Treatment for Women With ADHD

Women face an additional challenge when treating their ADHD. Hormones! The natural fluctuations of hormones, both monthly and through the different phases of life, can increase ADHD symptoms. However, when you understand what is happening and why, you feel empowered and in a stronger position to seek the best treatment for your ADHD.

ADHD, Estrogen, and the Brain

Estrogen is one of the main hormones that is responsible for regulating the female reproductive system. Estrogen also plays a role in cognitive functions as it is involved in the modulation of the neurotransmitters serotonin, dopamine, and norepinephrine. These neurotransmitters help with focus, concentration, mood, and memory. Estrogen levels vary considerably in the last two weeks of the menstrual cycle and, during perimenopause and menopause.

When estrogen levels are low, you may experience increased feelings of irritability, moodiness, and depression, problems with sleep, anxiety, difficulty concentrating, fuzzy thinking, forgetfulness and memory problems, fatigue and loss of energy, as well as hot flashes.

Hormones and ADHD Stimulants

Stimulant medications are either methylphenidate based (e.g., Ritalin) or amphetamine based (e.g., Adderall). Both classes block reuptake of dopamine and norepinephrine, leading to higher available levels in the synapse (space between nerve cells).

In the case of amphetamines, they also increase the release from and then block the recycling process inside the cell. They also block or slow down their speed of reabsorption. This means that the neurotransmitters stay in the neural synapse longer, allowing messages in the brain to be more effectively transmitted and received; and as a result, your ADHD symptoms are reduced. Studies have found that estrogen may aid in the effectiveness of stimulants.

Conversely, lower levels of estrogen are often associated with less effectiveness from or less response to stimulant medications. To complicate things further, the hormone progesterone may make stimulants less potent. Let’s look at how estrogen levels change throughout your life.

Puberty

The onset of puberty is also associated with changes in hormonal levels and so early adolescent girls with ADHD may experience increased difficulties in managing ADHD symptoms. It is not unusual for girls to also experience intense mood swings, irritability and become more over-reactive emotionally during the pubescent years.

Also, in their early teenage years, girls may start noticing that their ADHD medication is not as effective in helping them to manage their ADHD symptoms. This may be because, during puberty, both estrogen and progesterone levels increase. While estrogen seems to aid in the effectiveness of stimulants, progesterone likely decreases it.

PMS

During the monthly menstrual cycle, there are fluctuations in both estrogen and progesterone levels, and there tend to be varying response rates to the stimulant medications. It is helpful to track your symptoms by keeping a log or simple journal, noting when symptoms seem to escalate during your cycle. This way you and your doctor will have a clearer picture of the specific patterns you are experiencing and you can work to develop coping strategies to minimize any negative impact.

Pregnancy

Many women report that ADHD symptoms decrease during pregnancy, as this is when estrogen levels tend to be much higher. However, not every woman experiences a decrease in ADHD symptoms. In addition, doctors often advise women to stop taking their ADHD medication during pregnancy, which means pregnancy can be a challenging time as you are managing ADHD symptoms without medication.

Postpartum

After the baby is born, estrogen levels drop and ADHD symptoms return (or persist). Postpartum depression is something that can appear for new ADHD moms, particularly if depression was a condition that coexisted with ADHD before pregnancy. The lack of sleep that comes with a new baby, as well as the stress while you create a new routine, can make ADHD symptoms worse. If you are breastfeeding, it is important to get advice from your doctor before you start taking ADHD medication again.

Perimenopause and ADHD

Perimenopause often begins when a woman is in her late 30s or early 40s. It is the transition phase where a woman moves out of her reproductive years and into menopause. During this time estrogen levels can fluctuate.  You may notice that ADHD symptoms appear to be getting worse. A change in ADHD medication dosage can be helpful. Also, speak with your doctor if you feel depressed or anxious as these conditions can also appear at this time.

Menopause and ADHD

Menopause typically occurs between the ages of 45 and 55, with the average age at approximately 51. With the onset of menopause, there is a significant drop in estrogen levels for most women. However, many women say that once they reach menopause, they feel better than they did during perimenopause because their estrogen levels have stabilized.

A Word From Verywell

Throughout your life and your hormonal changes, be open with your doctor about your symptoms, so that they can get a clear picture of what you are experiencing when they are prescribing medication. Knowing that you will likely be making adjustments in treatment strategies at various stages of your life can also help you to be proactive in keeping your ADHD symptoms under better control.