20 years until the end of menstruation — is another period of hormonal fluctuation and precipitous drop-off that can worsen ADHD symptoms. Recent research found that perimenopause started up to 10 years earlier in women with ADHD, and over half of women with ADHD experienced debilitating symptoms of perimenopause, compared to just one-third of women without ADHD. Just a few of these intense symptoms include brain fog, struggles with working memory and task-initiation, sensory overwhelm, difficulty focusing, and difficulty regulating emotions. For some women, a beneficial effect of menopausal hormone therapy is that their ADHD symptoms return to manageable levels.
It’s hardly breaking news that women’s bodies, experiences, and health are an afterthought in scientific interest and medical research (and of course funding). There is a dearth of understanding about women’s hormones, and even less about the effects of hormones on ADHD. But slowly new findings are surfacing and more women are getting a few more answers. With a continued groundswell of demand for recognition, we can hope that the needs of girls and women with ADHD will rise to the surface as well.
Does this information bring up any new questions for you? Whatever your stage of life, could you use support in better managing your ADHD or ADHD-like symptoms? I’m here to help, and I would be delighted to talk with you about what you’re experiencing right now. Please feel free to get in touch!
Note: This is general information in broad strokes and not medical advice. Also, hormone levels vary from individual to individual, across all bodies and genders. For concerns about your own body and your own hormone levels, please consult your doctor.