ADHD in Women: How Your Periods, Progesterone, PMS, and PMDD Can Change Your Brain Every Month

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0:41Then, every morning it combines these factors into an easy-to-understand score from 1 to 100. So you'll know how to take the quality of your sleep from okay to very high. Know your sleep score with Apple Watch. iPhone 11 or later required. If you've ever thought, why can I focus just fine some weeks and then other weeks I can't finish a sentence, my medications feel useless and my brain feels like it's working against me, this episode is for you. We're going through the cyclical hormones that are wrecking your focus, influencing how your medications work, and disrupting your ability to sometimes even make yourself dinner.

1:21And I want you to stick around until the end because I'm going to give you some solutions that can help you get your brain back on track starting today. If you haven't heard, a major review published in the Journal of Clinical Medicine and analyzed nearly a decade of research on ADHD, cognition, and the menstrual cycle. And what it shows is something that many women with ADHD already know because they live in their body, and that is ADHD-related brain struggles don't stay stable across the cycle. There are times they get worse and times they get better. And for some brains, those shifts are anything but subtle.

2:00So if your doctor's ever told you your ADHD and hormones have nothing to do with one another, this study begs to differ. I'm going to go through exactly how your ADHD symptoms are changing during your cycle. But first, welcome back to the Dr. Brighton Show. I'm your host, Dr. Jolene Brighton, board certified in naturopathic endocrinology, nutrition scientist, and a gal with ADHD. And if you could take a quick second to leave me a review and subscribe to the channel, that would be amazing in supporting not just the growth of the show, but ensuring ADHD women finally get the hormone solutions they need, they deserve, and should have had honestly before they ever started their period.

2:38So let's talk the ADHD-related cognition changes. Okay, firstly, your brain is changing. It's fluctuating across the menstrual cycle and not subtly. So this review pulled together 29 human studies published between 2015, 2025, and they looked at attention, executive function, working memory, impulsivity, and inhibition. So your impulse control looked at them across the menstrual cycle. Now, if you don't know, as your hormones change, your brain structure actually changes. And that happens for everyone who cycles, but here's the key takeaways from this study. Firstly, cognitive performance systematically changes across the cycle phases, so follicular versus luteal, and that is especially true for ADHD women and ADHD women with PMS or PMDD.

3:33This is not talking about vague brain fog reports. Yes, that was found, but what researchers observed was objective impairment. So sustained attention, executive functioning, inhibition control, so your impulse control, interrupting people maybe, working memory, holding on thoughts, all of these things were measured. And this is important because there's the subjective symptoms that you feel that was tracked closely with objective performance. And what they found is, is that women with ADHD struggled with those in a specific part of their menstrual cycle. We're going to get into those specific parts today.

4:14If you're a woman who's ever felt like my brain doesn't work the same, depending on where I'm at in my cycle, the data backs you up, okay? The data backs you up, and we've got a very good study now to say true. And to all the people who like to say, we're all just a little ADHD. Nope, we're not. The hormone-related brain fluctuations were far more pronounced in women with ADHD and those who struggle with PMS, PMDD than in the non-clinical population, so those who don't have ADHD. And before we talk about what may feel like the worst time of your cycle, let's talk about when your brain may be working its best.

4:55Enter the follicular phase. So the follicular phase, that's when you start your period that kicks off the follicular phase, but especially mid follicular to pre ovulation is when your estrogen is at its highest. And that is when we find the brain works a little bit better. So relatively better attention. So your ability to attention and have focus much better. Executive functions get a lot easier. Medication actually works for you. Your brain feels stable, less volatile. And that is because this phase is corresponding to the higher estrogen or even just rising estrogen and low progesterone. And what that gives us is better dopaminergic support of the prefrontal cortex.

5:38That's where your executive functions are being run. And yes, we love dopamine, but it's also helping with serotonin, acetylcholine, norepinephrine. But if you are cycling, beware, because I call this the follicular trap, because our ADHD brain gets to working at its best. and then we overschedule, we overcommit, and then we hit a wall and we feel like a failure come the luteal phase. Now, before I talk about what is happening with your hormones and your brain in the luteal phase, I do want to let you know that you can grab the ADHD Brain Hormone Sync. It's a free course that I created just for brains like ours.

6:12It's at drbrighton.com slash synch. That's D-R-B-R-I-G-H-T-E-N dot com slash S-Y-N-C. It's a simple five-day course into working with your hormones so they work with your brain instead of against it. So again, that's drbrighton.com slash synch. With that said, let's hit the luteal phase. So what happens? We ovulate. Post-ovulation, the ovary has a little structure called the corpus luteum left behind, and it's going to produce progesterone. The mid-luteal phase is the key vulnerability window, but only for some brains, okay? So now here's where things get really interesting. The mid-luteal phase, so after ovulation, about five to seven days later, your progesterone is at its peak.

6:57So progesterone is high, and this shows opposite effects depending on the brain you're studying. What do I mean by that? If you do not have ADHD, you may actually have reaction times that are faster. You may be more accurate. Your language might be more accurate. You're not struggling for word finding in the same way. Attention can become more sensitive. So you're more sensitive to the environment. So in other words, cognition may actually look enhanced when you compare it to the ADHD brain. And I know there's a lot of people who have bought into cycle syncing these days and cycle syncing that treats all of us as if we're exactly the same.

7:41And those of us with neurodivergent brains are not in fact the same. So I say this because cycle syncing works great for some people. But if you feel like, why am I the girl that doesn't work for? Why is it failing for me? Because girl, you ain't got the same brain as the people who are like thriving with it. your brain is operating differently under the influence of hormones. So I always just think it's really important because like, I feel like ADHD brains, we always feel like we're a failure. You're not a failure. Because what the research shows is that if you have ADHD, this same phase is associated with worsening attention.

8:16You can't pay attention. You cannot focus. Executive function. So now you can't plan things. You can't execute things. Time blindness might get worse. This is me like right before my period. Increased impulsivity. Are you eating chocolate more? Are you shopping? Is it RIP your bank account? Emotional dysregulation. So here's the thing. Everyone can have a little bit of PMS. Those with ADHD have much more heightened emotional dysregulation. Luteal phase, very common to see rejection sensitivity go way up and you're way more sensitive and you think everybody hates you and everything's about you when you try to fall asleep at night, but you can't fall asleep at night.

8:56We replay all the worst things that you think you've done in your life, but probably aren't that big of a deal. And people have probably already forgotten about. And then on top of that, like half of women with ADHD in one survey were reporting the deal with PMDD. That is extreme PMS that like leads women to want to unalive themselves. So it is like not a mess around condition. And your medication, if you're on it, probably isn't working during that mid luteal phase until your period. So the big takeaway is the same hormonal environment that may sharpen cognition in a neurotypical brain destabilizes cognition in neurodivergent brains, in this case specifically ADHD brains.

9:38And it tells us something fundamental about how different brains respond to the same hormones. So what does the research tell us about the two key cyclical hormones, estrogen and progesterone. Before we get into that, I want you to stick around until the end because I'm going to give you some actual solutions. This is not all doom and gloom because I want to help you. I want to help you and help your brain through the luteal phase. I have struggled with this in my life. I've like figured things out because of my education and I want to help you out too because it shouldn't be as hard as it is.

10:13And I swear Sometimes with ADHD, it's just like, well, you look like you have a successful marriage, successful job. You're doing well in school, right? There's like all of these external boxes people check and they're like, therefore, you're not struggling. And you're like, do you know how freaking hard I'm working? Like I'm exhausted. And so let's just make that easier. Let's talk a little bit more about the low estrogen, high progesterone and the symptom amplification of ADHD. Now, across multiple studies, ADHD symptoms worsened most consistently when estrogen was low and progesterone was high.

10:51Now, I need you to understand this. Your estrogen may not look particularly low, but when we look at estrogen versus progesterone, progesterone can go quite high, as it should, in the luteal phase. And that's enough sometimes for you to feel like you have that low estrogen. Estrogen should be lower relative to progesterone levels in the luteal phase. And more specifically, five to seven days post-ovulation through until about you get your period. Now, there's one symptom in particular that's most reliably affected in those with ADHD when progesterone is high, and that is inattention. You are spacing out.

11:29You didn't hear what they just said. Like, you can't follow the conversation. Maybe you're in school and you're like, I don't remember. and this is the worst. Your professor's like, what did I just say? Because you seem like you're spacing out and you're like, excuse me, sir, my progesterone is high right now and my brain cannot handle how boring this is. That's real for ADHD. So if you struggle with the ability to pay attention, that is actually like pretty normal experience for ADHD. And so given that insight, we're going to switch some things about the way you live your life rather than telling you, oh, hack all these things to make your brain, you know, work better.

12:08We are going to talk about making your brain work better, but I want you to understand that you deserve accommodations as well. Now, the other symptoms we see, we have executive dysfunction. We've covered this. We've covered emotional dysregulation, but the impulsivity can also be really problematic here. And that can also sometimes be in part to testosterone also not being challenged by estrogen. Now, here is a very important nuance that the paper highlighted. These effects are strongest in women who have high baseline impulsivity. So what does that mean? So women who have high baseline impulsivity, they already have a propensity to be impulsive.

12:47They have larger drops in attention. They have greater executive dysfunction. They have more impulsive responding, you know, sticking your foot in the mouth sometimes. They also have more pronounced ADHD symptom spikes overall, and they have a greater perceived loss of medication efficacy. If you're a provider, listen up. If your patient has high impulsivity and they tell you their ADHD meds don't work in the luteal phase, listen, because the research is saying they ain't lying. But I need to be clear in this conversation because everybody loves to vilify hormones. Your hormones are not creating the problem.

13:27They are amplifying an existing vulnerability, which suggests this isn't just about hormones. It's also about dopamine sensitivity threshold, how your neurotransmitters are being affected, neuroinflammation. I mean, it covers your entire being. So if your dopamine system is already operating close to its limit, then the hormone shift of the luteal phase may push it over the edge. So there's likely two mechanisms that are operating simultaneously that's leading to this phenomenon. And if you've followed me for years, then you know I'm always talking about the full body experience of ADHD and the multifactorial events that take place that amplify what we feel.

14:09So the authors were very clear in this paper, there's not a single explanation for what's happening here. Instead, there's more likely two overlapping mechanisms that are driving these changes. Now, before I get into those mechanisms, I want you to know we are going to talk about the effects of ADHD medications across the cycle too. So be sure to stick around for that if you have more questions. So first mechanism, estrogen withdrawal, dopamine reduction, serotonin reduction, acetylcholine reduction, norepinephrine reduction. So estrogen enhances dopamine signaling in the prefrontal cortex. We talked about that.

14:45That's going to help with our focus. Acetylcholine, that's going to be helping with our memory. The inhibition control, that is the norepinephrine, the dopamine, the serotonin, all working together. And as estrogen starts to, it doesn't decline and go all the way down or drop in your luteal phase, but instead it takes a backseat to progesterone. Progesterone becomes amplified. It becomes the predominant hormone. that happens and dopamine signaling becomes less efficient and our cognitive control starts to weaken and in ADHD where dopamine tone and dopamine function is already lower that drop hits a lot harder now the other thing mechanism two is the allopregnenolone sensitivity I have discussed this in detail in two episodes which I will put in the show notes for you because if this episode is resonating with you, you have to listen to those.

15:39It's so important because no one's talking about it, but every ADHD brain needs to know about it. So progesterone, lovely hormone, metabolized to allopregnenolone, that acts on our GABA receptor. We should feel chill and calm. And in many women, they do feel that way. But for some women with ADHD and women with PMDD, and especially for women with ADHD and PMDD, normal levels of progesterone and allopregnenolone can trigger irritability, brain fog, emotional reactivity, cognitive instability. And the review that we're talking about in this episode suggests that women with ADHD may be more sensitive to this neurosteroid, especially when estrogen is coming down.

16:24And what may be underlying all of that is the brain's inability to adapt to the shifting and changing levels of allopregnenolone. One thing I hear from women all the time is that they're struggling with symptoms like hot flashes, sleep disruptions, and brain fog, but aren't sure where to turn to for help. Menopause is inevitable, but suffering through it isn't. That's why I want to tell you about Alloy. Alloy is a digital health platform that connects you with a menopause-specialized doctor who can create a personalized treatment plan tailored to your needs, all from the comfort of your home. Join the 95 % of women who tried Alloy and saw relief in the first two weeks.

17:06Head to myalloy.com and use the code DRBRYTEN. That's myalloy.com, M-Y-A-L-L-O-Y.com and the code DRBRYTEN, D-R-B-R-I-G-H-T-E-N. Share your symptoms and you'll get a fully customized treatment plan and unlimited messaging with your doctor. Plus, you'll get$20 off your first order today. That's M-Y-A-L-L-O-Y dot com, code Dr. Brighton. And this is something I have talked about forever, about how I have seen more women in perimenopause are sensitive to progesterone, they tend to be ADHD. And I actually teach this at conferences. I was just at a conference several months ago teaching this and somebody got up and said like, what happens?

18:02I give my patient progesterone and instead of sleeping, she's up all night and she's freaking out. And I'm like, have you evaluated her for ADHD? And she's like, she does have ADHD. And I'm like, lo and behold, we have to be more nuanced with these women because they're more hormonally sensitive. And we have data to back that up. Now, what are ADHD medications doing? So medications are helping with dopamine, norepinephrine. They also help the mitochondria function. They help with inflammation, reactive oxygen species. And so, you know, this, I will say, is one of the most validating findings for many women is that multiple studies report reduced stimulant effectiveness during the mid-illudeal phase, which is also called the premenstrual phase.

18:46But spoiler, they never thought to actually do studies on these medications and look at them through the lens of the menstrual cycle before they started prescribing them decades ago. These medications for the female brain, they rely on estrogen. So this is one of the most validating findings for many women and is that multiple studies have reported reduced stimulant effectiveness during the mid-luteal phase or the premenstrual phase. So what do women describe? They describe their medication not working. They are like, I had gains, things were better, but now executive dysfunction is returning.

19:23Mood symptoms get worse despite a stable dose, despite the dose having worked two weeks ago. And when we don't have large randomized control trials, there are small case series that have found something really important. temporary premenstrual stimulant dose adjustments restored baseline functioning with minimal side effects okay dr brighton in english when you adjust the stimulant dose just for that week or two when she is not filling in as much it restores baseline functioning it's same as the follicular phase and there isn't like the major side effects like anxiety and insomnia this doesn't mean everyone should change their medication definitely talk to your provider first it also doesn't mean that everyone needs to be on medication, but it does mean we need cycle-informed treatment.

20:13And cycle-informed treatment deserves some serious scientific attention because ADHD women shouldn't always be a damn afterthought when it comes to science. Now, I want to talk a little bit more about PMDD because this was another major takeaway from the study. If you have followed my content, you know I've struggled with PMDD. I struggled with PMDD before it was even an official diagnosis. I really wish my doctors had not just like brushed me off and known a little bit more back then. But ADHD and PMDD, they overlap far more than most clinicians realize. That's why I'm always like, if you have someone who's been diagnosed with PMDD, check them for ADHD, also autism.

20:51And that's because we know these more hormone sensitive brains, they tend to have a propensity towards that luteal phase dysfunction that is horrible. And it's PMDD. Now women with both ADHD and PMDD, they experienced greater memory problems, more dysfunctional impulsivity, worse attention across multiple cycle phases, and many earlier ADHD studies failed to screen PMDD at all. This is a huge flaw, huge flaw in the research. And that flaw means we may have a huge amount of inconsistent data that may actually be attributed to unrecognized hormone sensitivity. So clinicians will argue like the data is really inconsistent with ADHD.

21:38Therefore, my patients are all liars. Like for real, that's what it feels like. But what it actually is, is that the literature looks really messy because like there's these limitations that have never been accounted for until like recently. So the authors of the paper that I'm discussing in this episode, they pointed to some major issues that we have in ADHD female research. So one being small sample sizes, which, you know, there's a lot of women with ADHD who haven't been diagnosed. So like, it's very hard to be collecting clean data. Poor cycle phase verification. They don't even care where you're at in your cycle half the time when they're doing these studies.

22:18Inconsistent cognitive testing. It's not consistent across all the studies. There's also like single cycle design. So they look at one snapshot in time and then try to apply it to everything. There's a huge failure to control for PMS and PMDD. But here's the critical point. Despite all of that noise, luteal phase vulnerability in ADHD still shows up again and again. The consistency matters. So I want you to hear that. So just because the studies have been messy and flawed and having issues. Time and again, the luteal phase struggles, they're there. They're there in women. So that tells us that you know your body, you know what's normal, you know what's not, and it's time for doctors to start listening to you and be cycle informed in how they treat you.

23:05Because women with ADHD, they don't get the same neural buffering, so to speak, during hormonal transitions that neurotypical women do. We just don't. Like the brain is expected to do so much through the luteal phase. And we're struggling with things like energy production with the mitochondria, inflammation. We know that neuroinflammation can get worse as estrogen goes down. And so symptoms worsening is predictable. You need to track your cycle. I know, like I have to like use a calendar or something. I feel that. However, understanding your cycle, tracking these things, that helps you be informed and having a conversation with your provider.

23:45You can advocate if you are on stimulant medications to have those changed during the phase. If you are struggling with PMDD, there's lots of things that can help, you know, exercise, helping with neuroinflammation, saffron I've talked about, but you may need to consider an SSRI depending on how extreme it is. And that doesn't mean it's a forever medication. That might mean And you've got to use that for a few months so that, you know, you don't take your own life. That's a very serious thing. And so if you are struggling significantly during your luteal phase, you have to partner with a clinician.

24:20If you're someone who has PMDD, it's super, super important that you have a mental health provider on your side to help support you. Because I'm not being dramatic when I'm like, uh, women with PMDD, like they, they, they, they, you know, unalive themselves at a higher rate. I'm trying to like walk a line with social media here, but I am not being dramatic. This is well documented. So I want to move into some practical solutions for ADHD women because the answer is not just to shut down your hormones. And the one study that they decided to do just recently on ADHD and birth control showed that like we're at higher risk for depression.

24:58So birth control is not the answer if you're depressed during your luteal phase, because you may become more depressed. If it works for you, props to you, like that's fine. I love individualized medicine and I can respect it works for people, but I want to give you something besides the cookie cutter approach that was designed for neurotypical women. And then ADHD women were shoved into and told like, well, it should just work for you. And if it doesn't like, what is this like one more thing you're being extra about? Okay. As we talk about solutions, keep this in mind. If the luteal phase ADHD symptoms are predictable, then we can plan.

25:32Okay. And I'm going to help you. I know you're, you might be like, what plan? And we can also recognize the goal is not to push through. It's to reduce the biological load on your brain during a vulnerable window. Okay. That means accommodations for yourself. And it also means targeting three key things. So I've mentioned neuroinflammation. We've got to address neuroinflammation. If that's out of control, we stand zero chance. Neurotransmitter efficiency, we got to work with your brain so it can do what it's supposed to do best. And then we've got to think about environmental cognitive demands during the luteal phase and not fall into the follicular trap, okay?

26:08When it comes to neuroinflammation support, I need you to know that what you do during your entire cycle is affecting your luteal phase experience. So this isn't just something you do for five days out of your cycle. These are daily habits that you will build over time, and it's not about perfection. We do need to aim for blood sugar stability. This is a non-negotiable. We do need to increase omega-3 fatty acids. This is so, so important for the ADHD brain. So you're either eating cold water fish three times a week, or you're taking a high quality fish oil like omega plus. Magnesium. This helps with neurotransmitter function.

26:49Magnesium glycinate specifically will help with your sleep. It can help be feeling calm. It can help buffer against the effects of stress. We've got to get adequate protein, especially early in the day. And we've got to reduce ultra processed foods, alcohol, and anything that messes with our sleep because all of those things are going to spike neuroinflammation. I also want to talk to you about how you structure your luteal life specific to your ADHD brain's needs. But if you significantly struggle with these hormone-related ADHD fluctuations, I would recommend incorporating supplements consistently.