If you have an estrogen cycle, whether from having a uterus that menstruates or following a cyclical estrogen cycle while on feminizing hormone replacement therapy (HRT), you might have noticed something - or experienced something without realizing. For some people, the negative aspects of ADHD can worsen with hormone fluctuations, particularly a drop in estrogen. A big drop in estrogen typically occurs during the luteal phase of a menstrual cycle, and is part of what causes the typical symptoms you experience the week prior to and during your period. Comparatively, a rise in estrogen, usually during the follicular and ovulatory phases of the menstrual cycle (the first and second week after you've had a period), can also ease or level out the impact your ADHD has on your life.
Why does this happen? Estrogen encourages the production and regulation of dopamine, which as noted in previous blog posts, is the main neurotransmitter contributing to the traits and characteristics of ADHD. This isn’t the only factor that affects dopamine production, but it is a significant one worth talking about. Everyone experiences slightly different fluctuations in hormones during a menstrual cycle, and everyone also experiences their ADHD differently - so maybe you don’t notice a change in your ADHD traits throughout your cycle, or maybe you notice it a lot. (Or maybe you've always blamed it on general PMS symptoms!) More memory and concentration troubles, difficulties with emotional regulation, decreased motivation, increased rejection sensitivity, or feeling like your brain is just louder and more crowded aren’t uncommon during the luteal and menstrual phase of your cycle.
The cyclical estrogen effect can be even more apparent for trans women/femmes who are able to medically transition with estrogen-based HRT. Depending on the delivery method (pill, shot, topical), you may notice your estrogen levels dropping the longer it's been since you've taken your dose of E. For those whose ADHD traits are very impacted by their estrogen levels, this may mean noticing those cyclical changes throughout each day or over the course of just a few days, as opposed to the monthly cycles experienced by people who are born biologically female.
There’s also something else to be aware of around your menstrual cycle if you’re an ADHDer or Autistic (or both): if you feel like all of your menstrual symptoms are really difficult to deal with and seem to be worse than others, you could be right. PMDD, or Pre-Menstrual Dysphoric Disorder, disproportionately affects people with ADHD and autism. Up to 92% of Autistic people and 46% of people with ADHD who menstruate experience PMDD. Dysmenorrhea (very painful periods), poly-cystic ovarian syndrome (PCOS), and endometriosis are also more prevalent among neurodivergent women and AFAB folks. You’re not imagining it, it’s not that you just “can’t cope” - it’s worth looking into and talking to your doctor about better managing these symptoms. You’re not alone in struggling with them.