ADHD and PMDD: are they linked?
In this article
What's the lowdown?
Women who have ADHD are more likely to suffer from PMDD
There is an interesting link between oestrogen levels during the luteal phase and dopamine levels in the brain
ADHD
Attention deficit hyperactivity disorder (ADHD) is a behavioural condition that affects people making them restless, causing with their concentration and acting impulsive at times. ADHD tends to present during adolescence. Cases are often diagnosed before 12 years of age, but recently, there’s been an increase in diagnosis in adults1. Symptoms could improve with age, however, some adults can still struggle with the symptoms and need treatments daily. ADHD is known to have a genetic component to it, meaning it will run in families. People of any intellectual ability can develop ADHD, but it seems to be more common in people with learning disabilities2.
The exact mechanism behind ADHD is unclear but scientific consensus is around the dysfunction of the brain’s dopamine system. The dopamine system gives you that pleasant feeling when you have done something fun (essentially the brain’s reward system). Dopamine is a chemical transmitter in the brain that is involved in functions like focus, emotions and mood. People with ADHD tend to have lower dopamine levels in the brain which leads to loss of impulse control and regulation of negative emotions. People with ADHD might also crave specific dopamine-rich foods like carbohydrates3.
PMDD
PMDD, premenstrual dysmorphic disorder, is a severe form of premenstrual syndrome. PMDD is a diagnosis based on the American Psychiatric Association. You might however also hear the term severe PMS, which is very similar to PMDD but has slightly different diagnostic criteria.
20-40% of individuals have symptoms that classify as PMS with 5-8% of these experiencing them severely enough to impact their functioning, leading to PMDD4.
PMDD encompasses physical, emotional and behavioural symptoms around the luteal phase of the menstrual cycle. The luteal phase is around 1-2 weeks before your period. There are multiple theories behind the reason why some people experience PMDD. It is regarded as the body’s sensitivity to our hormonal changes during our menstrual cycle, due to the abnormal reaction of allopregnanolone, a metabolite of progesterone, produced by the body. Allopregnanolone is meant to cause peace and serenity, but PMDD sufferers, experience the opposite: depression, anxiety and agitation5.
Another study found that people with PMDD have genes that process their sex hormones (oestrogen and progesterone) differently from those without PMDD. This fits the understanding that PMDD can be inherited6.
This is the understanding we have of PMDD so far, but research is still ongoing.
Menstrual cycle and ADHD
Recently, scientists have agreed upon the multiple hormone sensitivity theory. While this theory has been around for a while, researchers have finally agreed that the lower level of oestrogen before your period can lead to symptoms such as lack of focus or concentration, fidgeting and difficulty regulating emotions. The hormones our ovaries produce are linked to our brain which is why you might have heard that our brains change throughout our cycle, depending on the hormones that act on them. Yes, you heard that right. As our brain reacts to these hormones, people with ADHD might notice an increase in the severity of their symptoms right before their period, due to the drop in oestrogen levels7.
So if you have noticed your symptoms worsening in the luteal phase of your menstrual cycle, you are not going crazy. The decline in oestrogen has a direct impact on your ADHD symptoms.
ADHD and PMDD
A research paper has found that PMDD tends to affect those with ADHD more than the general population. 45.5% of women with ADHD simultaneously had PMDD compared to 28.7% of people without ADHD8.
However, studies on ADHD and PMDD have not been large enough to give us reliable or broad based numbers.
Oestrogen and dopamine are interrelated. Low oestrogen levels have a direct impact on dopamine levels. So during the luteal phase, as oestrogen levels go downhill, so do dopamine levels. As ADHD sufferers may already have low dopamine levels, this further drop in dopamine can exacerbate symptoms like forgetfulness, impulsivity, difficulty concentrating and regulating emotions.
Treatments for PMDD
PMDD has many different treatment types ranging from lifestyle changes, medications, therapy or even surgery. The type of treatment depends on your preferences and how your body reacts to them. We have a detailed PMDD treatment article where we cover each option in more detail.
Preliminary research has demonstrated that it could be beneficial to increase the dose of ADHD treatment before your period starts for those with PMDD, which may benefit symptoms9.
Sadly, there is not enough research to specifically recommend treatment for those with co-existent PMDD and ADHD…..yet but as more researchers see the link, more research into specific treatments will happen.
Summary
ADHD and PMDD have only recently made their debut in the scientific limelight. There have been some interesting preliminary theories looking into the connection between the two disorders but, we are waiting on larger studies for more concrete evidence.
If you are struggling with ADHD, PMDD or both and don’t feel comfortable speaking about it, please do not suffer in silence. Our Lowdown GPs are extremely knowledgeable in women’s health and can support you in managing your symptoms.
Don’t suffer in silence, we are here to help!
Dr Fatema Dawoodbhoy
Fatema is currently training in London as an Academic doctor, with a special interest in Obstetrics and Gynaecology. She is passionate about championing women to understand their bodies better and prioritise their health. She understands the importance of clinically accurate articles and has been writing engaging and educative medical content for 5 years.
Our medical review process
This article has been medically reviewed for factual and up to date information by a Lowdown doctor.
