How does the menstrual cycle increase symptoms of ADHD?

Image caption, Laila Cornuta was diagnosed with ADHD in her childhood.

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Author, Vicky LoaderRole, BBC

Published 2 hours ago

Reading time: 5 minutes

Phone alarms help Laila accomplish her daily tasks; she has four alarms to wake up, another to get dressed, a third to pack her work bag, and so on.

Laila, 30, who works as a teaching assistant, scrolls through the alerts on her phone and says, "There are countless different alarms at various times throughout the day."

She adds, "It might seem excessive to many, but I have these alarms that I must stick to." Laila notes that this process helps her maintain focus despite having ADHD and establish a daily routine.

But this sense of control dissipates as soon as Laila's period approaches.

She says, "I feel like I'm clinging, with all my might, to a ball that won't stop spinning, and I curse myself and the world all the time."

According to the UK's National Health Service, ADHD is a condition where the brain works differently from most people, causing difficulties with things like concentration, emotional regulation, and sitting still.

Discussions are spreading on social media and chat forums about the impact of the menstrual cycle on ADHD symptoms in women.

Queen Mary University and King's College London are conducting a first-of-its-kind study to test this relationship, by asking 50 women with ADHD who take medication for it to record their menstrual cycles and their impact on ADHD symptoms and daily life in general.

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It is believed that about 2.5 million people in the UK suffer from ADHD, with hundreds of thousands waiting for a diagnosis from the NHS.

Social media, as well as increased awareness of ADHD—especially how women experience it—has led to an unprecedented increase in demand for assessments of the condition.

NHS statistics released in December last year show a 23 percent increase in prescriptions for stimulants and medications to treat ADHD compared to the previous year.

But a report by a government task force in November last year revealed that ADHD remains underdiagnosed and undertreated, and the BBC has revealed that some areas in England are now closing NHS waiting lists because they cannot meet the growing demand.

Image caption, Heloise uses medication to treat ADHD to help her focus on studying.

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Heloise, 19, is studying for three university degrees.

Heloise describes Ritalin—which she takes for ADHD—as a lifeline that gives her three hours of focus to study. She takes the pill, sits in the library, and waits for the medication to take effect.

But during her period, Heloise eagerly awaits a reaction that never comes. She says, "I feel like I've lost my walking stick or something I rely on to walk; suddenly it breaks."

Heloise only noticed the connection between hormonal changes and ADHD symptoms after recording her symptoms as part of the study.

Other women in the research used similar phrases, with some saying they felt "incapacitated" by their symptoms at certain times of the month.

The women participating in the project kept an electronic diary to record their hormone levels and the severity of their ADHD symptoms, including anxiety, depression, and impulsive behavior.

By mapping their cycle alongside their feelings, the researchers are investigating whether there is a pattern in their symptoms and how effective the medication is in helping manage them.

ADHD: How do those affected live with it?

The monthly impact

Psychiatrist Sally Cubbin, a neurodiversity specialist involved in the King's College study, believes hormones and ADHD are closely linked, and hopes this trial reflects that.

She describes how, at certain times for women, such as before the period when estrogen is low, dopamine—the body's 'feel-good' hormone—is affected, making ADHD symptoms much stronger.

Dr. Cubbin says this monthly drop in estrogen not only negatively affects the ability to concentrate and manage tasks, but also makes women more prone to risk-taking and impulsive decisions, with effects potentially including overeating, spending money, and even not using contraception.

For Laila, these impulsive decisions are very familiar. She says she struggles with overeating and strong cravings during her period.

She adds, for example: "I love pickles, and I know that if I eat too many, I'll feel sick." She says it's not about feeling hungry; rather, "it's just an overwhelming urge to do it, and once it gets into your head, it's really hard to stop or curb it."

Feeling valued and liberated

Dr. Jessica Agnew-Blais, lead researcher on the King's College project, says ADHD in women, especially adults, is a new and important research area. Until the late 1990s, it was seen as a condition affecting only children, and mainly boys.

Dr. Katherine Durkin of the Royal College of Psychiatrists says: "We are seeing an increase in the number of women with this disorder, and thanks to greater awareness of how ADHD symptoms manifest in women, more of them are recognizing the difficulties they have faced throughout their lives and are now seeking help."

Women are interested in the impact of menopause and perimenopause—two major hormonal transition phases—on their ADHD, questions that Dr. Agnew-Blais says her study—which is not yet complete—will be a good "starting point" to answer.