ADHD looks different in women. It expresses itself differently and it can also have a different impact on a woman’s brain and that impact? It’s constantly changing. Why? One word for you. HORMONES. As we all know, a woman’s hormones change throughout her life? Her symptoms change as well.
You see, hormones are like our body’s Wi-Fi. Carrying messages throughout our bodies to turn on and off systems as they go. And so a woman’s sex hormones: estrogen and progesterone? They not only turn on and off the processes related to puberty and childbirth but they also turn on and off the chemical processes in our brains as well- impacting mood, energy, and, yes, ADHD symptoms.
How do hormones impact ADHD?
So let’s look at the big 2 female sex hormones: Estrogen and Progesterone.
In fact, Estrogen acts like the key that unlocks happiness, satisfaction, and even cognitive performance in our brains by triggering the release of what I like to call the three happy horsemen: Dopamine, Serotonin, and Norepinephrine.
Progesterone, on the other hand, triggers the release of GABA. And GABA acts like a martini for our brain- calming everything down. And while this sounds great– to an ADHD brain that needs more dopamine? The depressing effect of GABA can feel more like kryptonite, than a luxurious cocktail. Because it erases all the goodness unlocked by estrogen and then makes fatigue, irritability, sadness, brain fog, and inattention even stronger than before.
So, over the course of a woman’s life, as her estrogen and progesterone levels change dramatically- her mood, energy, and other ADHD symptoms change as well. Let’s look at how this happens.
The Impact of Hormones on ADHD over the lifespan
ADHD and Childhood
At birth, an infant girl’s estrogen and progesterone are quite high but then they drop after just a few months to very low but also very consistent levels. For some girls, their ADHD symptoms may start to be apparent during childhood. But because their hormone levels are consistent, these symptoms can be easier to treat and that treatment usually looks a lot like the treatment for boys.
ADHD and Puberty
In puberty, however, a girl is flooded by a rapid increase in both estrogen and progesterone. And because they both rise so sharply, progesterone often negates estrogen’s positive emotional and cognitive effects. The increase in progesterone in a girl’s brain also primes her amygdala– The emotional center of her brain–for reaction. This can, in turn, increase her depression, anxiety, irritability, and impulsivity which in turn make ADHD symptoms harder to manage.
Adding to this whole messy picture, these rising hormone levels often make adolescent girls metabolize their medication more quickly, making it less effective. Unfortunately, though because of that rising progesterone;, increasing dosage doesn’t always help girls like it helps boys at this time, leaving already emotional and irritable girls without the same resources they once had.
ADHD and PMS
As a girl continues to grow, their estrogen and progesterone levels continue to rise to peak sometime in her 20s. But these levels change dramatically throughout the course of each month causing her mood, energy, and other ADHD symptoms to change as well.
In the first two weeks, peaking levels of estrogen will make her mood high and her ADHD symptoms more manageable. However, after ovulation, she is likely to notice her mood fall and her symptoms rise as her estrogen levels drop and her progesterone levels rise. Once her period arrives, however, both estrogen and progesterone fall again and the cycle starts all over.
ADHD and Pregnancy
During pregnancy, a woman’s hormones change again.
In the first trimester of pregnancy, a woman’s body sees a rapid and pretty intense rise in both estrogen and progesterone which leads to a tremendous increase in ADHD symptoms and increased fatigue mood issues, and anxiety. To make matters worse- just as a woman’s ADHD symptoms are rapidly increasing, she is usually advised to go off of her stimulant medication to protect the baby, often causing this picture to go from feeling hard to unmanageable.
Nature comes in with an assist, however, in the second and third trimester when a woman gets some relief from her high and steady levels of estrogen which often ease her symptoms and her mood.
After childbirth, however, both estrogen and progesterone levels drop dramatically. This can create deep depression, struggles with anxiety, and a renewed struggle with ADHD symptoms.
ADHD and Perimenopause
Sometime in her 40s, a woman enters perimenopause. During this approximately decade-long time, a woman’s estrogen and progesterone levels become erratic and drop almost 65%. This drop also causes a drop in serotonin, dopamine, and norepinephrine, which can cause sadness, irritability, fatigue, fuzzy thinking, memory lapses, and struggles with inattention.
And while this is hard for any woman, it’s especially tough for a woman with ADHD given the struggles she often already has with brain fog, short-term memory, and attention.
ADHD and Menopause
In menopause, which officially begins 12 months after a woman’s last period; estrogen levels have dropped dramatically which in turn causes a drastic decrease in the release of serotonin, dopamine, and norepinephrine, causing an increase in ADHD symptoms as well as mood symptoms.
The good news is that progesterone has also decreased down to zero allowing any estrogen that is there to do its job. The other good thing about this phase is that hormones stop cycling and so treatment gets easier as symptoms get more consistent.
What to do about changing hormones when you have ADHD
So what’s a woman to do? Our bodies need all these cycling hormones to bear children, but they make our mood and ADHD symptoms so much worse!
One of the most effective strategies when navigating changing hormone levels is tracking. By having a sense of what your hormone levels are doing, you can predict when your symptoms will be better or worse. Now, tracking isn’t easy for an ADHD brain. However, new technology like period trackers does make it a little bit easier.
Diet and exercise can also help ease the impact of changing hormones on mood and executive functioning systems.
CBT and meditation can both help create systems and strategies as well as mindsets that help accommodate for the issues that arise.
And finally, hormone replacement therapy and antidepressants can go a long way towards decreasing the pain and struggle of mood and ADHD symptoms on a changing woman’s body.
So start keeping an eye on your hormones and see if you can notice the impact they’re having on your symptoms. Because it might just be that thing you were labeled as lazy or crazy isn’t about who you are at all-but about your hormones.