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PMS, PMDD and ADHD
Summary
PMS and PMDD can intensify ADHD symptoms because hormonal shifts in the luteal phase affect brain chemicals like dopamine and serotonin - the same systems implicated in ADHD. This article explains how overlapping symptoms complicate diagnosis, why people assigned female at birth are often underdiagnosed, and what current research suggests about treatment, from ADHD medications and contraceptive strategies to SSRIs and CBT.
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🌿 Key takeaways
PMS, PMDD and ADHD: what to know
- ADHD, PMS, and PMDD all involve disruption to dopamine and serotonin - making the luteal phase particularly challenging for people with ADHD
- Research confirms that females with ADHD are likely to experience more severe PMS and PMDD symptoms than those without ADHD
- ADHD is significantly underdiagnosed in females due to different symptom presentation and longstanding gender bias in diagnosis
- The effectiveness of ADHD medications may reduce in the luteal phase due to low oestrogen; some clinicians recommend continuous oral contraceptives to stabilise hormone levels
- SSRIs taken during the luteal phase, and CBT, both show evidence of benefit for people managing PMS, PMDD, and ADHD together
What is PMS?
PMS (premenstrual syndrome) is a range of physical, psychological, and behavioural symptoms that occur during the luteal phase of the menstrual cycle - the two weeks before a period. These symptoms can significantly disrupt daily life but typically subside once menstruation begins.
What is PMDD?
PMDD is a cyclical, hormone-based mood disorder in which symptoms occur during the luteal phase and subside within a few days of menstruation. It is often described as a more severe form of PMS - though for many people, that framing feels like a significant understatement given the impact on daily functioning and mental health.
What is ADHD?
ADHD (attention deficit hyperactivity disorder) falls under the umbrella of neurodiversity and affects behaviour, attention, and emotional regulation. It often presents as restlessness, impulsiveness, difficulty concentrating, or difficulty regulating emotions. It may also manifest as impulsive behaviours such as interrupting others or a constant need for movement.
As with any neurodiverse condition (which also encompasses autism, dyslexia, dyspraxia, dyscalculia, dysgraphia, and Tourette's syndrome), symptoms manifest differently depending on the individual. In adults, more common symptoms include difficulty focusing or prioritising, continually starting new tasks before finishing existing ones, forgetfulness, mood swings, irritability, extreme impatience, time blindness, and choice paralysis.
🌿 If you think you may have ADHD: An online test like this one can give an initial indication, but there is no replacement for a medical assessment. Speak to your GP, and visit the ADHD Foundation for further information and support.
Diagnosis and prevalence of ADHD in females
The intersection between the menstrual cycle and ADHD is still being researched. Exact figures on how many people with ADHD also have a menstrual cycle are not fully established. Several factors contribute to this gap.
1. A lack of understanding about PMS and PMDD
Research into PMS and PMDD remains limited. Without widespread clinical awareness of these conditions, their intersection with ADHD is even less well-studied.
2. A lack of understanding about ADHD
Although ADHD was identified in the early 20th century, diagnoses only became more frequent from the 1990s onward. In recent years, there has been a spike in diagnoses among adults, including many who were missed in childhood.
3. Underdiagnosis in females
Around 4.2% of females will be diagnosed with ADHD in their lifetime, but the rate of diagnosis remains far lower than in males - for every girl diagnosed, between three and seven boys receive a diagnosis. This does not reflect a genuine difference in prevalence, but rather a diagnostic gap driven by how symptoms present differently across genders.
Boys typically present with external symptoms (hyperactivity, impulsive behaviour), while girls more often present with internal symptoms such as daydreaming, shyness, and low self-esteem. These are easier to miss or misattribute. A 2020 research paper confirmed that females with ADHD show a modified set of behaviours and comorbidities, are less likely to be identified for assessment, and therefore less likely to have their needs met.
⚠️ Worth noting: Trans men, non-binary people, and others assigned female at birth face additional diagnostic complexity - having been statistically less likely to receive an ADHD diagnosis during childhood, they may have spent years without appropriate support.
4. Symptom overlap
PMS and PMDD produce psychological and behavioural symptoms - including mood swings, irritability, brain fog, and difficulty concentrating - that overlap significantly with ADHD. When both are present, this makes it much harder to identify which condition is driving specific symptoms, and can substantially delay or complicate diagnosis.
ADHD and hormones
The exact cause of ADHD is still not fully understood, but it is widely agreed to be linked to how the brain processes certain chemicals - particularly dopamine. This is strikingly similar to the current understanding of PMS and PMDD. Critically, dopamine is implicated in all three.
Dopamine regulates emotional responses and motivates goal-directed behaviour. People with ADHD tend to have higher concentrations of dopamine transporters - meaning more dopamine is moved out of the brain, and less remains available. Then, during the late luteal phase, dopamine levels drop further. For someone with ADHD who also has a menstrual cycle, this means very low dopamine for approximately the final week of every cycle.
🧪 What the science says: Oestrogen and progesterone affect both dopamine and serotonin levels - both of which are implicated in ADHD, PMS, and PMDD. When the luteal phase brings hormone shifts, it affects the very neurotransmitters that are already dysregulated in ADHD.
Does ADHD make PMS and PMDD worse?
The short answer is yes. A study published in the Journal of Psychiatric Research confirmed that females with ADHD are likely to experience more severe PMS and PMDD symptoms than those without ADHD. When dopamine is already lower due to ADHD and then drops further in the luteal phase, the combined effect on mood, concentration, and emotional regulation can be significant.
Professor Sandra Kooij, founder of the European Network Adult ADHD, explains that in the final week of the cycle, "the ADHD, and potentially also mood, memory, and cognition" all worsen together.
"When I'm having really severe symptoms, it's hard to know whether it's my PMDD or ADHD. Obviously they're both very complex conditions, and doctors are still trying to fully understand them, so trying to determine how my PMDD is affecting my ADHD, or vice versa, is an ongoing process."
Amy, 38 - Evelyn community member, living with both PMDD and ADHD
🌿 What helps: Start with a symptom diary that records both ADHD symptoms and premenstrual symptoms across two cycles. Noting which symptoms occur when - and whether they worsen in the luteal phase - gives your GP the clearest possible picture of what is driving what. Advocating for yourself, as Sarah Graham discusses in Rebel Bodies, remains one of the most effective tools available.
How can the menstrual cycle affect ADHD treatment?
Many people with ADHD report that their medication feels less effective in the final week of their cycle. Professor Kooij explains why: "The effects of ADHD medication may be diminished in the fourth week of the cycle because oestrogen levels are low."
One approach Kooij recommends is continuous use of the oral contraceptive pill - taken across all four weeks of the cycle without a break - to keep oestrogen levels stable throughout. This can help maintain the effectiveness of ADHD medication and reduce PMS and PMDD symptoms simultaneously.
⚠️ Worth noting: Combined hormonal contraceptives do not help everyone with PMS or PMDD. The type of progestogen in the pill can affect how it interacts with symptoms, and some people prefer non-hormonal approaches altogether. Always discuss any changes to contraception with your GP before making them.
For those who prefer non-hormonal treatment, the same 2020 study explored alternatives including SSRIs. Adding SSRIs to a treatment plan solely during the luteal phase has been shown to help ease moodiness, irritability, and inattention in people with both PMDD and ADHD.
Other treatment options for ADHD alongside PMS and PMDD
ADHD medications
ADHD medications fall into two categories: stimulants (which increase dopamine levels) and non-stimulants (which boost norepinephrine). Both have strong evidence behind them. The most commonly prescribed licensed medications include:
- Methylphenidate
- Lisdexamfetamine
- Dexamfetamine
- Atomoxetine
- Guanfacine
Combining ADHD medication with other treatments - such as the oral contraceptive pill or antidepressants - is generally considered safe and may help to keep symptom management as stable as possible across the cycle. Always discuss this with your GP or specialist.
Cognitive behavioural therapy (CBT)
CBT has strong evidence for reducing anxiety and depression associated with both PMDD and ADHD. It is available in individual, couple-based, or group formats, and can be accessed in person or online. One key advantage over medication is that the benefits can persist after therapy ends. Studies show it improves the ability to cope with PMS, PMDD, and ADHD-related symptoms and reduces their severity.
Mindfulness-based cognitive therapy (MBCT)
MBCT combines traditional CBT with mindfulness strategies - teaching specific relaxation techniques and non-judgmental awareness of current emotions. Early studies show it can reduce anxiety and PMDD symptoms and improve quality of life. Further research is ongoing.
Final thoughts
The intersection of PMS, PMDD, and ADHD is genuinely complex, and research into it remains limited. The best first step is to speak to your GP - ideally arriving prepared with a symptom diary, notes on when symptoms occur across your cycle, and questions you want to ask. If your GP does not provide the support you need, you can ask to see a different doctor, request one with experience in menstrual health, or search for a specialist practice in your area.
Evelyn spoke to the ADHD Foundation as part of the research for this article. On the back of that conversation, the organisation is looking to update the resources available on their website specifically for people with ADHD and menstrual cycles.
Related articles
- Can supplements really help PMDD? Here's what the science says
- Evelyn's guide to talking to your GP about PMS and PMDD
Disclaimer: This content is for informational purposes only and is not intended as medical advice. Always speak to a qualified healthcare professional about any health concerns.
