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  • Writer's pictureJayne Wynne

Women - ADHD diagnosis and hormonal health

Exeter ADHD Therapy

As a therapist working in Exeter, I have the privilege of working with people who are both self-diagnosed and formally diagnosed with ADHD. This has become an area I specialize in, and it’s something I am very passionate about.

 

Diagnosis challenges

My focus recently has been on the different presentations of ADHD in men/boys and girls/women, and the importance of more education in these differences so we can better assess, diagnose and treat symptoms of ADHD.


Girls with ADHD are under diagnosed when compared to boys, they seem missed when seeking support for their symptoms. There are three reasons why: the ADD subtype that is more prevalent in girls means that they present as ‘not annoying enough’ to get help from their environment and their GP.


Girls with ADHD also present as ‘dreamy’ and ‘tired’ so when they present themselves to the GP, the focus is on a physical exploration such as a virus, and the symptoms of ADHD are not often considered in a diagnostic assessment. Furthermore, adolescent girls with ADHD often present with exceptional difficulties with their menstrual cycle leading to fluctuating moods.  If GPs are not aware of ADHD symptoms and how these can often be the underlying cause of such hormonal instability, then they don’t get the help they need even when they’re asking for it – the hormones are treated, and ADHD is missed.


Working with these wonderful people and keeping up to date with the latest research about ADHD and the available treatment options, I have discovered the importance of exploring hormones and the devastating impact on women’s health if they are ignored. Research in this area is currently growing, but we seem far behind so data is limited. This means supporting women with ADHD effectively and from a more holistic approach is rather difficult. Thirdly, girls and women that have ADHD can have other complications that come with ADHD e.g. depression and anxiety, PMDD (premenstrual dysphoria), insomnia, PCOS, migraine. These internalizing symptoms mean that these can become a focus of GP care leaving the underlying ADHD unseen. Women and girls with ADHD present as more withdrawn than boys/men so they can become rather stuck in trying to receive support due to the lack of knowledge and education of how this presents in them – they are essentially misunderstood.

 

Hormonal health

It is my belief that girls/women with ADHD experience premenstrual symptoms (pms) more acutely than those who do not have the condition. Feelings of sadness, anxiety and even worthlessness worsen during this time. The hormonal fluctuations are deeply felt, and they can severely impact well being, especially two weeks before their period begins when Oestrogen is low and Progesterone dominates. Early research has also suggested that girls/women with ADHD are 10x more likely to be diagnosed with PMDD (premenstrual dysphoric disorder).


It is my hope that more conversations start to happen that consider hormonal fluctuations when developing treatment plans for ADHD girls/women as we risk missing a key component that when treated, can drastically improve ADHD symptoms and the quality of life.

Our cultural, professional and educational knowledge focuses a lot on the neurological aspects of ADHD such as the difference in the four structures of the brain: the Prefrontal Cortex, Limbic System, Basal Ganglia and Reticular Activating System. And we know that the neurotransmitters most associated with ADHD are dopamine and norepinephrine which have an important effect on all these areas. When compared to a neurotypical brain, these transmitters are less in supply affecting the overall neural networking of the brain. But there is so much we’re not understanding and communicating about how our hormones such as oestrogen promote the release of feel-good neurotransmitters dopamine and serotonin – two essential components to manage ADHD symptoms and regulate mood.


By focusing only on neurological difference, we forget the crucial importance of hormones and if left in a state of fluctuation, it can drastically increase her ADHD symptoms, lower her mood and make her less receptive to ADHD stimulant medication. We need to build a full clinical picture, not just address and work with the neurological differences.

 

Contraceptive Pill

Many turn to the contraceptive pill to even out the hormonal fluctuations. The combined pill with both oestrogen and progesterone is reported to be the most effective and brings some emotional and cognitive stability enabling women to manage ADHD symptoms much more effectively, especially when taken without a break to stop the cycle. The intake of oestrogen provides the ingredients to build these neurotransmitters to regulate ADHD symptoms and mood especially in the luteal phase of the menstrual cycle (2 weeks before a period).

But what if the combined pill can not be taken? What other effective ways are there to manage these fluctuations whilst ensuring oestrogen levels are regulated? Is the progesterone only pill (POP) effective enough if taken without a break to avoid an Oestrogen reduction? Oestrogen is a natural mood stabilizer and anti-depressant necessary to produce serotonin, so I wonder is the progesterone only contraception as effective as the combined method? I also ask what other hormonal treatments can we offer women and girls with ADHD? Are these methods offered to girls/women in their GP practice or via referral to Gynaecology?


Looking at the research, other effective ways of managing symptoms are by using an antidepressant, ideally an SNRI due to the norepinephrine transmitter and hormone for its positive effects on ADHD neurology. Finally, reports have suggested women reported a better ability to cope in the luteal phase of their cycle by increasing their ADHD medications with support of their psychiatrist. But I still wonder can we regulate hormones better to let the body create its own natural medicine in these areas?


A lot of research in women hasn’t been undertaken due to the impact of hormonal changes on the data and this seems apparent in the many questions we still have unanswered. Research is now underway, and it seems we’re now playing catch up and finally learning more about women especially girls/women with ADHD, but many are unnecessarily suffering due to this lack of evidence-based data.

 

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