ADHD Symptoms and the Menstrual Cycle (Episode 559)

Full Transcript: Episode 559

Lisa Hendrickson-Jack:

Today I’m sharing another brand new episode in our FAM research series. This topic was actually brought to me by one of our FAM practitioners who expressed interest in it. And the topic of ADHD — of course, I am not an expert in attention deficit hyperactivity disorder — but it was brought to my attention the potential correlation between symptoms and menstrual cycle. So in today’s FAM research series, we are diving into a research article that looked at that specific question to try to determine if there was a link between symptoms and the menstrual cycle. So we’re going to go ahead and talk a little bit more about the potential link and how that could affect women who struggle with this condition.

The title of the study we’re going to be diving into today is Reproductive Steroids and ADHD Symptoms Across the Menstrual Cycle. A bit of background information about ADHD. It was once thought to be only a disorder that affected males, leaving women and girls to kind of fend for themselves. And the ratio of boys to girls with ADHD in childhood is about three to one, whereas in adulthood it’s actually closer to one to one. So when we look at the research into ADHD, it would suggest that girls may be presenting differently with these symptoms than boys, or providers may be more used to identifying it in boys and how it might show up in them. And so many girls who may be struggling with this condition may not be actually getting those diagnoses in childhood. And more and more women are starting to get these diagnoses in adulthood — maybe because they’ve noticed certain traits and certain symptoms or certain attention-related issues in themselves and they’re starting to look for more support with it.

So before we get into the study, I’m just going to share a little bit more about the background because it is interesting to see the difference between how men and women are being cared for and how this is being identified based on those sex differences. So there are a couple of key sex differences that have been identified in the research and one of those differences is the characteristics — the way that women present with it, the kinds of things that show up more in women compared to men. And so women tend to present when they have ADHD with decreased self-esteem, more difficulty in relationships, and an increased likelihood of anxiety and other similar types of issues. And women are more likely to present with the inattentive — so attention-related issues — rather than the hyperactive symptoms, which the researchers suggest may be harder to notice.

And this might be one of the reasons for the difference between the diagnosis, the rate of diagnosis in adolescence between boys and girls. Interestingly, women who are diagnosed with ADHD when compared to men — it tends to hit them harder. So the researchers say that they tend to have worse scores on the measures of ADHD compared to men. So although they may be presenting differently with it, they might be showing it in different ways, and they may be less likely to be diagnosed, the issues that they face may be more pervasive in women than men.

And interestingly — I mean, I don’t think that this is specific to ADHD necessarily — but for many women, what the researchers tell us is that the process of receiving a diagnosis and treatment is not necessarily straightforward, with many women finding their way to getting a diagnosis perhaps when their own daughters are diagnosed, or after seeking treatment for other conditions. There was one stat that really stood out to me when I was looking into this. The researchers said that 14% of girls with ADHD were prescribed antidepressants before being treated for it, compared to only 5% of boys. So these girls were presenting with certain symptoms and being prescribed antidepressants when they weren’t necessarily being screened for the ADHD.

And this draws some parallels between hormonal contraceptive use, where you have teenage girls on hormonal contraceptives, and we know that there’s a link between contraceptives and depression and sometimes anxiety. And even though these girls are on the hormonal contraceptives, they are also put on antidepressants instead of potentially looking at, well, what is at the root of this? And could it be related to that birth control pill that you’re on, given that we know that there’s this link? So I know those things aren’t directly related, but I think that it does speak to the deeper issue of women and girls being treated in a certain way by our healthcare system and not always having the actual root of the problem identified.

So that’s a little bit of background just to kind of get us thinking about this ADHD condition. And I also wanted to share a little bit more about the condition itself. So it is a developmental disorder characterized by developmentally inappropriate and impairing symptoms of inattention, hyperactivity, and impulsivity. One researcher described it this way — they said there are three main presentations dividing symptoms into the inattention, the hyperactive-impulsive, or a combination of the two. So we have the kind of inability to pay attention, and we also have this hyperactive component and this component of impulsivity as well.

So going back to the main study that we are going to be looking at today, the researchers are specifically looking to see if there is a link between the symptoms that women experience when they have ADHD and where they are in their menstrual cycle. And they did this in a number of ways. They had these women test their saliva throughout their cycle — a whole protocol where they were testing the saliva, freezing it, bringing it to the lab — so they were able to identify their levels of estrogen predominantly, progesterone, as well as testosterone. And specifically, they were looking at estradiol. And they also had the participants rate their levels of impulsivity and their symptoms of ADHD using a variety of specific questionnaires that have been proven in other studies to be a good measure of this data. So they had a variety of different ways to look at the hormone piece of it as well as the symptom presentation to determine if there was a link.

Unsurprisingly, the researchers did find that there was a link between the symptoms that these women were presenting and what was happening hormonally with them. And I could say that again — unsurprisingly — during that luteal phase, it’s always this luteal phase where we’re looking at some of these increases and changes. That phase of the cycle was associated with a higher portion of these ADHD symptoms. And when they were looking at the hormones in particular, what they were saying was the kind of lower levels of estrogen that were also associated with the higher levels of progesterone. So that is only happening in the post-ovulatory phase, because it’s only after ovulation that we’re seeing those higher levels of progesterone.

And so like I mentioned, they weren’t having these women chart their menstrual cycles — they were having them do these daily saliva tests. And so they were able to see where the estrogen levels were independently, where the progesterone levels were independently. And they noticed that when those progesterone levels are high and the estrogen levels were lower, that combination was associated with an increase in the symptoms that they were testing for.

And so it was interesting to see how the researchers concluded, when they looked at all this data and information, basically what they were saying was that based on the results of this, the symptoms are more variable — potentially in women than previously thought — because they’re seeing this variation that’s directly related to their menstrual cycle. And it said, interestingly, toward the end, that given that they’ve observed these changes — I’m paraphrasing here — this may suggest the need for clinicians to ask about the cycle phase, hormonal profiles, use of hormonal birth control, or stage of life during the ADHD assessment in women.

It’s really interesting. I think at the end of the day, this is how progress is made. I mean, we need to have studies that are looking at these topics to kind of validate women’s experiences. I would imagine that if we had women who had ADHD and they were diagnosed and they were charting their cycles and they were tracking some of their symptoms, I imagine that many of them may know that their symptoms may kick up. And interestingly, many of us who don’t have ADHD find that we have certain symptoms — whether that even be things like anxiety or how attentive we are throughout the menstrual cycle. It’s not unlikely that women without ADHD may notice a shift in some of these symptoms throughout their menstrual cycle. So it doesn’t surprise me that women with ADHD may find that some of those symptoms are more pronounced during that phase of the cycle.

Now, of course, one thing that this study does not tell us is how healthy these cycles are — if these women have other symptoms, if they have PMS symptoms, what’s even going on with their cycles, or whether their luteal phase is a normal length. There’s so much information that my fertility practitioner brain would love to know that isn’t necessarily available in a study like this. But I suppose the next step, the next question would be — if there is this link, is it possible that supporting hormonal health and stabilizing so that there is more of a healthy balance between the estrogen and progesterone levels in the late-luteal phase, would that actually result in lower symptoms for these women who are struggling with ADHD?

So often when we’re looking at research studies, I find that sometimes you end up with more questions than answers, because it does and should spark further questions for the research. So I’m really happy to see these types of studies coming to light. I’m really happy to see this kind of validation of women’s experiences. I think that as women we know — it’s like we’ve been trying to tell you for all these years that there are changes that happen when we are going through our menstrual cycle. And it’s unfortunate that we need so much scientific data to validate our experiences. But at the end of the day, that is the world that we live in, and it is really refreshing to see research like this being done.

With that said, there is also research to show that when studies like this are coming out that are cutting edge, it takes an average of 20 years or so before the latest research becomes standard practice in a conventional practitioner’s office. So although there’s a lot of research coming out now, it does take quite a while for it to trickle down into regular day-to-day practice.

I’d be really interested to hear your experiences. ADHD is a topic that is coming up more and more. There are many women — many men — who have struggled with certain issues throughout their lives who are learning more about this topic. And there’s advanced testing that can be done now. One of the things I’ll share — there was the main study that we were looking at, and there was another study that had a focus specifically on women and their diagnosis. The study is actually called Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. So I’ll make sure to link both of these studies so that you can take a look at the abstracts.

It was interesting because in that particular study, they looked specifically at women and ADHD, some of the differences in diagnoses between men and women, and also some of the specific challenges that women face in getting a diagnosis. Now, if you’ve been listening to the FAM research series for a while, you may have noticed a theme — that regardless of what it is that we’re trying to get diagnosed, we’re often facing challenges, whether that’s endometriosis, whether that’s PCOS, and apparently whether that is ADHD. It just unfortunately seems to be this common theme that when we as women are having a variety of different symptoms, for whatever reason, it’s just falling on deaf ears or we have to go to multiple practitioners or it can take a long time.

And interestingly, even in a topic like ADHD — which is very far outside of the topics that we’re usually talking about on the podcast, more so related to fertility and menstrual cycle health and hormone health — it’s the same story. So if this is a topic that you’ve been curious about and you’re wanting to dig into, you’ll find the studies and details over at fertilityfriday.com/559. If you’ve been enjoying the FAM research series, you can binge on our episodes over at fertilityfriday.com/research. You’ll find the list of all of our FAM research series episodes there. So with that said, I hope that you have a wonderful weekend whenever you’re tuning into the show, and of course, as always, until next time — be well and happy charting.