I was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) Inattentive Type about three years ago—I was a fully functioning adult, married with children before finding out that my brain worked a bit differently. Of course I've known that I functioned a bit differently than my friends since childhood. The signs were there early on, but in the '80s diagnosing a girl with ADHD just wasn’t a thing that happened.
Much of the early criteria for ADHD was written based on how it presented in males, more specifically, white male children, and I was neither. Women like me are being diagnosed more and more lately and it’s likely because social media has connected us in a way that was lacking pre- doom scrolling days.
With the help of social media, women can connect with others who share the same symptoms that were once a source of shame. They can learn what testing to ask for and how to advocate for themselves while having an army of supporters that you’ve never met to encourage you along the way. A lot of women that are diagnosed later in life don’t want medication, they just want an answer. Finally having an answer is what nearly brought me to tears. I wasn’t lazy and forgetful because I didn’t care. I had a neurological disorder that severely impacted my ability to pay attention to detail and organize tasks from most important to least. Just having the answer was a game changer, but hearing that untreated ADHD can cause unchecked anxiety, which I had in spades, I decided to listen to my doctor and give medication a try.
About 30 minutes after my first pill I was actually able to sit still. My brain slowed down and thought one thing at a time. I was suddenly able to finish the tasks that I started in a few minutes instead of hours, or not getting done at all. I remember calling my older brother and crying into the phone telling him that for the first time in my life I was able to not only sit and create a list, but mark stuff off said list. The excitement over my new found executive functioning skills wrapped in a peach colored diamond shaped pill was short lived. For a week out of the month, the pill did nothing. My brain went back to ping ponging from idea to idea, subject to subject. Things for work went unfinished or were messily completed in a last minute hurry. It was beyond frustrating, and no one had an answer as to why my period affected my medication.
My psychiatrist at the time suggested that I was building up a tolerance, but I took “medication vacations” and really only took it during the work week. It wasn’t until I reached out in a group specifically for moms with ADHD out of sheer exasperation that I got answers. Comment after comment were women saying, “my meds don’t work when I’m on my period either.” So many women didn’t have an answer as to why, it was just something that they’ve accepted that comes along with being a woman with ADHD. A week out of the month, your medication that literally helps you function is essentially reduced to being a Tic-Tac. It has no effect, and the symptoms of ADHD are cranked up to 100 that week. It was the most fascinating, bizarre and infuriating revelation. Why isn’t this talked about more?
orange and white pillsPhoto by Christina Victoria Craft on Unsplash
It seems that women are left to either struggle with thinking they’ve lost their minds or that their medication needs to be increased, when a lot of the time neither is true. In fact, after doing a bit of research I found a few articles written about the effects of estrogen on ADHD symptoms, but had difficulty finding one that was peer reviewed. Most articles were written by therapists and ADHD coaches that have been doing their own research into the matter to help their clients that menstruate.
One of the few peer reviewed articles found was by Chris Iliades, MD and peer reviewed by Lindsey Marcellin, MD, MPH. In the article, Iliades notes that “The hormone estrogen affects receptors in the brain that release the naturally occurring chemicals serotonin, dopamine, and norepinephrine. When estrogen levels drop during the weeks before a menstrual period or during the years before menopause, so does the level of these brain chemicals.” He goes on to explain, “because symptoms of ADHD are affected by many of these same brain chemicals, it stands to reason that women with ADHD are more sensitive to estrogen.”
The breakdown of how these chemicals work in conjunction with estrogen, which fluctuates throughout your menstrual cycle, is indeed interesting. But why are articles highlighting this issue outliers? Why aren’t doctors who prescribe these medications more forthcoming with this information? It makes you wonder if doctors are aware at all or if the biological makeup of women and girls taking ADHD medication is an afterthought that medicine has to catch up with. If it is an afterthought, there are thousands, if not hundreds of thousands of menstruating people who would love more research done on this—taking a weeks long vacation from work and daily life isn’t feasible. Here’s hoping for more research and doctors like Chris Iliades to tell us what to expect when ADHD and periods meet.