In women with attention deficit hyperactivity disorder (ADHD) who take stimulant medications, the severity of symptoms may depend on the phase of the menstrual cycle. This conclusion was reached by a small group of researchers - Rebecca Zaritsky, Stephanie S. Reed and Suzette M. Evans. Their work was published in the Journal of Attention Disorders.
ADHD is a neurodevelopmental disorder characterized by distractibility, impulsivity and hyperactivity. For a long time it was believed that mostly boys were affected, but now women make up almost half of adults with this diagnosis in the United States. Women more often have pronounced inattention and internal experiences rather than external hyperactivity.
Scientists suggest that fluctuations in sex hormones affect brain chemistry. Low estrogen levels may reduce dopamine transmission - a substance that helps with focus. Therefore, a natural drop in hormones could theoretically intensify ADHD symptoms.
The study involved 30 women aged 18 to 40 with a regular cycle (21-35 days). All of them took amphetamines (for example, Adderall) at least five days a week. Women using hormonal contraceptives or other psychiatric medications were excluded. For 35 consecutive days, participants filled out daily online questionnaires: they rated 18 ADHD symptoms on a four-point scale, mood on a six-point scale (17 emotions), and indicated their medication dose.
The responses were averaged and divided into three periods: the first five days of menstruation, the middle of the follicular phase (after bleeding ended) and the late luteal phase (before the next period). Participants reported the most severe ADHD symptoms during menstruation and the mildest in the middle of the follicular phase.
Separately by symptom type: hyperactive-impulsive traits changed depending on the phase, but after adjustment for multiple comparisons the difference turned out to be only a trend rather than statistically significant. Inattention also fluctuated, but not significantly. Participants did not report that symptoms interfered differently with their daily lives in different phases.
Mood correlated with ADHD symptoms: the more mood dropped during menstruation, the more symptoms intensified. A correlation is a statistical association that by itself does not prove causation.
The daily dose of amphetamines remained stable throughout the cycle. The women did not increase their medication intake to compensate for worsening well-being. This may be because doctors do not recommend changing the dose of stimulants depending on the cycle.
The study has limitations. All data are based on self-reports; hormone levels were not measured in a laboratory - phases were determined by days of bleeding. The sample is small (30 people), so the results require verification in larger groups. In addition, people with other psychiatric diagnoses were not taken into account, and the questionnaire is based on old criteria that do not reflect the characteristics of ADHD in adults.
The authors conclude: further work with direct hormone measurement is needed to accurately link biological changes with behavior. Some clinics are already interested in regimens in which the dose is slightly increased during the weeks when hormones work against the patient. But for now these are only assumptions, not a proven tactic.