# ADHD and Hormones **Channel:** How to ADHD **Source:** https://www.youtube.com/watch?v=tficYOiI1XE **Transcript page:** https://www.withtranscript.ai/video/tficYOiI1XE ## Chapters - 0:00 — Hormones and ADHD: The Big Picture - 2:23 — Menstrual Cycle Effects on Symptoms - 4:52 — Pregnancy and Postpartum Changes - 7:35 — Perimenopause, Menopause, and Treatment - 10:06 — Why Research Lags and What Helps ## Transcript **[0:00] Speaker A:** Hello brains. If you've ever noticed that your ADHD symptoms get way worse at certain times of the month or during big hormonal shifts, you are not imagining it. Hormones can have a real effect on ADHD. Unfortunately, this is something that a lot of people with ADHD, and even a lot of doctors, don't know much about yet. **[0:20] Speaker A:** So, let's talk about hormones. Specifically, estrogen and progesterone. More specifically, estrogen and progesterone fluctuations in those who menstruate, because that's what we have exciting new research on. To be clear, I want to point out that hormones affect everyone. But people who menstruate experience larger predictable hormone fluctuations across the menstrual cycle and life stages, and it turns out those fluctuations can have a significant impact on how our symptoms present and even the effectiveness of our medication. So, that's what we're going to be talking about here. Also, because ADHD research has historically focused mostly on young boys, we're still catching up when it comes to understanding how ADHD interacts with hormonal systems across different bodies and genders and across life stages. So, some of the supplies to you, great. If it doesn't, that's okay, too. Everyone's brain is different. But if your ADHD symptoms seem to change with hormonal shifts, there's actually some science behind that. **[1:10] Speaker A:** To understand that science, let's talk about the ADHD brain. ADHD is associated with differences in the brain systems that regulate dopamine and norepinephrine, which are neurotransmitters involved in motivation, attention, and executive function. Stimulant medications work largely by increasing the availability of these neurotransmitters in the brain, which in turn improves our motivation, attention, and executive function. At least until our meds wear off. **[1:39] Speaker A:** Here's the part that often gets overlooked. Hormones also influence these same neurotransmitter systems. In particular, estrogen appears to interact with dopamine in several ways, including affecting dopamine production, release, and receptor sensitivity. The simple version is that estrogen supports dopamine activity in the brain. So, when estrogen rises, ADHD symptoms often improve. And when estrogen falls, symptoms often get worse. But newer research suggests the relationship is more nuanced than simply high estrogen good, low estrogen bad. There are other factors that impact how estrogen levels impact our ADHD, including other hormones like progesterone. So, let's get into what we currently understand about what's happening during different hormonal shifts and how it may impact our ADHD. **[2:23] Speaker A:** The menstrual cycle. Bad news, it's a hormonal roller coaster. Good news, it's fairly predictable. During the first half of a period, the follicular phase, estrogen levels rise and estrogen can support dopamine and serotonin signaling. So, you might notice you get a lot done. You feel pretty good. You don't forget your keys every time you walk out the door. Maybe. Around ovulation, estrogen peaks and then begins to fall. Some newer research suggests that rapid estrogen changes around this time may worsen impulsivity for some people, especially those already higher in impulsivity. This explains a lot of my adolescence. Next is the luteal phase. In this phase, estrogen drops and progesterone increases before dropping sharply triggering menstruation. Many people with ADHD report their symptoms get significantly worse during the late luteal phase, roughly 1 week before their periods. For me, it's a couple of days before where I'm dysregulated, depressed, and I suddenly feel ugly in a way that goes away as soon as my period starts. **[3:24] Speaker A:** We had almost 400 responses when we asked about how menstrual cycles affect your ADHD. Lots of you reported difficulty focusing and a memory that resembles something like Swiss cheese. **[3:38] Speaker A:** Research backs you up, finding luteal phase ADHDers may experience more difficulty concentrating, worse working memory, and increased emotion dysregulation. A recent study found that those with ADHD are also over three times more likely to meet PMDD criteria. PMDD or premenstrual dysphoric disorder is a severe clinical mood disorder that causes profound sadness, intense irritability, even suicidal ideation. One brain in our community says the week before her period brings suicidal thoughts that come out of nowhere. If you want to know more about this, Dr. Jolene Brighton has a book coming out called ADHD and Women that has a whole chapter on PMDD. To make matters worse, many of you also mentioned it feels like your meds are significantly less effective in the period right before your period. And some of you reported needing a higher dose during that time. A recent pilot study explored this and found that a small targeted increase in stimulant dosage during the premenstrual week helped compensate for the loss of estrogen and improved both ADHD symptoms and emotional regulation. **[4:38] Speaker A:** This was a small pilot study without any comparison group or blinding, but the results are encouraging. So, if you've ever had a week where your ADHD suddenly feels like it went from manageable to absolutely impossible and then mysteriously improves a few days later, your hormones might be part of the reason. **[4:52] Speaker A:** Pregnancy and postpartum. Good news. During pregnancy, ADHD symptoms can improve. Bad news. The postpartum experience can suck. During pregnancy, estrogen rises dramatically and some women with ADHD report improved emotional regulation and functioning, but others struggle more, especially if they reduce or stop medication or are dealing with fatigue, sleep disruption, or increased demands. For some patients, stopping ADHD medication during pregnancy can worsen functioning and may contribute to mood symptoms. So, don't stop or change medication without talking to your clinician. Regardless of your treatment decisions during pregnancy, know that postpartum needs may differ. As soon as the placenta is delivered, estrogen and progesterone fall rapidly. And estrogen production doesn't go back to normal until weeks or months later, depending on whether or not you're breastfeeding. I knew that estrogen crash combined with my ADHD would put me at a significantly higher risk for postpartum depression than my neurotypical peers. **[5:47] Speaker A:** I did not fully appreciate how the hormonal drop would impact my ADHD. When estrogen plummets, I can tell you from personal experience, so does your ability to regulate at all, especially when you're not getting sleep, because sleep deprivation also exacerbates ADHD, and the difference can be shocking. While I was pregnant, for the first time in my life, I felt like I could not let things get to me. I could be calm, even when my partner was stressed. Postpartum, I suddenly found myself as dysfunctional and dysregulated as when I had no tools in my toolbox at all. Even with meds, my impulse control was nonexistent. I'd get an idea for a new book when nursing at 3:00 a.m. I'd hyperfocus on that for hours until the baby needed me again, and then take care of her, then rearrange the nursery, then start impulse buying adorable baby clothes online. **[6:28] Speaker A:** All while barricading myself in the nursery and yelling at my partner to get out. Unless you have something to contribute to my well-being, get out. Love you. This is a real sign I posted outside the door. Understanding the impact my hormones were having helped. So did a partial hospitalization program that allowed me to bring my baby and supported me in the transition to motherhood. By the way, every other mom in that program, at least at the time that I was there, also had ADHD. Once my daughter was able to eat solid foods, and I was getting at least 4 hours of uninterrupted sleep at night, my ADHD symptoms started to level out again. Although the postpartum depression remained, and I eventually needed to treat it with postpartum specific antidepressants. And again, the hormonal changes, which lead to changes in our ADHD symptoms potentially, is all happening on top of the added demands to our executive function, because now we're trying to take care of a whole new human that **[7:19] Speaker A:** can't do anything yet for themselves, and our usual routines have gone out the window. So, if you are struggling postpartum, of course you are. It would be weird if you weren't. But you don't have to struggle this hard. This is a time when even very self-sufficient humans need to ask for help, especially if you have ADHD. **[7:35] Speaker A:** Perimenopause, menopause, postmenopause. Good news, the hormonal roller coaster will stop, eventually. Bad news, the transition can be rough and last up to 8 years and happen earlier for us, much earlier. Let me explain. Perimenopause is the transition leading up to menopause. It's when menstruation becomes irregular and then eventually stops. Perimenopause lasts anywhere from 4 to 8 years on average and includes such fun experiences as hot flashes, depression, and night sweats. So, what's happening with your hormones here? While progesterone tends to gradually decline, estrogen levels can be a roller coaster, which can make ADHD wildly unpredictable. New research suggests that for people with ADHD, symptoms can intensify during this transition. A 2025 population-based cohort study found that women with ADHD reported more severe perimenopausal symptoms and those symptoms appeared at earlier ages. In that study, the highest rates of severe perimenopausal symptoms showed up around ages 35 to 39 in women with ADHD compared to 45 to 49 in women without ADHD. **[8:41] Speaker A:** So, if you're in your 30s or 40s and feel like your brain isn't working the way it used to, it might not be. Perimenopause is a time that a lot of women get diagnosed with ADHD. Their shift in brain function can be so significant, even women who don't have ADHD wonder if they do because they're suddenly struggling with executive dysfunction and memory and focus issues. If you're questioning whether you have ADHD, consider if the symptoms are new or not. If they've existed since childhood but are more problematic now that you're going through perimenopause, go get checked out. One brain in our community told us that perimenopause obliterated her memory. She said her short-term memory is so poor it causes her to totally forget entire conversations and things she's done over the past month. And she says her burnout, anxiety, and overwhelm are out of control. **[9:22] Speaker A:** Over half of people with ADHD report significant functional impairment during this time. Then comes menopause. Menopause is technically a point in time, the moment when you've gone 12 consecutive months without a period. Everything after that is postmenopause. Postmenopause, hormone levels stabilize, but they're still quite a bit lower than they used to be, which is why hormone replacement therapy is a thing. But, you don't have to wait to address the hormonal challenges. Depending on your age, symptoms, medical history, and risk factors, options might include menopausal hormone therapy, combined hormonal contraception, SSRIs, SNRIs, sleep support, or ADHD medication adjustments. This is very individualized. If you'd like to learn more, Dr. Patricia Quinn just gave a fantastic webinar on perimenopause in ADHD women. I will link to that in the description below. **[10:06] Speaker A:** Wait. So, if hormones have such a big impact on ADHD symptoms, why isn't it talked about more? Why is my doctor never mentioned it? It's not exactly common knowledge yet. One reason for this is historical. Women were often excluded from medical research because our hormonal cycles were seen as too complicated to study. Unfortunately, that means a lot of our current medical knowledge, including our knowledge about ADHD, is based on bodies that don't experience these hormonal fluctuations. Another reason is that research on ADHD in adults, especially adult women, is still pretty new. So, while clinicians and patients have been reporting these patterns for years, we're only just now getting the data to back it up. So, what's a brain to do? We're still learning that, how to best support ADHD brains through hormonal fluctuations. But, in the meantime, there are a few things experts recommend. First, pay attention to patterns. **[10:54] Speaker A:** Tracking your ADHD symptoms alongside your menstrual cycle can help you see if there are predictable times when your symptoms get worse. You can use a simple journal for notes or a free cycle tracking app like Clue or Stardust. Tracking this way can identify patterns and help you understand when you're doing well and when you're struggling harder than usual. In particular, pay attention to times when estrogen rapidly drops, as that may matter more than the estrogen levels themselves. Second, talk to your doctor about it to see if your stimulant meds need to be adjusted or if you might need a higher dose at certain times of the month to account for the fluctuations in your symptoms, to see if switching to birth control that contains estrogen might be a good option. If you're pregnant, talk to your doctor before having your baby about the best way to handle the estrogen drop, so you have a plan for supporting your brain function proactively. **[11:37] Speaker A:** If you're postpartum, make sure you're getting screened for things like postpartum anxiety and depression, and learn what your options are for addressing them, ideally as soon as possible. If you're in perimenopause, ask about hormone-related treatment options, and in general, know that you might have to advocate for yourself. A lot of doctors are working off outdated research recommendations, or even just neurotypical expectations, such as when perimenopause should start. Going in with an index card that includes your concerns, questions, patterns you've noticed, and any studies that might be relevant can make this easier. Finally, be compassionate with yourself. This might mean expecting that there are times you need to adjust your workload. It might mean accounting for fluctuations in your ADHD symptoms rather than getting frustrated with yourself about not being able to function like you usually can. It might mean accepting that postpartum is not the time to expect yourself to be supermom, or superpartner, or learn how to bake. **[12:26] Speaker A:** And it might mean reminding yourself that a lot of the expectations society has of women in general aren't realistic, even for neurotypical women navigating hormonal fluctuations, much less women with ADHD. We still need a lot more research about ADHD and hormones, especially research that includes women, trans, and gender-diverse people across the entire lifespan. And as more research comes out, I will talk about it, because everyone deserves care that reflects how their brain and body actually work. Thank you to our Brain Advocates and all our Patreon Brains for supporting content like this, so that we can bring you the latest in research and help everybody be more educated and make better decisions about their health and their bodies and brains. Let us know in the comments below what your own experience with ADHD and hormone fluctuations has been, because experiences can be so different. It's really nice to be able to hear from others who might be experiencing something that's similar to what we're experiencing, so please leave your stories in the comments below. **[13:18] Speaker A:** Like, subscribe, click all the things, and I will see you next video. Bye, brains. **[13:42] Speaker B:** Mhm.