ADHD & Women's Health
- May 11
- 4 min read
ADHD in Women
ADHD, or Attention Deficit/Hyperactivity Disorder, like many others, is a condition for which our knowledge has significantly broadened and changed over the course of time. We now know that ADHD can present with a completely different set of symptoms (or lack of outward symptoms) in various populations, such as age or biological sex, and even vary by the individual. In this blog, we’ll take a closer look at how ADHD presents differently in those assigned female at birth, and how that impacts diagnosis, management, and outcomes.
Research has consistently shown males are more likely to be diagnosed and treated for ADHD symptoms despite similar prevalence in the populations. Data has also demonstrated girls and women with ADHD being consistently under-identified, underdiagnosed, and having unmet needs in comparison to boys and men with ADHD. This is likely due in part to referral bias, symptom masking and coping strategies, and lack of understanding surrounding the altered presentation in females. (1)
Female-bodied individuals with ADHD often show less hyperactivity and impulsivity and more inattentive symptoms when compared with males, or their hyperactivity can present as mental rather than physical. Males with ADHD are also more likely to have co-existing disorders and symptoms such as oppositional defiant disorder, rule breaking, and aggression that are often generalized as part of a typical ADHD presentation, whereas females with ADHD tend to have more anxiety and other internalized disorders, which can lead to underdiagnosis and misdiagnosis.
Due to the symptoms more common with females with ADHD being less likely to be a disturbance in the classroom, they can be overlooked in school-age children. A study in 2008 demonstrated that teachers were more likely to refer boys for ADHD evaluation and treatment, even when showing equal or lower levels of impairment compared to girls. It is suspected that women with ADHD, similarly to women with autism or other neurodivergence, develop more coping/masking strategies to compensate for difficulties that arise from their symptoms such as working extra hard to maintain academic or professional performance to the point of burnout and exhaustion. (1)
Deeper Connections to Women’s Health
Having ADHD, especially undiagnosed and unmanaged, can severely impact a person’s life and health on its own. What if I told you with women it goes even deeper than that, and ADHD and other women’s health conditions, and even normal physiologic states, can exacerbate each other.
Estrogen is a hormone that, among many other roles, manages neurotransmitters (chemical messengers) in the brain. Some of the neurotransmitters estrogen can impact include:
Dopamine | Key neurotransmitter for executive functioning |
Serotonin | Regulates mood |
Acetylcholine | Important for memory |
Fluctuations in estrogen can cause dysregulation of these areas because of this relationship, which is why women can experience things like PMS, PMDD, and PPD (post-partum depression). However, in those with ADHD that already have altered levels and functioning of these neurotransmitters, these conditions can be more prevalent and more severe. It is suspected nearly two-thirds of women with ADHD experience PMS, PMDD, and/or PPD, (2) and that these conditions can be even more intense for these women vs their neurotypical counterparts. For conditions that are already serious and debilitating, an exacerbation like this is nothing small. This connection also means that ADHD symptoms can be worsened during hormonal fluctuations - which can be near constant for someone with a uterus. During the follicular phase of the menstrual cycle, high estrogen can lead to improved executive function, but also exacerbate impulsivity and hyperactivity, including mental hyperactivity/anxiety. During the luteal phase and menses, low estrogen and progesterone can worsen executive dysfunction, emotional dysregulation, memory issues, PMS, and more. So during certain times of the month, these individuals can be facing significant emotional dysregulation and depression, brain fog, inability to concentrate, irritability, and physical pain and other phases they’re experiencing better executive functioning, but higher anxiety levels. This can mean almost all of the month, every month, comes with a struggle.
Along with hormonal fluctuations that go along with a woman’s cycle, significant times of hormone fluctuations also include puberty, pregnancy, postpartum, and perimenopause; these are all times when ADHD symptoms can be significantly intensified. Women with ADHD have a fivefold higher risk for postpartum depression and severity, and 70% of women with ADHD reported a life-altering negative impact of worsened symptoms during perimenopause. (2)
Treatment of ADHD in Women
Standard treatment for ADHD, both pharmaceutical and otherwise, is the same, regardless of sex, as of current guidelines. However, there are some considerations that may impact treatment modification at certain times. As mentioned above, symptom changes can occur during various times of hormonal fluctuation, which may indicate need for dosage adjustment throughout the cycle. Re-evaluation of symptoms and treatment should be considered at these times. Additional adjunctive treatments may also be considered such as herbal supports, omega supplementation, and in some cases, creatine may be beneficial. If you’re a woman with ADHD and notice significant changes in symptoms around certain parts of your cycle, it may be helpful to track these to support your provider in treatment regimen changes. Providers should also be evaluating for co-existing PMS and PMDD in individuals with ADHD who experience significant mood changes during their luteal phase.
The most recent large scale comprehensive meta-analysis of gender differences and ADHD was over 20 years ago. Updated research is needed, along with more substantial research surrounding physiological hormonal changes (puberty, menses, pregnancy, postpartum, menopause) and their impact on ADHD symptoms and how this impacts management approaches. To have meaningful systemic change in improving long-term outcomes of girls and women with ADHD, there needs to be more information as well as more extensive training and education of healthcare professionals as well as those that may make referrals for ADHD evaluations such as teachers.
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