Why does my ADHD suddenly feel worse?
Why does my medication work some weeks, but not the next?
Why can’t I focus before my period?
Turns out, the estrogen fluctuations in your menstrual cycle predict a 2-fold increase in ADHD symptoms.
Recap of the neurobiology behind ADHD (1, 2)
ADHD is linked to alterations in key neurotransmitters systems - notably dopamine and noradrenaline.
• Dopamine is linked to cognitive functions like reward processing and attention.
• Noradrenaline is linked to working memory.
In ADHD, dopamine is cleared away from brain synapses more quickly than usual, as ADHD brains have higher dopamine reuptake transporters.
This means there’s less dopamine available to pass messages between neurones, making it harder to sustain focus, regulate impulses, and initiate tasks.
ADHD Symptom Patterns Throughout the Cycle (3, 4)
After ovulation, our bodies have a drop in estrogen, and this time period has been associated with increased ADHD symptoms in terms of impulsivity and hyperactivity.
In the late luteal phase, as estrogen drops again, there are reports of exacerbated ADHD symptoms in terms of inattention and executive dysfunction.
In fact, these estrogen drops can cause 2x increases in ADHD symptoms - including lack of focus and hyperactivity, especially in those with more impulsive behaviours.
→ Those with hyperactivity-impulsivity were driven estrogen drops
→ Those with inattention were driven by estrogen drops, but this effect wasn’t as intense if you had higher progesterone
Why Do Estrogen Drops Exacerbate ADHD?(5, 6)
Estrogen plays a surprisingly powerful role in the brain’s dopamine system, exactly the same system that is vulnerable in ADHD.
You can think of estrogen as a dopamine booster:
Estrogen can increase the amount of dopamine in the brain: either by increasing production or preventing degradation. On top of this, estrogen is seen to upregulate dopamine receptors, increasing the chance of dopaminergic transmission.
In contrast, with the decrease in estrogen after ovulation and just before your period, dopamine availability decreases, as does receptor availability, decreasing the overall dopaminergic transmission.
For individuals without ADHD, the brain may compensate for these shifts. But for those with ADHD, who already operate with reduced dopamine efficiency, this hormonal drop can significantly worsen symptoms like inattention, and impulsivity.
Why ADHD Medication Can’t Keep Up Sometimes (7)
With the fluctuations in hormones across the menstrual cycle, the corresponding changes in dopamine are not taken into account when dosing. Let me explain.
ADHD medication works by boosting dopamine availability in the brain. It blocks dopamine reuptake, allowing dopamine to remain active for longer. Those with ADHD are often prescribed a constant daily dose of medication.
However, for women, dopamine levels are not stable throughout the menstrual cycle.
At points in our cycle when estrogen is low, dopamine is even lower, and ADHD medication cannot keep up, allowing ADHD symptoms to seep through the cracks. This is why medication may feel inconsistent, even when you’re taking it correctly.
To combat this, temporary increases in ADHD medication have been proposed for during the premenstrual week only.
→ One study increased medication dose by 30-50% premenstrually, and this improved ADHD symptoms that were previously exacerbated in this time.
→ However, this study only included 9 people, and more research is needed to confirm efficacy and safety of variable dosing across the menstrual cycle.
PMDD and ADHD (8)
Women with ADHD have 3-4x higher rates of PMDD.
This is because both conditions depend on hormonal changes affecting neurotransmitter function. Those with ADHD are already vulnerable with lower levels of dopamine, so when there is a drop in estrogen, these effects not only make ADHD symptoms worse, but can trigger the onset of PMDD. We have a full article explaining this here.
Endometriosis and ADHD (9)
Those with endometriosis are TWICE as likely to have ADHD.
Endometriosis lesions can produce their own estrogen, which in turn can create larger fluctuations of estrogen levels, creating systemic dysregulation that ultimately influences dopamine levels, which trigger ADHD symptoms.
Potential theories include:
1. Chronic Inflammation in endometriosis could lead to neuroinflammation - which is linked to ADHD.
2. Environmental toxin exposure in the prenatal period could affect nervous, endocrine and immune development - increasing risk for both.
3. Possibility of shared genetic risk.
But more research is needed to confirm these.
DITTO and ADHD
Ditto contains saffron extract, studied for its benefits in both ADHD and PMDD. It
Saffron extract alone has been shown in some studies to be as effective as ADHD medication, and in others, to be even more effective when paired with Ritalin versus Ritalin alone.
It appears to have this effect through an influence of dopamine and serotonin pathways.
Interested in learning more about saffron? Click here.
References:
1. Sanju Koirala, Grimsrud G, Mooney MA, Larsen B, Feczko E, Elison JT, et al. Neurobiology of attention-deficit hyperactivity disorder: historical challenges and emerging frontiers. Nature reviews Neuroscience. 2024.
2. da Silva BS, Grevet EH, Silva LCF, Ramos JKN, Rovaris DL, Bau CHD. An overview on neurobiology and therapeutics of attention-deficit/hyperactivity disorder. Discover Mental Health. 2023.
3. Eng AG, Nirjar U, Elkins AR, Sizemore YJ, Monticello KN, Petersen MK, et al. Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and Behavior. 2024.
4. Osianlis, E., Thomas, E. H. X., Jenkins, L. M., & Gurvich, C. (2025). ADHD and Sex Hormones in Females: A Systematic Review. Journal of attention disorders, 29(9), 706–723.
5. Bendis PC, Zimmerman S, Onisiforou A, Zanos P, Georgiou P. The impact of estradiol on serotonin, glutamate, and dopamine systems. Frontiers in neuroscience. 2024.
6. Del Río JP, Alliende MI, Molina N, Serrano FG, Molina S, Vigil P. Steroid Hormones and Their Action in Women’s Brains: The Importance of Hormonal Balance. Frontiers in Public Health. 2018.
7.Jong, Wynchank D, Esther van Andel, Beekman A, Kooij S. Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage. Frontiers in Psychiatry. 2023.
8.Broughton T, Lambert E, Wertz J, Agnew-Blais J. Increased risk of provisional premenstrual dysphoric disorder (PMDD) among females with attention-deficit hyperactivity disorder (ADHD): cross-sectional survey study. The British Journal of Psychiatry. 2025.
9.Gao et al. Psychiatric comorbidity among women with endometriosis: nationwide cohort study in Sweden. Am J Obstet Gynecol. (2020)
