BY MARLEIGH SMITH, NEUROSCIENTIST AT DITTO

The Hidden Links Between PMDD and ADHD

 

Studies consistently show that having ADHD and a menstrual cycle makes you around 3 times more likely to have PMDD when compared to those without ADHD. The best evidence comes from a controlled 2025 study on 715 participants (1). 

This study showed:

• Symptom based ADHD: 
   41.1% had PMDD

• Self reported clinical ADHD diagnosis: 
   31.4% had PMDD

• Controls (no ADHD): 
   9.8% had PMDD

 

The Neuroscience Behind ADHD and PMDD

Attention-Deficit/Hyperactivity Disorder (ADHD) is characterised by executive function difficulties, inattention, impulsivity and hyperactivity that can create challenges in social life, academic performance, and productivity. But ADHD also shows up in ways that aren't on a diagnostic checklist: time blindness, losing train of thought mid-conversation, hyperfixating, or the quiet exhaustion of masking just to get through the day.

So, what's actually going on in your brain?  In ADHD, two key brain chemicals, or neurotransmitters, are involved: dopamine and noradrenaline. Dopamine is released during tasks involved in reward processing, motivation and attention, while noradrenaline is released during arousal, alertness and concentration. In ADHD brains, these systems don't work the same as in neurotypical brains, whether that's through lower dopamine availability or differences in how it's transported and used. These irregularities affect how the brain regulates attention, motivation and impulse control, which is what gives rise to the traits we recognise as ADHD (2).

Premenstrual Dysphoric Disorder (PMDD), on the other hand, involves markedly depressed mood, feelings of hopelessness, intense irritability, anger, anxiety and overwhelm that occur cyclically, typically in the one to two weeks before your period.

This is mostly attributed to the dysregulation of systems in the brain that occurs in response to normal hormonal fluctuations during the menstrual cycle. Two neurotransmitters appear to play a key role here too: GABA and serotonin. GABA is the brain's main inhibitory neurotransmitter, producing a calming effect, while serotonin helps regulate mood. A brain imaging study found that more severe PMDD symptoms are correlated with lower serotonin availability in the brain during the luteal phase (3). Hormonal shifts in this same phase also affect GABA systems (4), and research suggests that in PMDD, GABA receptors behave differently, so this chemical's calming effect doesn't regulate mood as effectively as it should. The result can be mood instability severe enough to be debilitating.

Hormones, Neurotransmitters, and Shared Vulnerability

In the days leading up to your period, estrogen drops sharply - and because estrogen directly supports dopamine production, that drop reduces dopamine activity too (6). For those with ADHD, whose dopaminergic system is already running below baseline, this premenstrual dip can be especially destabilising. ADHD-related difficulties, including attention and emotional regulation, which are already harder to manage day to day, often get noticeably worse in the days before your period - a pattern researchers call premenstrual exacerbation (7).  

So ADHD symptoms intensify around this time - but how does that make PMDD more likely? It's worth remembering that brain chemicals don't work in isolated silos: dopamine, serotonin, GABA and noradrenaline all interact with and influence one another, so a shift in one system rarely stays contained to just that system. ADHD and PMDD, despite being rooted in different primary neurochemistry, can start to connect. Studies have also found implications for GABA and serotonin in ADHD's core neurobiology (8, 9) - the same two neurotransmitters already shown to be central to PMDD symptoms.

It's thought that, because ADHD brains are starting from a more vulnerable baseline, it takes a smaller hormonal shift to tip mood symptoms into something severe enough to be classified as PMDD. Each condition can intensify the other, making symptoms of both harder to manage during the premenstrual window.

Trauma and Neuroinflammation 

Though the research is limited, and this is certainly not the experience of everyone living with PMDD or ADHD, one meaningful overlap is that early life trauma has been associated with both ADHD and PMDD. 

In a cohort of 100 women diagnosed with PMDD, 83% had experienced early life trauma in the form of either physical, sexual or emotional abuse - a rate substantially higher than that seen in the general female population in Australia, where the study took place (10). In another large study of 11,973 women, 90% of women with PMDD reported a history of childhood adversity, compared with 27% of women without PMDD (11)

And guess what? Those with ADHD consistently found to be more likely to have experienced multiple events of childhood trauma, or adverse childhood experiences (ACEs) (12, 13). 

This connection may involve the body’s stress response system and neuroinflammation. The hypothalamic-pituitary-adrenal axis, or HPA axis, controls how your body responds to stress by releasing hormones from the hypothalamus that ultimately trigger cortisol, the main stress hormone, to be released from the adrenal glands. Normally, this reaction stops after the stressor is removed, but with social threats or adversity from trauma, these hormones keep being pumped into the body and can lead to sustained inflammation throughout the body - and even in the brain. People who've experienced childhood trauma have been found to show elevated HPA axis stress reactivity (14).

Unfortunately, when trauma happens at an early age (when the brain is still developing), this sustained inflammation can persistently alter molecular pathways in your brain (e.g. neurotransmitter systems) in ways that continue to affect you later in life. And this can include rewiring how the brain responds to hormones. 

Here’s where it’s gotten particularly relevant: Since both PMDD and ADHD have been linked to early childhood trauma and involve neuroinflammation (15, 16), this may represent a shared underlying pathway - someone with ADHD who has also experienced early trauma could be more vulnerable to developing PMDD later in life. For some, rather than being coincidental, the overlap between these conditions may reflect common developmental origins.

Not everyone with PMDD or ADHD has childhood trauma - neuroinflammation can also arise from multiple sources including chronic stress that isn’t related to trauma, other medical conditions or genetic contributions, to name a few

To sum it up - the effect is two fold, both conditions make the brain more susceptible to mood and cognitive effects when hormonal fluctuations occur, and both conditions are independently linked to neuroinflammation, which could actually have shared roots.

 

Is there any research being done to help those with both conditions?

Research has been done on finding female-specific medication plans for those with ADHD. A small case study of 9 women (all with ADHD, and 6 with co-occurring PMDD) has shown that temporarily increasing the dose of already prescribed psychostimulants for ADHD during the premenstrual week led to not only improved ADHD symptoms but also mood symptoms that participants then felt resembled their “good” weeks  (17).

This is why it is essential that this research is amplified, so that clinicians can make more informed diagnoses, and be aware of the overlap between ADHD and PMDD. More research is needed to develop treatments for women navigating both ADHD and PMDD. Recognising this is a huge step towards improving care and validating the experiences of women with both conditions. 

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