Understanding the complex interplay between ADHD and Premenstrual Dysphoric Disorder (PMDD) is crucial for women who experience these intertwined challenges. This article delves into the nuances of ADHD and PMDD, exploring how hormonal changes throughout the menstrual cycle can impact symptoms. Through the experiences of Jane and Emily, it offers insight into effective strategies for managing these conditions, underscoring the importance of personalized approaches and the power of adaptability and self-awareness in managing ADHD and PMDD.

Executive Functioning Assessment from Effective Effort Consulting

What is Premenstrual Dysphoric Disorder?

Premenstrual Dysphoric Disorder (PMDD) goes beyond typical PMS, involving intense mood disturbances and physical symptoms. It is a severe form of PMS with symptoms emerging in the latter menstrual cycle phase. These include intense mood swings, irritability, anxiety, depression, physical discomfort, and concentration difficulties. They significantly impact overall well-being and daily life.

For instance, Jane, a graphic designer, experiences debilitating irritability and emotional sensitivity premenstrually, impacting her professional and personal life. Such severe symptoms, as highlighted by WebMD, affect a significant subset of women, necessitating greater awareness and tailored treatment approaches.

Severe psychological symptoms may include:

✔ Mood swings
✔ Anxiety and irritability
✔ Depressive moods
✔ Concentration difficulties (“brain fog”)
✔ Feelings of hopelessness, tension, and being overwhelmed
✔ Suicidal thoughts

Physical symptoms can include:

✔ Fatigue and body aches
✔ Gastrointestinal discomfort
✔ Breast tenderness
✔ Bloating
✔ Changes in appetite and sleep patterns.

What Is ADHD?

👀Attention-Deficit/Hyperactivity Disorder (ADHD) a neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity. These traits affect tasks requiring focus, organization, and impulse control. While commonly associated with children, ADHD can persist into adulthood, influencing personal and professional aspects.

Emily, a teacher, finds these symptoms exacerbated during her premenstrual phase, which notes that hormonal changes can aggravate ADHD symptoms. Emily also finds that her executive dysfunction, a common challenge in ADHD, significantly impacts her organizational skills and decision-making during her premenstrual phase. 

Girls and women are more likely to have the form of ADHD called predominantly inattentive, with problems related to focus and concentration rather than behavior and impulse control. 

➡️Have trouble paying attention
➡️Can’t stick to a task
➡️Can’t control emotions
➡️Find it hard to get organized
➡️Lose or forget things

Research indicates that people with ADHD who were assigned female at birth are more likely to experience PMDD symptoms compared to those without ADHD.

Symptoms of Premenstrual Dysphoric Disorder

Jane’s experience with PMDD involves not just emotional turmoil but also physical discomfort like fatigue, mirroring the comprehensive symptom list outlined by Natural Womanhood, where PMDD’s impact on daily life is emphasized.

Premenstrual Dysphoric Disorder and ADHD

Recognizing the interplay between PMDD and ADHD, as Jane and Emily did, is crucial.  

🔹Innattentive: Inattention in both PMDD and ADHD manifests as difficulty maintaining focus, often worsening during PMDD’s premenstrual phase.

🔹Impulsivity: Impulsivity, a common trait in both conditions, leads to spontaneous actions without full consideration of consequences, intensifying premenstrually in PMDD

🔹Mood swings: Mood swings, ranging from irritability to sadness or anxiety, are characteristic of both disorders, impacting emotional well-being and relationships. 

🔹Restlessness: Restlessness, a need for constant movement or a feeling of edginess, is shared between PMDD and ADHD, affecting the ability to relax and focus on tasks.

PMDD, Estrogen, and Dopamine: How ADHD is Affected by Severe PMS

The hormonal fluctuations during PMDD, especially changes in estrogen, can significantly impact ADHD symptoms by affecting brain dopamine levels. Estrogen affects the regulation of dopamine, a neurotransmitter playing a crucial role in managing ADHD symptoms. During PMDD, these hormonal changes can exacerbate ADHD symptoms, making them more challenging to manage. Inflow emphasizes understanding this hormonal interplay to develop effective strategies for women dealing with both ADHD and PMDD.

Jane’s work efficiency is a prime example of how these changes can manifest in everyday life. During these times of hormone fluctuation, Jane found herself struggling more often to focus, initiate work tasks, and effectively prioritize and break down work projects

How to Manage Premenstrual Dysphoric Disorder?

Managing PMDD involves a comprehensive approach, including lifestyle adjustments and medical interventions. 

Emily’s strategy of tracking her menstrual cycle and adjusting her ADHD medication is in line with these recommendations. 

Personal strategies that may work for you: 

  • Try to slow down and decrease your to-dos.
  • “The week of menses, I limit my client load and sometimes even take a few days off. This practice has decreased my need to cancel a client session and reschedule.” — Liz, Minnesota
  • “I slot into ‘only do what I can manage’ mode during my period. I get migraines and cramps, so I rest in bed on a heating pad, answer work emails on my phone, and order out or do easy meals for the kids and myself.” — An ADDitude Reader
  • “My daughter tries to keep workload to a minimum by planning errands, appointments, and even meals in advance. She often asks for assistance from me and her husband.” — Barbara, Georgia
  • “I’ve let go of trying to function the same way I do the rest of the month. I sleep more, eat what I want to, take time off, etc. It hasn’t been easy, but it feels healthier.” — Lynette, Illinois
  • Seek the support of an ADHD coach to help develop consistent lifestyle adjustments, as well as personal and professional priorities and responsibilities. 

How Does Your Period Affect ADHD?

The menstrual cycle, averaging 28 days, is divided into the follicular and luteal phases. Fluctuating levels of estrogen and progesterone during these phases influence energy, mood, and productivity. High estrogen typically enhances mood and executive functioning (EF), leading to better overall performance. Conversely, low estrogen states can diminish mood and EF, exacerbating ADHD symptoms.

Is There a Link Between ADHD and PMDD?

👍Yes, there is a suggested link between ADHD and PMDD. Research indicates that hormonal fluctuations during the menstrual cycle, particularly in PMDD, can exacerbate ADHD symptoms. This is thought to be due to the influence of hormones like estrogen on dopamine levels, which are crucial in managing ADHD. However, more research is needed to fully understand this connection and to develop targeted treatment strategies for women experiencing both conditions.

Coping with Symptoms of ADHD and PMDD

Combining medical treatments, lifestyle adjustments, and support systems is key. Both Jane and Emily found strategies like SSRIs, relaxation therapy, and lifestyle changes beneficial.  


Hormone Replacement Therapy (HRT):

💡HRT involves supplementing hormones like estrogen to alleviate PMDD symptoms. It can stabilize hormonal fluctuations, thus reducing mood swings and other related symptoms. Example: A woman finds her PMDD symptoms lessen significantly after starting HRT.

Selective Serotonin Reuptake Inhibitors (SSRIs):

💡SSRIs, often used for depression, can also be effective for PMDD. They help balance serotonin levels, improving mood and emotional regulation. An individual can experience fewer depressive episodes during PMDD after being prescribed an SSRI.

Birth Control:

💡Certain birth control pills regulate hormonal cycles, reducing PMDD symptoms. A patient on birth control may find a decrease in severe mood swings after starting a specific birth control regimen.

Lifestyle Changes:

💡Diet, exercise, and sleep improvements can positively affect PMDD and ADHD symptoms. Regular exercise routines can improve energy levels and mood stability.

Relaxation Therapy:

💡Techniques like yoga, meditation, and deep breathing can help manage stress and anxiety associated with PMDD and ADHD. Establishing time for regular mindfulness meditation helps individuals cope better with anxiety.

Vitamin and Mineral Supplements:

💡Supplements such as magnesium or vitamin B6 might help alleviate symptoms. For example, taking magnesium supplements may reduce the severity of her PMDD symptoms. 

Certain vitamins and minerals may help improve your condition, such as: 

  • Vitamin B6
  • Calcium
  • Magnesium

These are suggestions that not only help with overall well-being but are more critical when coping with the symptoms of ADHD and PMDD. 

📆Plan Ahead: Start projects early, especially if due before your period, to manage work and commitments effectively.

😴Sleep Well: Practice good sleep hygiene to combat PMS-related sleep disturbances. This includes maintaining a consistent sleep schedule, keeping electronics out of the bedroom, and avoiding alcohol and heavy meals before bedtime.

🍽Eat Healthy: A balanced diet with fruits, vegetables, and leafy greens can improve ADHD symptoms and PMS-related tiredness.

🏃🏽‍♀️Exercise: Cardio exercise may ease PMS and ADHD symptoms, although more research is needed.

😫Manage Stress: Reduce stress, which exacerbates PMS and ADHD, through mindfulness, deep breathing, or yoga, particularly for those with the inattentive form of ADHD.

💭Therapeutic Interventions: CBT helps modify negative thoughts and improve problem-solving and emotional regulation. Regular sessions provide tailored symptom management techniques.

💊Medication Management: Consultation with healthcare professionals is key for effective medication strategies. Options include stimulant or non-stimulant medications for ADHD. Hormonal therapies or birth control may be advised for PMDD.

Menstrual Cycle Phases and ADHD

The menstrual cycle, divided into the follicular and luteal phases, significantly influences ADHD symptoms. In the follicular phase, following menstruation, rising estrogen levels typically enhance mood and cognitive functions, potentially improving ADHD symptoms. Conversely, in the luteal phase, after ovulation, estrogen levels drop, and progesterone rises, which may worsen ADHD symptoms, increasing issues like inattention and emotional dysregulation. Understanding these phases helps in tailoring ADHD management strategies across the menstrual cycle.

Follicular Phase

The follicular phase lasts approximately two weeks, starting on the first day of your period and ending with ovulation.

⏱During the follicular phase of the menstrual cycle, when estrogen levels rise, it’s a good time to tackle challenging tasks and projects, as cognitive functions and mood might be enhanced. This phase can be leveraged for activities requiring focus and energy. Planning and initiating new projects or organizing tasks can be more effective during this time. It’s an opportune period to engage in activities that might seem more challenging in other phases of the cycle.

Luteal Phase

✋🏼During the luteal phase, when estrogen levels drop and progesterone increases, it’s advisable to focus on self-care and stress management, as this phase can intensify ADHD symptoms. Prioritize tasks that require less mental exertion and allow for more flexibility. Incorporating relaxation techniques, such as mindfulness or light exercise, can help manage stress and mood swings. Adjusting your schedule to accommodate potential decreases in energy and concentration can also be beneficial during this time.

Get a Free Screening Call with Dr. David Murphy

Conclusion

Navigating ADHD and PMDD requires understanding and support. Both Jane and Emily have learned to navigate their ADHD and PMDD with tailored strategies. Jane, leveraging her enhanced focus during the follicular phase, tackles complex projects, while in the luteal phase, she prioritizes self-care and stress reduction. Emily, recognizing her fluctuating energy and concentration levels, adjusts her work and personal commitments accordingly. Their journeys reflect growth in understanding and managing their symptoms, serving as an inspiration to others facing similar challenges. Their experience underscores the importance of personalized strategies in handling the nuances of ADHD and PMDD.

[1] Dorani, Farangis et al. “Prevalence of hormone-related mood disorder symptoms in women with ADHD.” Journal of psychiatric research vol. 133 (2021): 10-15. doi:10.1016/j.jpsychires.2020.12.005