This is the first in a series of blogs about how women with ADHD navigate their unique challenges. She/her pronouns are used, but these concerns can impact those in gender transition and/or anyone with a uterus.
Andrea used to think she was losing it. For several days every month, she’d be unable to focus, sad, and more disorganized than usual.
“It was like I fell off a cliff. All the systems I had in place to keep me on track were pointless and I would cry if someone looked at me the wrong way on the street,” she says.
For years she wondered why she couldn’t muster the energy or focus to execute basic tasks at home and work around the same time each month.
Diagnosed with ADHD in her late 20’s, Andrea takes stimulant medication and has stabilized on a dose that overall works very well for her. When she noticed it wasn’t as effective as usual, she started to wonder why her male friends with ADHD didn’t have the same experience.
Concerned and curious, she spoke with her doctor.
The estrogen connection
Turns out estrogen plays a crucial role in the production of neurotransmitters in the brain, including dopamine, norepinephrine, and serotonin. They all play a role in cognitive function, so when they’re running low, it can have dramatic and unwanted impact.
When someone with a uterus experiences an average 28-day cycle, estrogen levels remain steady, but around the 14-day mark, called the luteal phase, progesterone production begins to minimize the beneficial effects of estrogen.
For women with ADHD this time of the month, emotional storm clouds gather and it may feel like stimulant medications aren’t working.
“Even with my medication, I would struggle to get to work on time and it felt like I had to make excuses for late deadlines,” says Andrea. “It was like walking through a soupy fog for two or three days.”
In addition to lowered focus, decreased estrogen can lead to anxiety, irritability, trouble sleeping, low libido, and even depression.
It’s no wonder Janice struggled!
Neurotransmitters and medication
Widely considered the standard treatment for ADHD, stimulant medications are either methylphenidate based or amphetamine based and they work by blocking re-uptake of dopamine and norepinephrine, leading to higher available levels in the space between nerve cells, known as the synapse. Note: not everyone benefits from this treatment, it’s important to speak with a professional familiar with stimulant therapy.
Some studies point to estrogen aiding in the effectiveness of stimulants, but more research is definitely needed.
The good news is there are ways to manage your well-being. Some women find relief through doctor-monitored hormone treatment, others find reducing caffeine and making dietary and exercise adjustments are helpful.
For Andrea, adjusting her birth control prescription and stimulant medication made a big difference. She feels more even-keeled throughout the month.
“I know folks often talk about medication feeling like putting on glasses for the first time, but that’s exactly what happened when I adjusted my birth control pill and stimulants. I feel amazing!”
She says even though this has helped her, she still has sad days from time to time. She also says it’s always wise to work with a medical professional.
Some other suggestions to help gain control of your focus and well-being:
1: Keep a diary of your menstrual cycle and highlight problem days
2: Focus on getting enough sleep
3: Reduce caffeine
4: Speak with your doctor about your ADHD medication, it may be time for an adjustment
5: Eat a well-balanced diet with plenty of fruit, vegetables and healthy proteins
Wherever you are on your ADHD discovery journey, it’s important to educate yourself and practice self-compassion.