A small pilot study suggests the menstrual cycle modulates the severity of ADHD traits in women taking stimulant medications, with symptoms peaking during menstruation and easing in the days after. The work, published in the Journal of Attention Disorders, points to the potential for hormone-aware treatments and was led by researchers Rebecca Zaritsky, Stephanie C. Reed and Suzette M. Evans.
ADHD is a neurodevelopmental condition marked by distractibility, impulsivity and hyperactivity. Historically seen as a condition affecting mainly young boys, the diagnostic gap is closing and women now account for around half of the adult ADHD population in the United States. Women often present with different patterns, tending towards severe inattention and internalising behaviours rather than overt disruptive hyperactivity.
Among the biological variables distinguishing women from men is the fluctuation of ovarian hormones. In the follicular phase, oestrogen rises and peaks near ovulation; the luteal phase features both oestrogen and progesterone before they fall rapidly ahead of menstruation.
Researchers suspect these hormones play a direct role in brain chemistry. Low oestrogen levels are thought to diminish dopamine signalling, and dopamine is central to focus and attention, so natural hormonal drops could theoretically worsen ADHD symptoms.
Zaritsky, Reed and Evans sought to understand how these hormonal changes interact with ADHD treatments. Earlier laboratory work suggested amphetamines—the most commonly prescribed ADHD medications—may be less effective during the luteal phase, with case reports hinting that mood and concentration could worsen in the days before a period.
The study was designed to track daily changes prospectively. Participants were recruited online, aged 18 to 40, with regular menstrual cycles of 21 to 35 days and a diagnosed ADHD who used amphetamine salts for at least five days a week (commonly known by brand names such as Adderall). The researchers excluded anyone on hormonal birth control or using other psychiatric medications.
After screening and dropouts, the final sample comprised 30 participants who completed the long-term tracking.
At baseline, participants completed a survey detailing medical history, baseline mood and impulsive behaviours. They then filled out a daily online questionnaire for 35 consecutive days, rating 18 ADHD symptoms on a four-point scale and 17 mood states on a six-point scale, while recording the day’s stimulant dose and whether they were menstruating or spotting.
Researchers averaged responses and grouped them into three biological windows: the first five days of menstruation, the mid-follicular phase after bleeding ends, and the late luteal phase just before the next period.
They found that most severe ADHD symptoms were reported during active menstruation, with comparatively milder symptoms during the mid-follicular phase.
When separating the symptom types, hyperactive and impulsive traits varied across phases, but after adjusting for multiple comparisons this was only a trend rather than a statistically significant difference. Inattentive symptoms also fluctuated, but the differences were not statistically significant, and participants did not report any differences in how much their symptoms generally impaired their daily lives across the different phases.
Mood tracking revealed a link between negative emotions and ADHD symptoms. Participants reported higher negative mood during the late luteal and menstruation phases compared with the mid-follicular phase, and those experiencing larger mood drops during menstruation also noted greater increases in ADHD symptoms, for both inattentive and hyperactive traits.
Daily amphetamine doses remained remarkably steady across the cycle; participants did not instinctively take more medication to compensate for feeling more distracted or hyperactive during their periods. The researchers had hypothesised that some participants using flexible dosing regimens might attempt to counteract their worsening symptoms with higher doses, but this was not observed, possibly reflecting prescribing practices.
This research relied entirely on self-reported surveys, and the investigators did not measure hormone levels in a laboratory to confirm each biological phase, opting instead to estimate phases based on reported bleeding days. The small sample size limited statistical power, meaning the results require confirmation in larger populations. Because participants taking other psychiatric medications were excluded, the results might not represent individuals managing ADHD alongside conditions such as mood disorders or premenstrual dysphoric disorder.
The study carried a few distinct demographic and methodological limitations. The researchers did not explicitly gather information on gender identity, and the standardized survey tool used to track daily symptoms was based on older diagnostic criteria. The researchers also noted baseline mental health scores for depression and anxiety showed a trend: individuals with higher baseline scores might experience slightly smaller shifts in ADHD symptoms across their cycles. However, having a higher overall symptom count consistently predicted a lower ADHD-related quality of life.
Future studies will need to incorporate direct hormone sampling to precisely map biological changes to behavioural shifts. Researchers might also explore how oral contraceptives or specific antidepressants impact this hormonal cycle in neurodivergent populations. Some clinics have already begun testing symptom-based dosing regimens, where patients take slightly more medication during the weeks when natural hormones work against them, in attempts to tailor care for women navigating adult ADHD.
The study, “Changes in ADHD Symptoms and Mood Across the Menstrual Cycle in Females Treated With Stimulants: A Pilot Study,” was authored by Rebecca Zaritsky, Stephanie C. Reed and Suzette M. Evans.
