Cartoon image with a pink-haired character frowning and the bold text 'ADHD & PMDD' above. The creator's handle @the_mini_ADHD_coach is present.

The Impact of Premenstrual Dysphoric Disorder on People with ADHD

Premenstrual Dysphoric Disorder (PMDD) significantly exacerbates the symptoms of ADHD in women and people who menstruate. This complex interaction often leads to heightened emotional responses, increased impulsivity, and greater difficulty in managing typical ADHD symptoms. Understanding and addressing the unique challenges posed by ADHD and Premenstrual Dysphoric Disorder is crucial for effective treatment and improved quality of life. It's important for people with ADHD to be aware of these potential changes and to seek tailored management strategies during their menstrual cycle

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Written by

Alice Gendron

Founder of The Mini ADHD Coach

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The Link Between Your Monthly Cycle & ADHD Symptoms

Ever feel like the days leading up to your period go beyond the typical PMS symptoms? Then, once your period starts, things suddenly feel normal, leaving you wondering if you were overreacting. Rest assured, you're not overthinking it.

• The hormonal shifts impacting ADHD mean that both ADHD and PMS symptoms can exacerbate each other, creating a cyclical challenge.

• If PMS symptoms escalate to a point where they significantly affect mental health, it may indicate something more serious at play - such as Premenstrual Dysphoric Disorder (PMDD). Premenstrual dysphoric disorder (PMDD) is a much more severe form of premenstrual syndrome (PMS).

• Up to 46% of women and people who menstruate* that also have ADHD are affected by PMDD, indicating a higher prevalence of this condition among those with ADHD.

• Coping tips for managing PMS and ADHD include cycle tracking, education, and lifestyle changes.

• Managing PMDD involves a more holistic approach, including exploring an official diagnosis and possibly trying medication and therapy to regulate mood.

Are you interested in exploring how your menstrual cycle intersects with symptoms of ADHD and learning how to manage both effectively? If so, this article is for you.

*Note: We acknowledge that not all individuals who menstruate identify as women. Menstruation is a biological function primarily linked with women, but it's important to recognize that not all women experience menstruation. This topic can be particularly complex for transgender and nonbinary individuals. We aim to use inclusive language throughout this article to ensure all readers feel represented and respected. We know that people with ADHD already encounter stigmatization in many aspects of life, and we don't want to add to this further. 💕

ADHD Symptoms Throughout the Menstrual Cycle

The menstrual cycle's phases significantly impact the symptoms of ADHD  due to hormonal changes affecting dopamine levels.

• Follicular Phase (Day 1-14): As soon as we start bleeding (menstruation), estrogen levels rise steadily. 📈This increase in estrogen boosts dopamine production, potentially improving focus and reducing your usual ADHD symptoms. People might experience temporary relief from the usual ADHD challenges during this phase.

• Ovulation (Mid-Cycle): Around ovulation, estrogen peaks, potentially enhancing mood and cognitive function. Some people may notice their symptoms of ADHD are more manageable during this time.

• Luteal Phase (Post-Ovulation to Menstruation): Estrogen levels decline, and progesterone rises after ovulation. 📉This decrease in estrogen can lead to a drop in dopamine levels, worsening ADHD symptoms. Increased difficulty with concentration, heightened impulsivity, and more pronounced mood swings are common, as is feeling that ADHD medication is less effective.

• Pre-Menstrual Period: In the days leading up to menstruation, the decline in estrogen and dopamine may intensify ADHD symptoms further. This period can be particularly challenging, marked by increased emotional reactivity, food cravings, anxiety, and brain fog. 🤯Sleep is more likely to be disrupted, leading to more fatigue and irritability.

Given the natural fluctuations in hormonal levels throughout the month, it becomes clear how an ADHD diagnosis can amplify nearly all PMS symptoms and vice versa.

Understanding PMDD

Premenstrual Dysphoric Disorder (PMDD) is a more intense and less common condition compared to Premenstrual Syndrome (PMS). While PMS affects a broader range of people who menstruate - up to 48%- PMDD's prevalence is relatively low, ranging from 3 to 9%.

Illustration of a worried pink-haired character with text above explaining 'Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS that can cause emotional and physical symptoms during the days before a period'. A calendar with a marked date is captioned 'PERIOD STARTING'.

Despite sharing symptoms with PMS, PMDD's impact is much more severe, deeply affecting daily life and requiring specialist medical treatment. The disorder carries an increased risk of suicidal thoughts/completing suicide, highlighting the importance of timely and effective diagnosis and treatment.

Graphic showing a series of expressions to represent PMDD symptoms: mood swings, sadness, anxiety, irritability, headaches, insomnia, breast tenderness, and increased appetite. The caption reads 'PMDD SYMPTOMS CAN INCLUDE:' with the creator's handle @the_mini_ADHD_coach

In the luteal phase of the menstrual cycle, PMDD symptoms intensify, including severe mood swings, depression, anxiety, and physical discomfort similar to severe PMS. These symptoms, significantly influenced by hormonal fluctuations, particularly estrogen levels, can profoundly impact mental health and daily functioning 1-2 weeks before menstruation. Behavioral symptoms such as apathy and depression are common, alongside physical symptoms that surpass the typical PMS experience.

A visual timeline illustrating 'These symptoms occur during the days leading up to menstruation and usually dissipate once menstruation begins,' with a point marked 'PERIOD START' and a pink-haired character looking distressed to represent PMDD symptoms. Creator's handle @the_mini_ADHD_coach is shown.
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The Intersection of PMDD and ADHD

There is a significant link between ADHD and PMDD, particularly concerning how hormonal changes affect the brain and, consequently, ADHD symptoms. ⬇️

The contributing factors towards this include:

Estrogen's Influence on Neurotransmitters

Estrogen affects the same brain receptors that release key neurotransmitters like dopamine, serotonin, and norepinephrine. This relationship is crucial for understanding why ADHD symptoms may be more severe in individuals with PMDD. 

Lower estrogen levels, particularly during parts of the menstrual cycle, lead to a decrease in these neurotransmitters. Since people with ADHD already have deficiencies in these brain chemicals, the drop in estrogen can exacerbate ADHD symptoms​​​​.

Pie chart comparing PMDD and PMS with explanatory text above: 'While PMDD shares symptoms with Premenstrual Syndrome (PMS), PMDD is less common and more severe.' It notes PMS may occur in up to 48% of people who menstruate, while PMDD only occurs in 3 to 9%.

Increased Severity of Symptoms

Research indicates that hormone related mood disorders and mood disorder symptoms, including sexual dysfunction, anxiety, and depression, are more prevalent and often more severe in adult ADHD. This link is especially evident in those with PMDD, as their emotional and physical symptoms intensify beyond typical PMS experiences​​​​. 

According to the same study, women with ADHD may also be more susceptible to episodes of postpartum depression symptoms (PPD) due to the change in hormone levels following a pregnancy, especially since these hormones directly affect ADHD.

Impact on ADHD Medication

Psychiatric research also suggests that depleted estrogen levels can negatively impact the effectiveness of stimulant medications used to treat ADHD. As estrogen levels drop, particularly during menstruation, these medications may become less effective, making the usual symptoms of ADHD more challenging to manage​​​​.

This connection highlights the importance of considering hormonal fluctuations when treating ADHD in women and those who menstruate, particularly those who also suffer from PMDD. ✅

Managing ADHD Symptoms During the Luteal Phase

Even without a PMDD diagnosis, the luteal phase is tough enough for those of us with ADHD due to suddenly needing to adapt to low estrogen levels. The trick to getting on top of this is planning and predictability. 

To do this, you could:

Get Smart with Your Cycle

Use apps or your phone's calendar to track and understand your cycle. 🩸Many free apps send you notifications during certain phases of your cycle and remind you to log your period, which can be helpful if you forget. Try to line up your month with your cycle's rhythm. When the luteal phase hits, take a break from the intense stuff (like big projects or social events) if it's an option. 

Remember, we're usually much more sociable and productive during the follicular and ovulation phases, so that's the best time to tackle the tough stuff. Then, when the luteal phase rolls in, take it down a notch, and as your period kicks off, you can start ramping things back up gradually. 💕

Adjusting ADHD Medications

It's important to note that the effectiveness of ADHD medications, particularly stimulants, can be impacted during this phase due to hormonal fluctuations. Progesterone, which increases in the luteal phase, can diminish the beneficial effects of estrogen on the brain and potentially reduce the effectiveness of stimulant medications​​. It's worth checking in with your healthcare provider about this, as they may want to adjust your medication during this time to help you manage. 💊

Take Care Of Your Body

Incorporating lifestyle changes such as stress-reduction techniques, regular exercise, and a balanced diet can help mitigate the impact of hormonal fluctuations on ADHD symptoms, especially during the luteal phase. 

Practices like yoga, mindfulness, or deep breathing exercises can be particularly beneficial in managing stress and emotional dysregulation while also allowing your body the rest it needs as it prepares for your period to start. 😴

Support and Education

Joining support groups or seeking educational resources about managing ADHD and menstrual cycles can provide valuable insights and coping strategies. Sharing experiences with others who face similar challenges can also be a source of support and understanding.

General Management Strategies for ADHD and PMDD

As important as the general tips for the luteal phase are for those with PMDD, handling both ADHD and PMDD can be pretty complex, so it's all about using a holistic approach that goes beyond the basics. 👇

This includes:

  • If you suspect PMDD may be affecting you, it's crucial to seek a formal assessment, especially since PMDD is an officially recognized disorder. Regular check-ins with healthcare providers are essential to ensuring your treatment plan is effective and making necessary adjustments.

  • A balanced diet rich in nutrients can help stabilize mood and energy levels. Incorporating foods that support brain health, such as omega-3 fatty acids, can be particularly beneficial. Supplements like magnesium, vitamin B complex, iron, zinc, and calcium can also support this further.

  • Regular exercise, even moderate activities like walking or yoga, can help manage both ADHD and PMDD symptoms by reducing stress and improving overall mood. 🧘

  • During the luteal phase, many people experience a significant drop in sleep quality. Research indicates the rapid hormonal change in PMDD contributes to this decline. 😪Adequate sleep is crucial for brain health and balance of hormones; sleep deprivation heightens the risk of depression and suicidal thoughts. Aiming for 8-9 hours of sleep per night is critical to managing symptoms effectively.

  • Research indicates that proper treatment with medications such as stimulants for ADHD or selective serotonin reuptake inhibitors (SSRIs) during the luteal phase can be effective. It's essential to consult with a knowledgeable doctor to develop a treatment plan that considers the symptoms of both conditions.

  • Therapy can be a valuable tool in managing mood disorders, anxiety, and other severe symptoms associated with ADHD and PMDD. Cognitive-behavioral therapy (CBT) and other forms of counseling can offer strategies to cope with emotional and behavioral challenges.

Informative illustration stating 'Managing both ADHD and PMDD can be challenging, but with the right treatment, it's possible to reduce symptoms and improve quality of life' with icons for medication, therapy, lifestyle changes, and a comforting message 'YOU ARE NOT ALONE.' Creator's handle @the_mini_ADHD_coach is included.

At the end of the day, it's important to remember that reproductive health, and specifically issues like PMDD, are not always given the recognition and validation they deserve. It's worth seeking a doctor or therapist specializing in these areas, ensuring you feel heard and supported. Don't settle for anyone who dismisses your symptoms or feelings - listen to your body and get the support you deserve. 💕

Key Takeaways

  • Estrogen's Role in Neurotransmitter Regulation: ADHD management can vary throughout the menstrual cycle due to estrogen's impact on neurotransmitters like dopamine, serotonin, and norepinephrine.

  • Vicious Cycle of Symptom Severity: The severity of ADHD symptoms and PMS/PMDD symptoms can exacerbate each other, creating a challenging cycle of increased symptoms.

  • Effectiveness of ADHD Medications: The efficacy of ADHD medications can fluctuate, especially during the luteal phase, due to hormonal changes.

  • Navigating the Luteal Phase: Knowing how your cycle impacts your mood and symptoms is essential, particularly for managing the more challenging luteal phase.

Key. strategies include:

  • Cycle tracking and planning activities and responsibilities accordingly
  • Adjusting medication where appropriate and under the supervision of a medical professional
  • Lifestyle changes related to sleep, nutrition and exercise
  • Learning about your specific symptoms and how they affect you throughout your cycle

  • Strategies for Managing PMDD with ADHD: For those diagnosed with PMDD and ADHD, specific management strategies can be implemented to handle the interplay of symptoms more effectively.

Key strategies include:

  • Seeking a formal PMDD diagnosis and regular healthcare consultations.
  • Adopting a diet rich in nutrients and maintaining regular physical activity.
  • Prioritizing adequate sleep to support brain health and hormone balance.
  • Consulting doctors for tailored medication plans and considering therapy for coping strategies.

  • Advocate for Your Health: Remember the importance of seeking specialized medical support for issues like PMDD to ensure your symptoms are validated and adequately addressed. You know your body best, and you deserve to get the help you need.
Here's what you need to know to navigate ADHD and PMDD

What’s Next?

Want to learn more about the PMS symptoms that can also be linked to ADHD, such as stress, anxiety, or mood dysregulation? Check out these related articles.

The Vicious Cycle Of ADHD And Stress Management

Navigating Emotional Dysregulation in ADHD

The Emotional Rollercoaster of ADHD and Chronic Irritability

ADHD and Anxiety: Understanding Their Coexistence

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Frequently Asked Questions (FAQs)

Is PMDD common with ADHD?

Yes, PMDD (Premenstrual Dysphoric Disorder) and ADHD (Attention Deficit Hyperactivity Disorder) can often coexist, especially in women. Studies suggest that women with ADHD may experience more severe symptoms of PMDD, including extreme mood swings, irritability, and depression. This overlap might be due to the same brain chemicals affecting both conditions, such as serotonin receptors, hormonal changes, and low estrogen levels.

What is the best treatment for PMDD and ADHD?

The best treatment for PMDD and ADHD involves a multifaceted approach that addresses both the emotional and physical symptoms. Treatment options may include medication such as antidepressants for PMDD and stimulant or non-stimulant medication for ADHD. Estrogen replacement therapy has also been considered for women with low estrogen levels. Lifestyle changes, including ensuring enough sleep, managing stress, and dietary adjustments (like reducing intake of salty foods), play a crucial role. In severe cases, it's vital to consult a doctor to tailor the treatment to individual needs, considering the hormonal changes and the impact on daily life.

Why does ADHD get worse before your period?

ADHD symptoms often worsen before a period due to hormonal changes that affect the brain's chemistry. In the days leading up to menstruation, fluctuating levels of estrogen and progesterone can impact the same chemicals in the brain that are involved in ADHD, leading to more severe symptoms. These hormonal shifts can exacerbate the mood disorder aspects of ADHD, leading to increased feelings of stress, anxiety, and difficulty managing daily tasks. Understanding these patterns can help seek appropriate treatment options and strategies for managing symptoms.

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