After I was diagnosed with attention deficit hyperactivity disorder (ADHD) at 30 years old, a lot of things started to make sense. Suddenly, I could see where some of the more “textbook” ADHD symptoms — things like difficulty focusing, task avoidance, and issues with object permanence — explained so much of my experience since childhood. While it was incredibly validating, I started feeling frustrated as well. The more I learned, the more I wished I’d been diagnosed sooner… which was a sentiment that only grew as I started realizing that there’s a lot about ADHD that many people don’t know. 

I didn’t know, for instance, that people with ADHD often struggle with rejection-sensitive dysphoria, aka extreme emotional sensitivity and pain when faced with rejection or criticism. I didn’t know that there’s a strong link between ADHD and anxiety and that nearly 50% of adults with ADHD also have an anxiety disorder. And I didn’t know that ADHD can play a major role in your menstrual cycle, which is something I’ve been battling since I was a teenager. 

so, how is the menstrual cycle linked to ADHD?

I’ve known that I had PMDD for nearly a decade — and I’ve even shared my story about my PMDD diagnosis with Thinx before — but I’ve only recently learned how interconnected my PMDD and ADHD actually are. Because, as it turns out, ADHD impacts your period in many ways. Not only are people with ADHD more likely to experience more intense PMS symptoms, but a whopping 46% of people with ADHD also suffer from PMDD compared to 5 to 10% of the general population, and — according to one study — that number skyrockets to 92% for folks with autism. 

Unfortunately, that’s only the tip of the iceberg. Many people report that their ADHD symptoms change throughout their menstrual cycle — something I’ve definitely experienced myself — and there’s some research to back this up. One study concluded that there was an increase in ADHD symptoms in both the early follicular and early luteal phases, and I’ve read countless stories of people sharing how much worse their ADHD symptoms are in the week prior to their periods.

Plus, this doesn’t even mention the fact that many people report that their ADHD meds don’t feel as effective in the lead-up to their periods. 

why does this happen?

Short version? It’s all about hormones. Long version? As your hormones fluctuate during your menstrual cycle, you might experience fluctuating ADHD symptoms as well. In my own experience, for example, I’ve noticed that my ADHD symptoms tend to improve during my follicular phase. I’m typically more productive, more social, and more present than I am in other phases of my menstrual cycle. The two weeks prior to my period, however, are what I typically call my “PMDD window,” which is when my PMDD symptoms emerge *and* my ADHD symptoms are at their worst.

Unfortunately, the week prior to my period is also when my ADHD medication seems to be the least effective, which can also be explained by changes in hormone levels. Studies show that hormones like estrogen impact both serotonin and dopamine receptors in the brain — with estrogen causing an increase in dopamine synthesis in your brain — so when your estrogen levels start to fall in the second half of your period (especially right before bleeding starts), you might start to struggle like I do. 

managing ADHD and your menstrual cycle

So what can we do about it? There isn’t a clear solution or a magic wand that can solve these problems, as much as I wish there was, mostly because the relationship between ADHD and menstrual cycles is widely understudied. If you’re struggling to manage your menstrual cycle — or any worsening ADHD symptoms — it’s important to talk to your doctor about any medications you’re taking, what you’re experiencing, and whether or not there are any additional resources that could help you. 

As for me? Simply knowing that my ADHD was playing a role in my battle against my cycle made a huge impact. I’ve always used a cycle tracker with notifications set to alert me a few days prior to my PMDD symptoms starting, but I’m also starting to implement cycle syncing into my daily life. I started by taking brief notes of what I noticed during each phase of my menstrual cycle with regard to my ADHD symptoms: is there a time when I’m most productive? Least productive? More creative? More communicative? More detail-oriented? The more I understand how my own cycle impacts my life, the more I can do to set myself up for success… or, at the very least, reduce my stress. 

From there, I make changes whenever possible to support myself. If I know that I’m more withdrawn and struggle to focus during my luteal phase, for instance, I try to avoid extra phone calls, big meetings, or interviews during that time. On the flip side, I know that my ADHD symptoms aren’t nearly as bad a few days prior to ovulation, so that’s when I schedule my hardest tasks — aka the ones I’m most likely to struggle with task initiation — so I know my ADHD meds will also be the most effective.

This level of understanding also helped me make changes in my personal life as well. I don’t give myself a hard time about not wanting to hang out with friends in the week prior to my period, and I pay attention to how my sensory issues get worse once my period starts. Instead of fighting those things, I lean into them — I even bought myself a comfy jumpsuit that is a sensory-friendly “uniform” for the first day of my period, and I stopped making myself wear tampons when I just wanna wear period underwear and sweatpants — and do things that support my body instead of fighting against it.

The more I’ve learned to work with my cycle — and my ADHD — the less I’ve had to struggle with extremes. It’s still not perfect, and there are definitely times when I wish I didn’t have to deal with this mess, but over the last few months, my PMDD has been way more manageable than it’s been in the past. I’m more mindful and patient with myself, and that alone makes dealing with all of this a whole lot easier.

Jandra Sutton is a mental health advocate, writer, and speaker based in Nashville, TN. She's also the host of The Wildest Podcast, a weekly personal development podcast in 10 minutes or less, and her work has appeared in countless publications including Healthline, Fast Company, Refinery29, and more. You can follow her on TikTok, Instagram, and Twitter as she shares more about fear, failure, and getting things done.

At Thinx, we strive to provide our readers with the most up-to-date, objective, and research-based information. Our content is crafted by experienced contributors who ground their work in research and data. All information has been fact-checked and extensively reviewed by our team of medical professionals to ensure content is accurate. Articles contain trusted third-party sources that are either directly linked within the text or listed at the bottom to lead readers to the original source.

sources:

ADDitude. “How ADHD Ignites Rejection Sensitive Dysphoria.” https://www.additudemag.com/rejection-sensitive-dysphoria-and-adhd/ 

Anxiety & Depression Association of America. “Adult ADHD (Attention Deficit Hyperactive Disorder).” https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/adult-adhd 

Periodical. “I Thought I Had Depression. Turns Out It Was Undiagnosed PMDD.” https://www.thinx.com/thinx/blogs/periodical/voices/i-thought-i-had-depression-turns-out-it-was-undiagnosed-pmdd 

Journal of Psychiatric Research. “Prevalence of hormone-related mood disorder symptoms in women with ADHD.” https://pubmed.ncbi.nlm.nih.gov/33302160/ 

International Association for Premenstrual Disorders. “PMDD Facts & Figures.” https://iapmd.org/facts-and-figures 

Journal of International Medical Research. “Prevalence of Premenstrual Syndrome in Autism: A Prospective Observer-rated Study.” https://journals.sagepub.com/doi/10.1177/147323000803600208 

Psychoneuroendocrinology. “Reproductive Steroids and ADHD Symptoms Across the Menstrual Cycle.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803442/ 

ADDitude. “PMS and ADHD: How the Menstrual Cycle Intensifies Symptoms.” https://www.additudemag.com/pms-adhd-hormones-menstrual-cycle/ 

Reddit (r/ADHD). “Women with ADHD: Does PMS make your meds useless?” https://www.reddit.com/r/ADHD/comments/2fx2nl/women_with_adhd_does_pms_make_your_meds_useless/ 

Frontiers in Public Health. “Steroid Hormones and Their Action in Women's Brains: The Importance of Hormonal Balance.” https://www.frontiersin.org/articles/10.3389/fpubh.2018.00141/full

by Jandra Sutton