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Hormones and Women’s ADHD Symptoms—Part Two

In Part One, we learned that girls and women affected by ADHD have a disadvantage. The guidelines used to assess ADHD and treatment options were created based on research on young white males with hyperactivity. But girls are different from boys in many ways! 

Hormones and ADHD in teen girls

While boys typically have a decrease in ADHD symptoms when they reach puberty, the opposite is true for girls as estrogen increases during puberty. 

Estrogen and progesterone levels fluctuate during monthly menstrual cycles. ADHD symptoms change along with rising and falling hormone levels. As girls approach and go through puberty, they experience significant physical changes and changes in their brains. These changes directly affect their ADHD symptoms. Because ADHD is a brain-based disorder, it is strongly impacted by hormonal fluctuations. 

  • Estrogen levels begin to increase on the first day menstruation starts. This is the beginning of the menstrual cycle, and sometimes results in an increased sense of wellbeing. 
  • When ovulation occurs (10-17 days after the first day of menstruation), estrogen levels take a dive and progesterone levels increase. Moods can take a turn, with increased irritability and lower energy levels. 
  • In the last days of the monthly cycle, both estrogen and progesterone drop, causing a significant shift in mood and energy for most women. 
  • When estrogen drops, so do dopamine levels, which are already low in the brain affected by ADHD. Symptoms of ADHD are magnified at this time; and she may experience:
    • Sadness and mood swings
    • Difficulty sleeping
    • Irritability
    • Anxiety
    • Confusion
    • Fatigue
  • ADHD symptoms usually worsen a few days before the start of the menstrual cycle, according to Patricia Quinn, MD, a developmental pediatrician.

Tools and strategies

“The majority of clinicians don’t understand the impact of hormones on ADHD symptoms,” says Terry Matlan, MSW, ACSW, a psychotherapist and ADHD coach who specializes in ADHD in adults, with a special focus on women. “If a girl or woman is undiagnosed, she sees herself as lacking or less-than, rather than understanding it is part of a disorder. That leads to shame, which impacts all aspects of her life.”

Matlan urges women and girls to learn to embrace the difficulties of ADHD. “If you pretend it doesn’t exist, you won’t be a whole person,” she says.

How can you use information about hormones’ affect on your daughter’s ADHD as she approaches and goes through puberty? 

Educate yourself and your daughter. It is important for you, and your daughter, to learn as much as you can about ADHD and how hormonal fluctuations affect ADHD symptoms. Here are two books recommended for young girls:
  • Get Ready for Jetty! My Journal About ADHD and Me, Jeanne Kraus. A simple book written in diary form, this tells the story of a young girl who faces challenges after entering fourth grade. The book can help young girls recognize they are not alone when facing ADHD, and provides ideas and strategies to help them become more organized and aware of their strengths and challenges. 
  • Attention, Girls! A Guide to Learn All About Your AD/HD, by Patricia Quinn, MD, is a good book for young girls to learn more about ADHD and its presentations. While it includes different characters and illustrations to make it more understandable for young girls, it is helpful to read the book with your daughter and use it as a discussion tool.
Have your daughter track her cycle. It is helpful to understand how fluctuations in ADHD symptoms align with the normal hormonal fluctuations that occur during her monthly cycle. She will learn what is “normal” for her in terms of symptoms, what happens most often when she’s stressed or her routine changes. By mapping her symptoms to the timeline of her cycle, she can work with her healthcare provider to better manage her treatment.

Dr. Quinn says she increases stimulant medication levels on certain days for her female patients based on their cycle and symptoms. “Some women may need an increase in dosage a few days prior to getting their period, while others may only need it while menstruating. What I do with these women is very individualized based on their symptoms.” 

Here are a few suggestions for tracking the menstrual cycle:

  • Paper journal or day planner. Keep a hand-written journal or your day planner near your bed to keep notes. Choose the same time each day to jot down what you notice about your menstrual cycle and ADHD symptoms. Note the start and end dates of your cycle, and symptoms you experience each day. Physical symptoms include things like bloating, cramps, headaches, and amount of flow (light, medium, heavy). Emotional symptoms include calm, happy, depressed, anxious, and more. Note how physical and emotional symptoms affect your ADHD symptoms, and the level of intensity of your symptoms.

  • Apps. For some, electronic apps are easier because you can carry it with you on your smart phone and set reminders to help you enter notes. Most apps create reports or graphs to help you understand your patterns and some include online communities. Free, highly rated apps to tracking your monthly cycle that are simple and colorful include: 

  • Self care. When you know that certain days during your menstrual cycle are going to make your ADHD symptoms worse, you can take steps to support yourself. 

    • One or two days before you expect a shift in symptoms, focus on self care: eat well, get enough sleep, exercise and reduce stress. 
    • Mindfulness training can help improve awareness of the present moment, and allow you to shift from the multiple thoughts that typically bombard someone affected by ADHD. It can help you let go of self-judgement—that inner voice that pops in with criticism.
    • Behavior therapy for ADHD is focused on changing behavior to overcome impairments due to the underlying neurodevelopmental disorder. Positive outcomes include greater self-control and higher self-esteem, both negatively impacted during hormonal fluctuations. 

  • Ask for help. Girls are taught from an early age to be self-reliant and not ask for help. Early diagnosis and treatment are important to prevent the self-esteem issues and self-harm that is much higher with girls affected by ADHD. Instead, teach your daughter to ask for help when she is frustration, sad, or feeling overwhelmed.

Resources for Parents:
Do you have a question for our health information specialists? Call us at (800) 233-4050, Monday through Friday, 1-5 p.m. or post your question to one of our new Online Communities for Parents of Children with ADHD or for Adults with ADHD.

This article appeared in ADHD Weekly on August 10, 2017.

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