Author: admin

Women with attention deficit hyperactivity disorder (ADHD) may be more likely to experience severe premenstrual symptoms, according to new research from Queen Mary University (QMU) of London.

Published in The British Journal of Psychiatry, the study found that women with ADHD, diagnosed or not, were more likely to meet criteria for provisional premenstrual dysphoric disorder (PMDD), especially if they also had depression or anxiety.

Why ADHD and PMDD in women have been overlooked

ADHD has long been thought of as a childhood condition that mostly affects boys. As a result, many girls and women with ADHD go undiagnosed, often until adulthood. Their symptoms, such as trouble focusing or emotional impulsivity, are usually less disruptive than the hyperactivity seen in boys – and easier to miss.

There’s growing awareness that changes in hormone levels throughout the menstrual cycle can affect mental health. PMDD is a severe condition characterized by emotional, cognitive and physical symptoms that appear in the days before menstruation. Its effects are serious, and PMDD has been linked to an increased risk of suicide.

Recent research is beginning to suggest that women with ADHD might be especially vulnerable during hormonal changes. Studies have found higher rates of depression after starting hormonal contraception, and a higher risk of postpartum depression among women with ADHD.

One small clinical study also hinted that women with ADHD might be more likely to have PMDD; however, the participants were already receiving care, raising questions about whether this applies more broadly.

“Because ADHD was historically considered a condition that mainly affected boys, many issues specific to females have been overlooked, including associations between ADHD and times of hormonal change,” said senior author Dr. Jessica Agnew-Blais, a senior lecturer in psychology at QMU.

The new study set out to examine whether women in the general population who show signs of ADHD, regardless of a formal diagnosis, are at higher risk for PMDD. Unlike earlier studies that focused on women already in clinical care, this research used a broader, population-based sample.

Higher PMDD risk in women with ADHD symptoms

The study surveyed 715 women in the UK, aged 18 to 34 years, using the online research platform Prolific. All participants were assigned female at birth and reported having regular menstrual cycles. The researchers deliberately recruited more participants with ADHD to make sure they could look closely at this group.

Each participant was placed into one of three groups:

• Had a clinical diagnosis of ADHD.
• Did not have a formal diagnosis but met criteria for ADHD using a questionnaire, the Adult ADHD Self-Report Scale (ASRS).
• No diagnosis and did not meet the threshold for ADHD, forming the non-ADHD comparison group.

The study also asked participants if they had ever been diagnosed with depression or anxiety.

To assess PMDD, the researchers used the Premenstrual Symptoms Screening Tool (PSST). This tool asks about common PMDD symptoms such as mood swings, fatigue and difficulty concentrating. The PSST is based on recalled symptoms, not daily tracking, meaning it cannot give a formal diagnosis.

The results showed women with a clinical ADHD diagnosis were over three times more likely to meet criteria for provisional PMDD than those without ADHD. For those who met the ADHD criteria using the ASRS but had no formal diagnosis, the risk was even higher – over four times greater.

In terms of prevalence, 31% of women with a clinical ADHD diagnosis met criteria for provisional PMDD, compared to just 10% in the non-ADHD group. Among those who met ADHD criteria via the symptom checklist, the rate was 41%.

The highest risk was among women with ADHD who also reported depression or anxiety.

While PMDD symptoms looked similar across all groups, insomnia was reported more often by those with ADHD.

Screening and support for PMDD in women with ADHD

The findings point to a clear need for PMDD screening in women with ADHD – especially those who also live with depression or anxiety.

It adds to growing evidence that women with ADHD may be more vulnerable at other times of hormonal change too, such as during pregnancy, postpartum or menopause.

One explanation is that ADHD is linked to differences in dopamine regulation. Drops in estrogen before menstruation also reduce dopamine availability, which could make women with ADHD more sensitive to these shifts.

The study was a cross-sectional analysis based on recalled symptoms, which means PMDD and other conditions can’t be fully separated. The design also doesn’t confirm a formal diagnosis, only a provisional one.

Future research needs to track symptoms daily, over multiple cycles and in more diverse populations. It also needs to explore how medications, both psychiatric and hormonal, interact with these symptoms.

“Our findings emphasise the need to consider issues affecting adult women with ADHD, and more specifically how females with ADHD may be at higher risk for experiencing PMDD,” said Agnew-Blais.

“Our findings also suggest that further research is needed to improve understanding of the link between ADHD and times of hormonal change, including the menstrual cycle, and to reduce health inequalities and diagnostic bias in women and girls with ADHD,” said lead author Dr. Thomas Broughton, a postdoctoral research assistant in the School of Biological and Behavioural Sciences at QMU.