Throughout a woman's life, starting at puberty and continuing on through menopause, hormone levels flucuate on a monthly basis. These changes can sometimes exasperate ADHD symptoms or cause mood swings, depression or effect the way ADHD medications work.
This week we will go through the various cycles of a woman's hormonal changes and how ADHD may be affected:
- Puberty, Adolescence and Reproductive Years
- Pregnancy and Childbirth
- Perimenopause and Menopause
Puberty and Adolescence
Many young girls, and their parents, find ADHD symptoms that may have been manageable in previous years, rage out of control during the pre-teen and teenage years. In an article, ADHD and Adolescence on ADDitudemag.com, Dr. Stephen Hinshaw, professor at University of California, Berkeley, is quoted as saying, "We found that ADHD girls in their early teens have more academic problems, more aggressive behavior, earlier signs of substance-related problems, and higher rates of depression than girls who don't have the condition." 
Parents often find that medications for ADHD just don't work like they used to. Throughout the years, parents of pre-teen and teenage girls have written to me talking about girls that once excelled in school suddenly forgot homework on a regular basis and were struggling just to stay above water in school. This may be a result of the fluctuations of estrogen and progesterone.
During a woman's monthly cycle, estrogen is higher during the first two weeks. Progesterone is higher during the last two weeks. Low levels of estrogen have been linked to difficulties with memory and cognitive functioning as well as depression. In addition, estrogen may help ADHD medications work and progesterone may interfere with the effectiveness of ADHD medications. Because of this, the first two weeks of a woman's cycle may be okay, but the last two weeks may bring about exasperated symptoms and non-effective medications. Increasing the dosage of medication has been found to work well for boys through puberty, but not for girls.
Some suggestions on managing this difficult time:
- Keep a calendar and keep track of yours or your daughter's monthly cycles and ADHD symptoms. Knowing what to expect (better during first two weeks, maybe really off course the second two) can help. Find strategies to help during the end of the cycle and be prepared for more mood swings and less attention.
- Plan schoolwork and other tasks accordingly. If your daughter has a major project due, make sure the majority of the work is done during the early part of her cycle, when focus is at its highest and frustration at its lowest.
- Work closely with your doctor to find the right medication and the right dosage. This may take some doing. Some women find taking antidepressant medication or taking anti-anxiety medication for a few days prior to the start of their period to be helpful.
- For severe PMS (girls and women may experience more severe PMS symptoms), see your doctor and discuss treatment options, including birth control pills to regulate hormonal fluctuations.
- Add exercise to your daily routine. Exercise can help improve memory and mental alertness.
- Work on time management, organization, reminder systems and other behavioral strategies to help fill in the gaps for times medication is not as effective.
- Praise your daughter based on her individual strengths and help her develop those rather than focusing on negative habits.
Pregnancy and Childbirth
Hormones fluctuate wildly during pregnancy. In the early months, estrogen levels may be low and all women can experience mood swings and fatigue. As the pregnancy develops, estrogen levels rise.
Most women will choose to not take ADHD medications during pregnancy (more on that next week) and while there is not any specific studies relating to ADHD symptoms improving during pregnancy, many women have claimed they do feel an improvement in their ADHD symptoms as their pregnancy develops. This certainly makes sense, as estrogen levels rise, symptoms may improve.
Estrogen takes a sharp drop right after childbirth causing mood swings and, in some women, postpartum depression. It isn't clear whether women with ADHD may be more prone to postpartum depression, but it is possible. Because of the drastic drop in estrogen levels, ADHD symptoms suddenly reappear, possibly increasing the level of depression.
In addition, new mothers must juggle household responsibilities, other young children at home, a new baby and may be returning to work. All of this can create feelings of overwhelm and frustration.
Some suggestions to help during pregnancy and childbirth:
- Some ADHD medications may cause heart defects or can cause addiction in babies that are being breastfeed. Talk with your doctor about your current treatment and what you can do during the times you cannot take medication.
- Seek help. Use family members, local agencies, visiting nurses or a local cleaning service to make your burden a little lighter. If someone offers help, take it. If they don't, seek out those that are in a position to chip in; watch your other children for a few hours or run some errands to help you through the first few weeks after childbirth.
- If you are breastfeeding and want to take ADHD medication, talk with your doctor about which medications would be best and whether or not you are able to take short-acting medications if you time your breastfeeding for after the medication loses its effectiveness.
- If you are feeling depressed after childbirth, talk with your doctor immediately. Postpartum depression can be treated and it is important to address it as soon as possible.
Perimenopause and Menopause
For about 10 years prior to the onset of menopause, women are going through a period known as "perimenopause." During this time, estrogen in the body slowly decreases, until, at menopause, it has decreased by about 65 percent. As estrogen decreases, serotonin and dopamine levels in the brain also decrease.
During perimenopause, women may experience:
- Mood swings
- Memory lapses
- Problems with word recall
- Difficulties with mental clarity
As menopause nears, a woman may have additional symptoms such as hot flashes, night sweats and insomnia. Lack of sleep, or not sleeping well, can exasperate ADHD symptoms.
As you look at the above list, many of these symptoms mimic those of ADHD. Perimenopause, and menopause, can make the original symptoms of ADHD worse, making you feel as if you suddenly lost your mind. Some medical professionals surmise that this is why many women will be diagnosed with ADHD around menopause, the symptoms of ADHD, combined with symptoms of menopause, can send you looking for help.
Tips for coping with ADHD and perimenopause/menopause:
- Talk to your doctor about ways to balance hormones, including birth control pills or estrogen replacement therapy.
- Make sure you eat properly, maintaining good nutrition levels.
- Add exercise to your daily routine.
- Get a good night's sleep. If you are suffering from insomnia, talk with your doctor. Many women with ADHD already have difficulty sleeping and menopause can make this worse. Your doctor may have suggestions to help you sleep better.
- Discuss with your doctor whether you should take vitamin supplements, dietary supplements or omega-3.
- Discuss whether your ADHD medication, if you are taking any, should be adjusted.
Kathleen G. Nadeau, PhD, Ellen B. Littman, PhD, Patricia O. Quinn, MD. Understanding Girls with AD/HD. Advantage Books. Washington, DC. 2006.
 Laura Flynn McCarthy, "Women, Hormones and ADHD", 2009, ADDitude Magazine
Patricia O. Quinn, M.D, "Hormones and ADD (ADHD) in Women", 2004, ADDvance.com