Sex Hormones in Women Impact ADHD Symptoms, Medication Efficacy: Study
Fluctuating estrogen and progesterone levels influence inattention, impulsivity, and emotional dysregulation as well as the efficacy of ADHD medication, according to a systematic review.
May 27, 2025
ADHD symptoms are impacted by changes in sex hormone levels in females across the lifespan, finds a new systematic review published in the Journal of Attention Disorders.1 The review included 11 studies that investigated puberty, pregnancy, postpartum, and the menstrual cycle and tracked changes in symptomology and in the efficacy of ADHD medication during these times.
“There is an ADHD experience that is unique to females,” the study’s authors concluded. “Recognizing potential influences of sex hormones on ADHD symptoms in females may have key implications to clinical management and treatment of ADHD.”
The study included several key findings.
Sex Hormones and ADHD During Menstrual Cycle
The research reviewed four studies that explored the fluctuation of ADHD symptoms during the menstrual cycle. The following associations were identified:
- Early luteal phase: increased impulsivity and hyperactivity2
- Mid-luteal phase: increased emotional dysregulation, executive dysfunction, inattention3
- Late luteal phase: increased inattention and executive dysfunction, and mental health symptoms such as depression, irritability and anxiety4
Linking these symptom trends to increase and decrease of specific female hormones, the authors wrote: “Inattention symptoms may be related to decreasing estrogen and moderated by progesterone, whereas hyperactive/impulsivity symptoms may similarly be driven by reducing estrogen levels, though without effect of progesterone.” 5
These significant shifts in symptom severity were vividly described by Chloe, an ADDitude reader, in an article titled “Menstrual Cycle Phases and ADHD.” “The entire week leading up to my period is where my ADHD symptoms get even more intrusive than usual,” she wrote. “My executive functioning dips even lower, distractibility and difficulty focusing is increased, and my mood/energy level is much lower, causing me to feel badly about all the things I’m not being successful at that week.”
The review found that increasing stimulant dosage premenstrually resulted in improvement of ADHD and mood symptoms, including emotional dysregulation. This point was echoed in the lived experience of many ADDitide readers, who reported that their typical medication dosage seems less effective in the luteal phase of their cycle. Norma, a reader from Wisconsin wrote: “The week leading up to my cycle, I might as well not even take my ADHD meds. It’s like my body overrides them.”
Sex Hormones and ADHD in Pregnancy and Postpartum
The review included one study investigating ADHD in pregnancy.6 Three groups of pregnant women were included: those who discontinued ADHD medication, those who continued, and those who took medication as needed.
The study found hyperactivity symptoms were significantly lower and both mood and family functioning were better among the women who continued medication compared to those who discontinued. Other ADHD symptoms did not differ between the groups, leading researchers to theorize that, for some, the high estrogen of pregnancy may ameliorate certain ADHD symptoms. Because just one study was reviewed, and its sample size was small, the authors stressed that more research is required to contextualize the results.
Allison Baker, M.D., lead author for the study included in the review, wrote about her findings in an article for ADDitude, “Treating for Two:” “Women who discontinued stimulant treatment during pregnancy were more likely to experience conflict within their family, rate parenting as more difficult, and report feeling more isolated. Those who discontinued stimulants but did not stop taking their antidepressant medication, experienced a clinically significant increase in depression.”
While the study did not investigate an association between ADHD and postpartum depression, other studies have found that 17% of women with ADHD experience PPD compared to 3.3% of women without ADHD. and 25% experience postpartum anxiety disorders, compared to 4.61% of women without ADHD.7
“New mothers with ADHD face distinct postpartum challenges that are as ubiquitous as they are unstudied,” wrote Baker in “Postpartum Care for Mothers with ADHD.” “The months following the birth of a baby are uniquely difficult, and women with ADHD do not usually receive the medical support and treatments they need during this time.
Future Research on Hormones and ADHD
Understanding the role that sex hormones play on ADHD symptoms in women has far-reaching implications for diagnosing the condition and treating it. The review’s authors put forth the following interventions as possible ways to improve ADHD symptoms exacerbated by female hormones:
- premenstrual adjustment of stimulant dose 8
- use of hormonal therapies to stabilize estrogen and progesterone levels during menopause9 for those who struggle with PMDD 10
The main limitation of the review, authors acknowledged, is the small number of studies included, many of which include small sample sizes. “To advance our understanding of ADHD in females, research that seeks to understand the mechanisms underlying how sex hormones may influence ADHD symptoms is essential,” they wrote, calling for a multi-disciplinary approach that combines assessments of hormone levels with neurocognitive, brain imaging, genetic, or neurophysiological investigations.
This call for research was echoed in the ADDitude magazine article “Hormonal Changes in Women with ADHD: 4 Gaping Holes in Research,” written by five leading experts on ADHD in women, including Michelle M. Martel, Ph.D., a lead author of several of the studies included in the review. “We know that hormones collide with ADHD to cause heightened mood dysregulation, memory problems, and impulsivity each month,” the authors explained. “But 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.”
Sources
1Osianlis, E., Thomas, E. H. X., Jenkins, L. M., & Gurvich, C. (2025). ADHD and Sex Hormones in Females: A Systematic Review. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547251332319
2Roberts B., Eisenlohr-Moul T., Martel M. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015
3Bürger I., Erlandsson K., Borneskog C. (2024). Perceived associations between the menstrual cycle and Attention Deficit Hyperactivity Disorder (ADHD): A qualitative interview study exploring lived experiences. Sexual & Reproductive Healthcare, 40, Article 100975. https://doi.org/10.1016/j.srhc.2024.100975
4de Jong M., Wynchank D. S. M. R., van Andel E., Beekman A. T. F., Kooij J. J. S. (2023). Female-specific pharmacotherapy in ADHD: Premenstrual adjustment of psychostimulant dosage. Frontiers in Psychiatry, 14, Article 1306194. https://doi.org/10.3389/fpsyt.2023.1306194
5Eng A. G., Nirjar U., Elkins A. R., Sizemore Y. J., Monticello K. N., Petersen M. K., Miller S. A., Barone J., Eisenlohr-Moul T. A., Martel M. M. (2024). Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and Behavior, 158, Article 105466. https://doi.org/10.1016/j.yhbeh.2023.105466
6Baker, A. S., Wales, R., Noe, O., Gaccione, P., Freeman, M. P., & Cohen, L. S. (2020). The Course of ADHD during Pregnancy. Journal of Attention Disorders, 26(2), 143-148. https://doi.org/10.1177/1087054720975864
7Andersson, A., Garcia-Argibay, M., Viktorin, A., Ghirardi, A., Butwicka, A., Skoglund, C., Bang Madsen, K., D’onofrio, B.M., Lichtenstein, P., Tuvblad, C., and Larsson, H. (2023). Depression and Anxiety Disorders During the Postpartum Period in Women Diagnosed with Attention Deficit Hyperactivity Disorder. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2023.01.069
8de Jong M., Wynchank D. S. M. R., van Andel E., Beekman A. T. F., Kooij J. J. S. (2023). Female-specific pharmacotherapy in ADHD: Premenstrual adjustment of psychostimulant dosage. Frontiers in Psychiatry, 14, Article 1306194. https://doi.org/10.3389/fpsyt.2023.1306194
9Herson M., Kulkarni J. (2022). Hormonal agents for the treatment of depression associated with the menopause. Drugs & Aging, 39(8), 607–618. https://doi.org/10.1007/s40266-022-00962-x
10Appleton S. M. (2018). Premenstrual syndrome: Evidence-based evaluation and treatment. Clinical Obstetrics and Gynecology, 61(1), 52–61. https://doi.org/10.1097/GRF.0000000000000339
