How do hormonal fluctuations during the menstrual cycle affect women with ADHD?

Objective: There is limited knowledge about how female specific factors such as fluctuating sex hormones influence symptom display and health-related conditions that are unique to, or more prevalent in females with ADHD. This study aims to investigate how women of reproductive age with ADHD experience their ADHD symptoms and well-being in relation to hormonal fluctuations, and secondly, how they perceive hormonal and reproductive counseling in healthcare. Method: Semi-structured interviews were conducted with 14 women with ADHD and analyzed using inductive thematic analysis. Results: Three main themes emerged from the analysis; (1) Controlled by female hormones, (2) Frustration with lack of knowledge/understanding, and (3) Living with ADHD and comorbidities. Many women have experienced challenges and fluctuations related to hormonal changes during their menstrual cycles and in different stages of life. Using hormones to stabilize mood and impulsivity and adjusting stimulant doses were suggested as potential solutions. Participants expressed frustration about the lack of knowledge, interest, and understanding from healthcare professionals regarding ADHD and how hormones influenced symptoms of ADHD and comorbidities in women. Conclusion: This qualitative study highlights the impact of cyclical hormonal fluctuations on daily functioning across the menstrual cycle. Specifically, participants reported cyclic patterns of high energy and productivity related to ovulation followed by low energy and difficulty managing tasks in the premenstrual week. This aligns with clinical experience, anecdotal evidence, and limited literature that suggest that women with ADHD may be particularly vulnerable to hormonal fluctuations. Our findings suggest that especially the premenstrual phase is a challenging time for women with ADHD. Our results emphasize the need for healthcare professionals to improve their understanding of the role sex hormones and the menstrual cycle play in female ADHD. The potential effect of adjusting ADHD medication dosage and introducing hormonal treatment for premenstrual dysphoric disorder (PMDD) in women with ADHD should be further explored.

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