Your patient isn’t imagining it — her ADHD gets worse before her period
STUDY: McTaggart J et al, Journal of Attention Disorders 2026
STUDY TYPE: Qualitative interview study
FUNDING: Philanthropic (Tham Family Invest)
Background
ADHD research has focused on males, leaving a large blind spot: how fluctuating sex hormones affect ADHD symptoms in women. This study, though basic in its methods, is one of the first to explore the issue.
The Study
Researchers conducted semi-structured interviews with 14 Swedish women of reproductive age with ADHD and analyzed the results using inductive thematic analysis. They reported:
- Higher energy and productivity around ovulation (mid cycle)
- Followed by a crash in the week before menses, with worse inattention, impulsivity, and emotional dysregulation
- Feeling controlled by female hormones
- Frustration with clinician knowledge gaps
- Hormonal contraceptives influenced their ADHD symptoms in ways that had never been addressed by their providers
Premenstrual dysphoric disorder (PMDD) is common in ADHD, with rates around 40%, and may explain some of these changes.
Limitations: Small, no quantitative outcomes, no controls. This is hypothesis-generating, not definitive, but it is consistent with a recent review and a new observational study that found worse ADHD symptoms in the week before menses.
Practice Implications
- When assessing ADHD in women, ask about how their symptoms change before their period or with hormonal therapies
- Unfortunately, there are no clinical trials of how to treat premenstrual worsening in ADHD. Some suggest raising the dose in that phase (as long as it is within safe range) or treating separately for premenstrual dysphoric disorder.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
What’s Your Take? Share in Comments
- Are you seeing ADHD worsen before menses?
- How do you address it?
