Exploring the connection between ADHD and PMDD

If you're not familiar with the acronym PMDD, it stands for premenstrual dysphoric disorder. It's essentially a much more severe form of premenstrual syndrome (PMS) and starts in the two weeks leading up to a period. This hormone-related mood disorder can have a serious impact on the physical and mental health of those who suffer from it.  

Symptoms include depressed mood, feelings of worthlessness, anger and irritability, rejection sensitivity, and suicidal thoughts. There are also physical symptoms, such as cramps, bloating, weight gain, muscle soreness and breast tenderness. PMDD can make it challenging to work, socialise and have healthy romantic relationships.  

The severity of PMDD symptoms officially classifies it as a disability in the UK. A 2021 study (1) showed that people with ADHD are significantly more likely to have PMDD than the general population. This is because they are more sensitive to estrogen levels. As a result, they can experience more intense ADHD symptoms as well as intense physical and mood symptoms. 

The different stages of the cycle 

• Follicular Phase (Day 1-14): This is when your period starts. At this point, estrogen levels rise. This increase of estrogen boosts dopamine production. This can potentially improve focus and give people temporary relief from ADHD symptoms.
• Ovulation (Mid-Cycle): This is the time when estrogen levels peak. This can cause a lift in mood and boost cognitive function. People with ADHD may experience more manageable symptoms during this phase. 
• Luteal Phase (Post-Ovulation to Menstruation): At this stage, Estrogen levels begin to drop, and progesterone rises following ovulation. Lowered estrogen levels can lead to a decrease in dopamine levels. This can worsen ADHD symptoms.  

Some people experience lower concentration, heightened impulsivity, and more pronounced mood swings at this stage. It's also common to feel that ADHD medication is less effective. 

• Pre-Menstrual Period: Lowered estrogen and dopamine levels in the days before menstruation may intensify ADHD symptoms. This can be an especially challenging period. It's common to experience more intense emotional reactions, food cravings, anxiety, and brain fog. Sleep can also be disrupted, leading to irritability and fatigue. 

This 2016 study (2) looks at the relationship between PMDD and sleep. 

Managing PMDD symptoms 

Whilst there is no one correct way to manage PMDD, there are things you can do to lessen mood disorder symptoms. You may wish to consult your doctor to determine what treatment routes are available.  

If you are trans or non-binary and are currently using hormone treatment, then some of your options may be different to those suggested below. Consult your doctor to see what treatment plan would work best for you. 

• Know your cycle 

Knowledge is power! Getting to know your menstrual cycles, and your fluctuating estrogen and progesterone levels, will help you prepare for the physical and mental changes ahead. Once you understand the patterns of your mood better, you can plan your time accordingly. For example, 

-rearranging stressful events 

-setting aside time for rest or solitude if necessary 

-creating a support plan so that those around you understand how best to help you 

You might find it helpful to download a period tracker app. Loads of different ones are available, so see which works for you! 

• Lifestyle changes 

Looking at diet, sleep and exercise can be very helpful when it comes to managing both PMDD and ADHD symptoms. For example, regulating your sugar intake can help to steady your energy levels and mood. Getting 7-8 hours of sleep a night can reduce tiredness and irritability. Also, exercise can help to elevate mood by boosting your endorphins. 

• Counselling and talking therapy 

Cognitive Behavioral Therapy (CBT) has been shown to be helpful for those with PMDD. Your doctor may be able to refer you for talking therapy, but waitlist times often vary depending on where you live. If you are UK-based, you can check NHS talking therapies to see what services are available in your area.  

• Medication 

Selective Serotonin Reuptake Inhibitors (SSRIs) are an antidepressant. They are often the first form of treatment a doctor will suggest for PMDD. They are the only type of antidepressant that has shown to help. 

Treating PMDD can be different to treating other conditions such as depression. Your doctor may recommend that you only take SSRIs during your luteal phase. Your doctor should review your treatment after two months. 

• Combined oral contraceptives 

Sometimes known as 'the pill', oral contraceptives can help by stopping or controlling your period. Reviews for this form of treatment vary, with some reporting it can reduce symptoms of PMDD, whilst for some it makes them worse.  

Different oral contraceptives contain different combinations of hormones. Therefore, you may need to try different ones to find one that works for you. You may find that a pill that stops ovulation works best, as ovulation is when PMDD occurs. 

If you decide to try an oral contraceptive, your doctor should arrange to review your symptoms after three months. 

• GnRH analogue injections 

If no other treatment has worked, it may be worth considering gonadotrophin releasing hormone (GnRH) analogue injections. These alleviate PMDD symptoms by bringing on a temporary menopause. 

There are a number of side effects, however, such as a reduction in bone density. This can mean a higher risk of developing osteoporosis. To lower this risk, GnRH analogues are often prescribed alongside hormone replacement therapy (HRT). Treatment should only last for six months. 

• Surgery 

In extreme cases, where PMDD is proving detrimental to someone's day-to-day life, a doctor may suggest surgery. This may include a hysterectomy (uterus removal) and a bilateral salpingo-oophorectomy (removal of your ovaries and fallopian tubes). This prevents symptoms by permanently stopping your menstrual cycle. 

It may be possible to have a bilateral oophorectomy without a hysterectomy. In this case, you would need to take HRT in the form of progesterone. 

Obviously, all surgery comes with risks. It's important to take your time, do your research and think very carefully about whether this is the right course of action for you. 

And finally 

If you have PMDD and would like some help and support, there are a number of resources you may find useful. 

If you're UK-based, you may wish to contact National Association for Premenstrual Syndrome (NAPS).

And for those in the US, it's International Association for Premenstrual Disorders (IAPMD).

You may also find it helpful to use this PMDD symptom tracker at Me v PMDD. 

About the author  

Madison Ashworth is the founder of Pushing Past PMDD - a PMDD online community where she offers education, support and tips for anyone wishing to learn more about the causes of, and treatment for Premenstrual Dysphoric Disorder. By talking so honestly about her own personal experiences of living with the condition, Madison has created a positive, supportive community of like-minded individuals. If you’d like to learn more, you can follow her @pmddsucks and also check out the Instagram reel created with get dopa here.