The Hidden Link Between PMDD and ADHD

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The Hidden Link Between PMDD and ADHD
BY MARLEIGH SMITH, NEUROSCIENTIST AT DITTO

Having ADHD makes you around 3 times more likely to have PMDD when compared to those without ADHD, according to a 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 Hyperactive Disorder (ADHD) is characterized by inattention, impulsivity and hyperactivity that leads to challenges in social lives, academic performance, and work productivity. So, what’s going on in your brain? In ADHD brains, there is dysfunction in two neurotransmitters, or chemicals, called dopamine and noradrenaline. Dopamine is released during tasks involved in reward processing, motivation and attention whereas noradrenaline is released during arousal, alertness and concentration. When these neurotransmitters become too low or too high, it creates impairments in these cognitive functions (2). 

Premenstrual Dysphoric Disorder (PMDD), on the other hand, is associated with markedly depressed mood, feelings of hopelessness, intense irritability and anxiety that occur cyclically (typically 1-2 weeks before menstruation). This is mostly attributed to the increased sensitivity to normal hormonal fluctuations during the menstrual cycle. Specific neurotransmitters could play a role: GABA and serotonin. GABA is the inhibitory neurotransmitter in your brain, producing a calming effect and serotonin is helpful in mood regulation. A recent brain imaging study shows that more severe PMDD symptoms are correlated with lower serotonin availability in the brain (3). Changes in estrogen and progesterone during the cycle also affect GABAergic systems, notably the progesterone metabolite, allopregnanolone, or ALLO (4). Research finds those with PMDD have GABA receptors that work a bit differently, so GABA’s “calming” effect doesn’t work so well, making them more vulnerable to the mood effects of normal monthly hormone changes (5).  


The Hidden Link: Hormones, Neurotransmitters, and Vulnerability

In the days leading up to your period, there is a significant drop in estrogen. Estrogen directly affects the production of dopamine, so when estrogen falls, dopamine activity is reduced, too (6). In those with ADHD, who already have a dysfunction in the dopaminergic system, this premenstrual drop can be particularly destabilizing. ADHD symptoms such as attention and emotional regulation difficulties often worsen, creating feelings of discomfort and tension that can be expressed as anxiety and irritability (this is termed “premenstrual exacerbation”) (7). 

This means those with ADHD are starting from a more vulnerable place, so when hormones fluctuate during the menstrual cycle, it takes less to trigger severe mood symptoms. Some people's brains are more sensitive to hormonal changes, and in ADHD, where the brain's chemical systems are already impacted, hormonal shifts during the cycle can have an amplified effect - making someone more likely to experience PMDD.

Both ADHD and PMDD can be seen as comorbid, both their pathophysiologies affect the other, making symptoms worse in both conditions. 


Trauma and Neuroinflammation 

To top it off, though the research is limited, 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. This is 61.9% greater than the general female population in Australia, where the study took place (8). Similarly, those with ADHD are more likely to have experienced multiple events of childhood trauma, or adverse childhood experiences (9, 10). 

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 results in cortisol, the main stress hormone, being released from the adrenal glands. Normally, this reaction stops after the stressor is removed, but with constant stress in your life (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. Those with childhood trauma are seen to have an elevated HPA axis stress reactivity (11).

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

Here’s where it’s gotten particularly relevant: Since both PMDD and ADHD have been linked to early childhood trauma and are considered inflammatory conditions in both body and brain (12, 13), it’s a potential shared pathway that makes someone more vulnerable to both ADHD and PMDD. Rather than being coincidental, the overlap between these conditions may have common developmental origins, for some.

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 linked to inflammation, making them similar in origin. 

 

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  (14).

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 personalized treatments for women navigating both ADHD and PMDD. Recognizing this is a huge step towards improving care and validating the experiences of women with both conditions. 



  1. 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;226(6):410-417. doi:10.1192/bjp.2025.104
  2. Koirala, S., Grimsrud, G., Mooney, M.A. et al. Neurobiology of attention-deficit hyperactivity disorder: historical challenges and emerging frontiers. Nat. Rev. Neurosci. 25, 759–775 (2024). https://doi.org/10.1038/s41583-024-00869-z
  3. Sacher J, Zsido RG, Barth C, Zientek F, Rullmann M, Luthardt J, et al. Increase in Serotonin Transporter Binding in Patients With Premenstrual Dysphoric Disorder Across the Menstrual Cycle: A Case-Control Longitudinal Neuroreceptor Ligand Positron Emission Tomography Imaging Study. Biological Psychiatry. 2023 Jan;93(12).
  4. Hantsoo L, Payne JL. Towards understanding the biology of premenstrual dysphoric disorder: From genes to GABA. Neurosci Biobehav Rev. 2023 Jun;149:105168. doi: 10.1016/j.neubiorev.2023.105168. Epub 2023 Apr 12. PMID: 37059403; PMCID: PMC10176022.
  5. Stiernman L, Comasco E, Johansson M, Bixo M. Transcription of GABAA receptor subunits in circulating monocytes and association to emotional brain function in premenstrual dysphoric disorder. Transl Psychiatry. 2025;15(1):255.
  6. Bendis PC, Zimmerman S, Onisiforou A, Zanos P, Georgiou P. The impact of estradiol on serotonin, glutamate, and dopamine systems. Frontiers in neuroscience. 2024 Mar 22;18.
  7. Eng AG, Nirjar U, Elkins AR, et al. Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Horm Behav. 2024;158:105466
  8. Kulkarni J, Leyden O, Gavrilidis E, Thew C, Thomas EHX. The prevalence of early life trauma in premenstrual dysphoric disorder (PMDD). Psychiatry Research. 2022 Feb;308:114381.
  9. Rucklidge JJ, Brown DL, Crawford S, Kaplan BJ. Retrospective reports of childhood trauma in adults with ADHD. J Atten Disord. 2006 May;9(4):631-41. doi: 10.1177/1087054705283892. PMID: 16648230.
  10. Brown NM, Brown SN, Briggs RD, Germán M, Belamarich PF, Oyeku SO. Associations Between Adverse Childhood Experiences and ADHD Diagnosis and Severity. Acad Pediatr. 2017 May-Jun;17(4):349-355. doi: 10.1016/j.acap.2016.08.013. PMID: 28477799.
  11. Neigh, G. N., Gillespie, C. F., & Nemeroff, C. B. (2009). The Neurobiological Toll of Child Abuse and Neglect. Trauma, Violence, & Abuse, 10(4), 389-410. https://doi.org/10.1177/1524838009339758 (Original work published 2009)
  12. Cheng M, Jiang Z, Yang J, Sun X, Song N, Du C, Luo Z, Zhang Z. The role of the neuroinflammation and stressors in premenstrual syndrome/premenstrual dysphoric disorder: a review. Front Endocrinol (Lausanne). 2025 Mar 28;16:1561848. doi: 10.3389/fendo.2025.1561848. PMID: 40225329; PMCID: PMC11985436. 
  13. Schnorr, I., Siegl, A., Luckhardt, S. et al. Inflammatory biotype of ADHD is linked to chronic stress: a data-driven analysis of the inflammatory proteome. Transl Psychiatry 14, 37 (2024). https://doi.org/10.1038/s41398-023-02729-3
  14. de Jong M, Wynchank DSMR, van Andel E, Beekman ATF, Kooij JJS. Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage. Front Psychiatry. 2023 Dec 13;14:1306194. doi: 10.3389/fpsyt.2023.1306194. PMID: 38152361; PMCID: PMC10751335.

 

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