Hormonal Changes in Women with ADHD: 4 Gaping Holes in Research
Virtually no studies exist on the relationship between lifelong hormonal changes and ADHD symptoms in women. Here are four key research priorities.
Each menstrual cycle brings hormonal peaks and valleys that significantly influence ADHD symptoms. Our recent research confirms that anxiety, mood, and attention all worsen as estrogen falls during the luteal phase. As this hormone climbs again in the follicular phase, risk for substance use rises along with it.1
We know that hormones collide with ADHD to cause heightened mood dysregulation, memory problems, and impulsivity each month, but we don’t know how hormonal transitions over a lifetime impact ADHD symptoms, comorbid conditions, and treatment outcomes. We don’t yet see the big picture of how symptoms manifest during different reproductive stages because research is scant and leaves more questions than answers. Here are four high-priority areas in need of study and advancement.
ADHD and Hormones in Women: Research Priorities
Priority #1: Improved Assessments
When conducting assessments, clinicians should ask about patients’ reproductive events (e.g., puberty, pregnancy/postpartum, menopause) and hormonal profiles (e.g., menstrual cycle phase, use of hormonal medications and contraceptives). Women in the latter half of their menstrual cycle or who are in menopause are more likely to present with ADHD symptoms. Evaluations conducted at other times (e.g., first half of menstrual cycle, before menopause) may lead clinicians to underestimate the probability that a woman has or is at risk for ADHD.
[Get This Free Download: Hormones and ADHD in Women]
Overall, adult ADHD evaluations today rely largely on self-reported questionnaire data, and they do not utilize objective testing, such as biological assays of hormone levels or reproductive indicators (e.g., urine tests for ovulation or blood or saliva samples for hormones). Using these tests would improve care and begin to build empirical connections between hormonal data and observed ADHD symptoms.
Priority #2: Studies on Pivotal Developmental Periods
During puberty, why are depression and self-harm more common in girls with ADHD than boys with ADHD?2 We can surmise that the hormonal fluctuations of puberty and adolescence exert a more profound effect on the mood of girls with ADHD; however, we don’t know for certain.
Estrogen rises during pregnancy and declines rapidly through the postpartum stages. This hormonal decline is thought to place women at risk for anxiety and mood problems, like postpartum depression; however, it is extremely understudied in neurodivergent women. Similarly, perimenopause and menopause are thought to intensify ADHD symptoms and affective problems in women, but they are largely overlooked in the literature. Studies on these pivotal developmental periods are long overdue.
Priority #3: Formal Consideration of Comorbid Conditions
Truly personalized assessments and treatment plans should not only factor in hormonal effects, but also consider the cognitive, affective, and comorbid profiles associated with ADHD. A deep understanding of coexisting conditions across various life stages would also improve evaluation and diagnoses of disorders that often co-occur with ADHD.
[Read: Why Do Comorbid Conditions Uniquely Impact Women with ADHD?]
Depression, substance use, premenstrual dysphoric disorder, eating disorders, and borderline personality disorders all appear alongside ADHD and are also likely impacted by hormonal shifts. Determining how these effects influence ADHD symptoms, and vice versa, will be important for refining our broad understanding of cognition, affect, motivation, and impairment.
Priority #4: Testing Interventions in Women
Leading clinicians suggest that adjusting psychostimulant dosages across the menstrual cycle, with potentially higher doses during the second half, might be especially effective in easing ADHD symptoms. Hormone therapies, including contraceptives, may be another useful treatment choice during the reproductive and post-reproductive years. Anecdotal evidence is encouraging; however, these interventions have not been subject to scientific scrutiny.
Hormonal Changes in Women with ADHD: Next Steps
- Free Download: Managing Menopause and ADHD
- Read: We Demand Attention! A Call for Greater Research on Women with ADHD
- Read: The Menstrual Cycle Impacts ADHD Symptoms in Disparate Ways
- Read: Complex ADHD Is More Common in Women and Girls, Leading to Later Diagnoses
Michelle M. Martel, Ph.D., is the Chair and University Research Professor in the Department of Psychology at the University of Kentucky.
Madeline K. Petersen, M.S., Miranda P. Ramirez, M.S., Carleigh A. Letteral, M.S., and Layne E. Robinson, M.S., are graduate students in the Psychology Department at the University of Kentucky.
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1 Peters, J. R., Schmalenberger, K. M., Eng, A. G., Stumper, A., Martel, M. M., & Eisenlohr-Moul, T. A. (2025). Dimensional Affective Sensitivity to Hormones across the Menstrual Cycle (DASH-MC): A transdiagnostic framework for ovarian steroid influences on psychopathology. Molecular psychiatry, 30(1), 251–262. https://doi.org/10.1038/s41380-024-02693-4
2 Hinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A. J., Schrodek, E., & Swanson, E. N. (2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of consulting and clinical psychology, 80(6), 1041–1051. https://doi.org/10.1037/a0029451
