Is Your Menstrual Cycle Making Your ADHD Worse? (Episode 616)

Full Transcript: Episode 616

This is the Fertility Friday Podcast, episode number 616. Today’s episode is all about ADHD. It turns out that not only does ADHD show up differently in women, but unsurprisingly, symptoms do shift around the menstrual cycle. In today’s episode, we are diving into a study that looks at how ADHD symptoms change with the menstrual cycle.

If you’re noticing my hoarse voice, don’t worry, I pre-recorded this episode so you won’t have to listen to my hoarse voice the whole time. Without further ado, let’s go ahead and jump into today’s episode.

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. The topic of ADHD — I am not an expert in attention deficit hyperactivity disorder, but it was brought to my attention the potential correlation between symptoms and the menstrual cycle.

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. We’re going to talk a little 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. 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.

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. Many girls who may be struggling with this condition may not be actually getting those diagnoses in childhood. More and more women are starting to get these diagnoses in adulthood — maybe because they’ve noticed certain traits, certain symptoms, or certain attention-related issues in themselves, and they’re starting to look for more support with it.

Before we get into the study, I’m going to share a little 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.

There are a couple of key sex differences that have been identified in the research. 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. Women tend to present when they have ADHD with decreased self-esteem, more difficulty in relationships, an increased likelihood of anxiety, and other similar types of issues.

Women are more likely to present with the inattentive symptoms — attention-related issues rather than the hyperactive symptoms — which the researchers suggest may be harder to notice. This might be one of the reasons for the difference in the rate of diagnosis in adolescents between boys and girls.

Interestingly, women who are diagnosed with ADHD, when compared to men, tend to have it hit them harder. The researchers say that they tend to have worse scores on the measures of ADHD compared to men. Although they may be presenting differently with it and showing it in different ways, and may be less likely to be diagnosed, the issues that they face may be more pervasive in women than men.

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. These girls were presenting with certain symptoms and being prescribed antidepressants when they weren’t necessarily being screened for the ADHD.

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 symptoms of depression and anxiety. Even though these girls are on the hormonal contraceptives, they are also put on antidepressants instead of potentially looking at what is at the root of this — and could it be related to that birth control pill, given that we know there’s this link?

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.

I also wanted to share a little more about the condition itself. It is a developmental disorder characterized by developmentally inappropriate and impairing symptoms of inattention, hyperactivity, and impulsivity. One researcher described it this way: there are three main presentations dividing symptoms into the inattention, the hyperactive-impulsive, or a combination of the two.

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. They did this in a number of ways.

They had these women test their saliva throughout their cycle — a whole process where they were testing the saliva, freezing it, bringing it to the lab. They were able to identify their levels of estrogen predominantly, progesterone, as well as testosterone. Specifically, they were looking at estradiol, if any of our practitioners are curious to know.

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. 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 — and I think that’s what is interesting sometimes about these studies — 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 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.

When they were looking at the hormones in particular, what they were saying was that the kind of lower levels of estrogen that were also associated with the higher levels of progesterone is only happening in the post-ovulatory phase, because it’s only after ovulation that we’re seeing those higher levels of progesterone.

They weren’t having these women chart their menstrual cycles — they were having them do these daily saliva tests. They were able to see where the estrogen levels were independently, where the progesterone levels were independently. 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.

It was interesting to see how the researchers concluded when they looked at all this data. 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 — this variation in their symptoms.

Interestingly, toward the end, it said that given that they 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.

At the end of the day, this is how progress is made. 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, who were diagnosed and were charting their cycles and tracking some of their symptoms, many of them may know that their symptoms may kick up.

Interestingly, many of us who don’t have ADHD find that we have certain symptoms throughout the menstrual cycle — whether that’s anxiety, or how attentive we are. 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 and if these women have other symptoms — if they have PMS symptoms, what’s even going on with their cycles or their luteal phases, the normal length. There’s so much information and data that my fertility awareness brain would love to know that isn’t necessarily available in a study like this.

I suppose 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?

I find that sometimes you end up with more questions than answers, because research can and should spark further questions. 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.

As women, 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. It’s unfortunate that we need so much scientific data to validate our experiences. It’s unfortunate that our healthcare providers may need to see studies like this to actually believe when we say that we’re experiencing changes and that a variety of things can be linked to the menstrual cycle. But at the end of the day, that is the world that we live in. It is really refreshing to see research like this being done.

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 your conventional practitioner’s office. 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. But it’s still really helpful to know that this is coming out.

I’d be really interested to hear your experiences. ADHD is a topic that is coming up more and more. There are many women and many men who have struggled with certain issues throughout their lives who are learning more about this topic. There’s advanced testing that can be done now.

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 Misdiagnosis: A Systematic Review of ADHD in Adult Women. I’ll make sure to link both of these studies so that you can take a look at the abstracts.

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.

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. There unfortunately seems to be this common theme that when we as women are having a variety of different symptoms, it’s just falling on deaf ears, or we have to go to multiple practitioners, or it can take a long time.

I know that experience isn’t only for women — there are plenty of times when men also have to go through a lot of different providers to get diagnoses for a variety of things. But certainly when we’re looking at women and our experience of healthcare, this is often a common theme. And interestingly, even in a topic like ADHD — which is very far outside of the topics 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.

I hope that you enjoyed today’s episode. The topic of ADHD is becoming more and more prevalent as more women are being diagnosed, as more awareness is being raised about it, and hopefully more practitioners are starting to understand the link between symptoms and the menstrual cycle. One can hope, right?

The bottom line is that charting can help you to understand your symptoms, especially when you think of it through this lens. I can’t tell you how many times I’ve worked with clients who have cyclical issues — whether it’s ADHD, whether it’s migraines, whether it’s painful symptoms related to menstruation or whatever it is. But I can’t tell you how infrequently women actually make those connections.

As a listener of the podcast, maybe you’re making those connections already. But if you’re a practitioner and you’re working with women, you may have already found that so many of your clients are experiencing these symptoms cyclically, but they just never make those connections.

If you enjoyed today’s episode and you can think of someone who would benefit from it, you can find the share link — just head over to fertilityfriday.com and you will find the details for today’s episode. I hope that you have a wonderful week, weekend, whenever you are tuning into the show. And of course, as always, until next time, be well and happy charting.