ADHD in Women

ADHD and the PMDD Roller Coaster

Premenstrual dysphoric disorder (PMDD) plagues nearly half of all women with ADHD. Learn about PMDD’s symptoms and how to treat it.

By Dara Abraham, D.O. Updated on May 7, 2025
Click to Add Comments

What Is PMDD?

PMS is unfamiliar to few women. Roughly 80% of menstruating women experience premenstrual symptoms like irritability, mood swings, and cramps.1 Now imagine PMS symptoms with the volume turned up to 11. You feel hopeless, depressed, worthless. You’re on edge, exhausted, overwhelmed. You have no interest in beloved activities. Your sleep is disrupted. You can’t concentrate. You may even have suicidal thoughts.

And then your period arrives, and the symptoms recede as quickly as they arrived – until two weeks later, when the cycle begins anew. This is the debilitating reality experienced by up to 45% of women with ADHD2, and it is known as premenstrual dysphoric disorder (PMDD).

PMDD is caused by a high sensitivity to fluctuations in estrogen and progesterone, as well as decreases in serotonin – hormonal changes that happen during the luteal phase of the menstrual cycle.

In the first two weeks of the menstrual cycle, estrogen increases, keeping dopamine high. During the luteal phase that follows ovulation, estrogen decreases, as do dopamine, serotonin, and eventually progesterone. These changes cause painful and distressing symptoms until the menstruation begins and hormone levels rise again.

PMDD Symptoms

A PMDD diagnosis is warranted if at least five of these symptoms impact daily functioning during the luteal phase.

  • depressed mood, hopelessness
  • anxiety or overwhelm
  • anger and irritability
  • diminished interest is usual activities
  • feelings of worthlessness
  • mood swings
  • difficulty concentrating
  • tiredness and/or sleep disturbance

[Could You Have PMDD? Take This Self-Test]

PMDD vs. PMS Exacerbation (PME)

It can be difficult to differentiate PMDD from PMS exacerbation (PME) of underlying conditions. Physical and psychiatric conditions that are affected by hormonal fluctuations worsen during the luteal phase of the menstrual cycle; these include ADHD, depression, bipolar, and anxiety, as well as issues like asthma, diabetes, epilepsy, and migraines.

Who’s at Risk for PMDD?

The following factors increase one’s risk for PMDD:

  • anxiety or depression
  • ADHD
  • PMS
  • family history of PMS, PMDD, postpartum depression, or mood disorders
  • personal history of trauma or abuse

How to Treat PMDD

The first-line treatments for PMDD are selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Zoloft, Lexapro, or Paxil. Dosing methods include:

  • Continuous dosing: This is for people who exhibit symptoms for the whole month.
  • Symptom onset dosing: This works well for people who experience symptoms prior to menstruation. Dosing begins with symptom onset and stops at menstruation.
  • Luteal phase dosing: This is used by women whose symptoms present in the week or two leading up to their period. Once ovulation occurs, medication is started and taken until a day or two after menstruation begins.

[Read: Why Do Women with ADHD Face Elevated Risk for PMDD and PPD?]

It’s important to note that PMDD is not the same as depression, though the same medication can be used to treat both. With depression, SSRIs are used to regulate serotonin receptors, a process that takes three to six weeks to work. With PMDD, the initial boost of serotonin caused by an SSRI serves the same function as allopregnanolone, a natural byproduct of progesterone, which is deficient in women with PMDD. Because of this, the SSRI works in days, not weeks. This is essential as the symptoms present and recede so quickly.

How to Treat PMDD: Other Options

If SSRIs aren’t effective, the second-line treatments are gonadotropin-release hormone (Gn-RH) agonists or antagonists to suppress ovarian function. The third-line treatments are hormonal contraception or hormone replacement therapy to reduce hormonal fluctuations. It usually takes between three to six months for either of these options to work.

In the rare cases where nothing else is working, a hysterectomy may be an option. This might include removal of the uterus as well as the fallopian tubes and ovaries.

Supplements for PMDD

Deficiencies in calcium and magnesium can exacerbate both ADHD and PMDD, so supplementation may be helpful. In the luteal phase, calcium levels drop in most women, and I suggest a daily dose of 900 to 1,200 mg, broken down to 300 to 500 mg throughout the day. Magnesium can help with neurotransmitter regulation and hormonal fluctuations; the recommended daily dose is 320 to 500 mg, also in divided doses throughout the day.

PMDD and ADHD: Next Steps

Dara Abraham, D.O., is a psychiatrist in private practice in Philadelphia. She specializes in the diagnosis and treatment of ADHD in adults.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

View Article Sources

1Yonkers, K. A., & Casper, R. F. (2024, January 18). Epidemiology and pathogenesis of premenstrual syndrome and premenstrual dysphoric disorder (R. L. Barbieri & W. F. Crowley Jr., Eds.) https://www.uptodate.com/contents/epidemiology-and-pathogenesis-of-premenstrual-syndrome-and-premenstrual-dysphoric-disorder?topicRef=7382&source=see_link

2Dorani, F., Bijlenga, D., Beekman, A. T. F., van Someren, E. J. W., & Kooij, J. J. S. (2021). Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of psychiatric research, 133, 10–15. https://doi.org/10.1016/j.jpsychires.2020.12.005