“You Are Way Too Hard On Yourself…”

In a recent ADDitude roundtable titled “Living with ADHD: It’s Different for Women,” five experts addressed the impact of hormones, diagnostic gaps, gender bias, the unique experiences of neurodivergent Black women, and therapeutic strategies for building skills and self-esteem.

Here are highlights from that conversation.Women with ADHD experience significant hormonal fluctuations from puberty through menopause, as sex hormones like estrogen and progesterone directly affect brain regions linked to ADHD’s challenges.Studies suggest that women with ADHD may be more sensitive to hormonal fluctuations across the cycle than are women without ADHD.1, 2 Of course, ADHD varies from person to person, and individual reactions to hormonal fluctuations differ based on the ADHD profile.[Read: Let’s Talk About Perimenopause and ADHD]If your ADHD profile is defined by inattention and emotional dysregulation, higher estrogen levels around ovulation may come as a very welcome energy and mood boost.

On the flipside, you may suffer tremendously from depressive symptoms and rejection sensitivity during the premenstrual or luteal phase.One small study from the Netherlands has explored cyclic or flexible dosing — increasing the dose of ADHD stimulant medication around the premenstrual period.3 We need more research, but the theoretical model is there for cyclic dosing.

However, as clinicians, we have no guidelines and very little support on which to rely. We must consider every woman’s individual hormonal profile and make treatment decisions in that context.Treatment and diagnosis become more complicated during perimenopause and menopause, when women with and without ADHD are affected cognitively and physically.