ADHD is a neurodevelopmental, behavioral, and mental health condition characterized by difficulty with attention, routine, hyperactivity, fidgeting, focus, organization, and planning. It's considered more common in young boys; however, research shows that the disorder is under-diagnosed and under-researched in young girls, adult women, and people assigned female at birth (AFAB). Consequently, it makes sense that the disorder’s relationship with estrogen and PMS might fly under the radar. A 2021 article published in the International Journal of Molecular Sciences suggests ADHD symptoms frequently worsen a week before menstruation and improve during the first two weeks of your cycle (as well as during pregnancy). The reason? Estrogen fluctuation.
Your menstrual cycle is characterized and orchestrated by changes in the levels of hormones like estrogen and progesterone, according to Tina Gupta, MD, a medical doctor who specializes in women's reproductive health, including dysmenorrhea, PCOS, and infertility. "Estrogen leads to a release of the ‘feel good’ hormones such as dopamine and serotonin, which leads to fewer ADHD symptoms. So when these are not being released (i.e., during the last premenstrual period), ADHD symptoms are often worse."
Why estrogen levels are important
"During the luteal phase, which is the third or fourth week of a menstrual cycle, hormone levels change: progesterone increases and estrogen levels drop," says James Gohar, OBGYN, CEO and ObGyn at Viva Eve, a women’s health & fibroids practice in NYC. These hormone fluctuations are part of your menstrual cycle, and they signal that it’s time to ovulate and menstruate. When it is time to menstruate, both estrogen and progesterone levels drop even more, signaling the body to begin menstruation. Increasing progesterone and decreasing estrogen levels often affect mood, sleep patterns, and irritability, he says. And, as a result, ADHD symptoms can also be impacted.
These fluctuations occur every month during the last two weeks of your menstrual cycle, but they’re also prevalent during puberty and menopause, Dr. Gupta says. And even though estrogen is typically associated with sexual maturation and reproduction, it also affects the brain quite a bit.
How to manage worsened ADHD symptoms
What does this mean for menstruators who have ADHD? Well, being aware is the best place to start, Dr. Gupta says. Pay attention to changes in behavior, mood, and concentration leading up to and during menstruation. This can help you approach a professional (like a primary care physician, therapist, or specialist) to develop a treatment plan, she says.
Dr. Gupta recommends strategies to manage exacerbated symptoms. Get enough sleep, food, and water for starters. Dr. Gupta also recommends eating foods higher in phytoestrogens like soy, flaxseeds, walnuts, lentils, tempeh, apples, and carrots. Your body registers phytoestrogens as something similar to estrogen and responds to them accordingly, which can cause a potential reduction in symptoms, she says. However, research on phytoestrogens is inconclusive.
"People who menstruate should try to adopt regular stress-reducing techniques to help keep serotonin and dopamine levels high as well," Dr. Gupta says. These include activities such as yoga, Tai Chi, meditation, nature walks, meditating, dancing, or anything that combines light movement with relaxation. And, if you think you might have low estrogen levels, Dr. Gupta suggests speaking with a healthcare provider about options. Dr. Gupta adds that combining therapy with a stimulant, antidepressant, and estrogen may be incredibly beneficial for folks finding the symptoms disruptive to their lives.
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