Part 1 and 2: How Hormonal Fluctuations Can Affect a Female’s ADHD Symptoms

Adapted from the CHAAD Weekly ADHD Weekly Newsletter August 2017

Part I: Is It PMS or ADHD?

Most women I know experience the symptoms of premenstrual syndrome to varying degrees. One question I think is very important to ask is:

Are women with ADHD especially vulnerable to PMS symptoms?

Recent studies show that sex hormones play a role in regulating communications between brain cells and can negatively affect executive function. To understand the role of hormones in ADHD, experts are now calling for new research focusing on the subtle fluctuations and combinations of hormones that influence emotions and executive function.

Researchers Ronit Haimov-Kochman, MD, and Itai Berger, MD believe the investigation of the role of hormones could generate new and improved diagnostic and treatment strategies that could change the course of cognitive-behavioral disorders like ADHD.

So what’s Going On In Your Brain?

• On the first day menstruation starts, estrogen levels begin to increase. This is the beginning of the menstrual cycle, and sometimes results in an increased sense of wellbeing.
• When ovulation occurs (10-17 days after the first day of menstruation), estrogen levels take a dive and progesterone levels increase. Moods can take a turn, with increased irritability and lower energy levels.
• In the last days of the monthly cycle, both estrogen and progesterone drop, causing a significant shift in mood and energy for most women.
• When estrogen drops, so do dopamine levels, which are already low in the brain affected by ADHD. Symptoms of ADHD are magnified at this time; and you may experience:
• • Sadness and mood swings
  • Difficulty sleeping
  • Irritability
  • Anxiety
  • Confusion
  • Fatigue

According to Patricia Quinn, MD, a developmental pediatrician, ADHD symptoms usually worsen a few days before the start of the menstrual cycle,.

The First Step: Recognizing the Symptoms

Simply recognizing your periodically changing hormones can have a significant effect on your ADHD symptoms. Recognize that ADHD is a brain-based disorder with increasing evidence that it is strongly impacted by hormones. Take the time to educate yourself and find good healthcare providers who will listen and help you find the best treatment options for your unique symptoms.

“The majority of clinicians don’t understand the impact of hormones on ADHD symptoms,” says Terry Matlan, MSW, ACSW, a psychotherapist and ADHD coach who specializes in ADHD in adults, with a special focus on women. “If a girl or woman is undiagnosed, she sees herself as lacking or less-than, rather than understanding it is part of a disorder. That leads to shame, which impacts all aspects of her life.”

Tools and Strategies

In order to identify the influence of hormones on your ADHD, you should keep a log of your menstrual cycles along with a daily log of your ADHD symptoms and share the data with your doctor, to support an optimized treatment regime. Your doctor may adjust your medicine accordingly.

You should also educate yourself on this topic as much as you can, focus on self-care, engage in mindfulness training and learn behavioral therapy techniques.

Perhaps most importantly, Terry Matlan urges women and girls to learn to embrace the difficulties of ADHD. “If you pretend it doesn’t exist, you won’t be a whole person,” she says.

Part II: How Hormonal Fluctuations Can Affect a Female’s ADHD Symptoms

How We Can Help Our Daughters with ADHD

As girls approach and go through puberty, they experience significant physical changes and changes in their brains. These changes directly affect their ADHD symptoms. Because ADHD is a brain-based disorder, it is strongly impacted by hormonal fluctuations.  While boys typically have a decrease in ADHD symptoms when they reach puberty, the opposite is true for girls as estrogen increases during puberty.

In the last days of a female’s monthly cycle, both estrogen and progesterone drop and so do dopamine levels.  Dopamine levels are already low in the brain affected by ADHD. Your daughter may experience all the symptoms you might find on the Midol bottle: mood swings, sadness, sleeping difficulty, irritability, anxiety, confusion and fatigue. So how can you use information about hormones’ affect on your daughter’s ADHD as she goes through puberty? Embrace these strategies.

Have your daughter track her cycle.

It is helpful to understand how fluctuations in ADHD symptoms align with the normal hormonal fluctuations that occur during her monthly cycle. She will learn what is “normal” for her in terms of symptoms, what happens most often when she’s stressed or her routine changes. By mapping her symptoms to the timeline of her cycle, she can work with her healthcare provider to better manage her treatment.

Patricia Quinn, MD, author of AD/HD in Women: Do We Have the Complete Picture? says she increases stimulant medication levels on certain days for her female patients based on their cycle and symptoms. “Some women may need an increase in dosage a few days prior to getting their period, while others may only need it while menstruating. What I do with these women is very individualized based on their symptoms.”

Keep a paper journal or day planner.

Your daughter should keep a hand-written journal or day planner near her bed to keep notes. She should choose the same time each day to jot down what she notices about her menstrual cycle and ADHD symptoms. Ask her to note the start and end dates of her cycle, and symptoms she experiences each day. Physical symptoms include things like bloating, cramps, headaches, and amount of flow (light, medium, heavy). Emotional symptoms include calm, happy, depressed, anxious, and more. She should note how physical and emotional symptoms affect her ADHD symptoms, and the level of intensity of her symptoms.

They have apps for this.

For some, electronic apps are easier because you can carry it with you on your smart phone and set reminders to help you enter notes. Most apps create reports or graphs to help you understand your patterns and some include online communities. Free, highly rated apps to tracking your monthly cycle that are simple and colorful include:

• Clue Period Tracker, rated number one by the journal Obstetrics & Gynecology. It is available for iPhoneand Android.
• Period Tracker for Androidand Period Tracker Lite for iPhone
• My Calendar – Period Tracker, for iPhone and Android

Focus on self-care.

When she knows that certain days during her menstrual cycle are going to make her ADHD symptoms worse, your daughter can take steps to support herself.

• One or two days before she expects a shift in symptoms, she should focus on self-care: eat well, get enough sleep, exercise and reduce stress.
• Mindfulness training can help improve awareness of the present moment, and allow her to shift from the multiple thoughts that typically bombard someone affected by ADHD. It can help her let go of self-judgment—that inner voice that pops in with criticism.
• Behavior therapy for ADHDis focused on changing behavior to overcome impairments due to the underlying neurodevelopmental disorder. Positive outcomes include greater self-control and higher self-esteem, both negatively impacted during hormonal fluctuations.

Ask for help.

Girls are taught from an early age to be self-reliant and not ask for help. Early diagnosis and treatment are important to prevent the self-esteem issues and self-harm that is much higher with girls affected by ADHD. Instead, teach your daughter to ask for help when she is frustration, sad, or feeling overwhelmed.

Educate yourselves. 

It is important for you and your daughter, to learn as much as you can about ADHD and how hormonal fluctuations affect ADHD symptoms. Here are two books recommended for young girls:

• Get Ready for Jetty! My Journal About ADHD and Me, Jeanne Kraus. A simple book written in diary form, this tells the story of a young girl who faces challenges after entering fourth grade. The book can help young girls recognize they are not alone when facing ADHD, and provides ideas and strategies to help them become more organized and aware of their strengths and challenges.
• Attention, Girls! A Guide to Learn All About Your AD/HD, by Patricia Quinn, MD, is a good book for young girls to learn more about ADHD and its presentations. While it includes different characters and illustrations to make it more understandable for young girls, it is helpful to read the book with your daughter and use it as a discussion tool.

Additional Resources for Parents:

• 100 Questions & Answers About Attention Deficit Hyperactivity Disorder (ADHD) In Women And Girls, Patricia Quinn, MD
• Understanding Girls with ADHD, Updated and Revised: How They Feel and Why They Do What They Do,Kathleen Nadeau, PhD, Ellen Littman, PhD, and Patricia Quinn, MD
• Raising Girls with ADHD: Secrets for Parenting Healthy, Happy Daughters, James W. Forgan, PhD, Mary Anne Richey, MSEd

Do you think you can benefit from hiring a professional ADHD coach?  Are you ready to hire a coach that can help you manage your ADHD symptoms and thrive?  Contact Kimberly at Kimberly@KimberlyPutmanCoaching.com or to schedule a consultation to learn more about ADHD coaching with KPC.