top of page
Search

ADHD in Women

ADHD is a neurodevelopmental condition rooted in differences in brain structure, function and neurotransmission — particularly involving dopamine and noradrenaline circuits in the prefrontal cortex.


Women with adhd working
Women & ADHD - how symptoms differ acorss a lifespan

In women, ADHD is frequently under-recognised because symptoms are often more internalised and fluctuate with hormonal changes. Oestrogen, progesterone and other sex hormones influence the same neurotransmitter systems implicated in ADHD, meaning that hormonal transitions (puberty, menstrual cycle, pregnancy, perimenopause) can amplify or attenuate symptoms. Understanding these neurobiological and hormonal interactions is key to effective diagnosis and management.


Physiology and Neurobiology of ADHD


ADHD (Attention-Deficit/Hyperactivity Disorder) arises from a complex interplay between genetic, neurochemical, and environmental factors that influence brain development and function.


Core neuroanatomical features:


  1. Prefrontal cortex — under activation in areas responsible for attention regulation, working memory, planning and impulse control.

  2. Basal ganglia and striatum — reduced dopaminergic signalling impairs motivation and reward anticipation.

  3. Cerebellum — differences in connectivity may contribute to timing and coordination deficits.

  4. Default mode network (DMN) — excessive activity during tasks, reducing focus and sustained attention.


These variations are developmental, not degenerative, and reflect delayed or altered cortical maturation rather than damage.


Neurotransmitter physiology


Two key neurotransmitters regulate attentional control and motivation:

Dopamine (DA): governs reward, reinforcement, motivation and executive drive. Low dopaminergic tone contributes to difficulty sustaining focus and regulating impulses.

Noradrenaline (NE): enhances alertness and cognitive control; reduced NE availability leads to distractibility.


ADHD medications (methylphenidate, lisdexamfetamine, atomoxetine) increase dopamine and noradrenaline availability or inhibit their reuptake.


Genetic and developmental factors

ADHD is highly heritable (heritability ~70–80%). Genes linked to dopamine transmission (DAT1, DRD4, COMT) are strongly implicated. Environmental influences such as prenatal stress, premature birth, and early adversity interact with genetic predisposition.


ADHD in Women — Why Presentation Differs


Historically, ADHD was characterised based on male cohorts. The female phenotype—dominated by inattentiveness, internalised distress, and emotional dysregulation—was under-recognised.


Women more commonly experience

  1. Mental restlessness rather than overt hyperactivity

  2. Chronic disorganisation and forgetfulness

  3. Emotional sensitivity, rejection sensitivity

  4. Anxiety- Perfectionism and compensatory overachievement masking symptoms


ADHD Subtypes (DSM-5 Classification)


  • Predominantly Inattentive Presentation (ADHD-I): commonest in females; daydreaming, distractibility, poor focus.

  • Predominantly Hyperactive-Impulsive Presentation (ADHD-H): restlessness, impulsive actions, excessive talking.

  • Combined Presentation (ADHD-C): features of both inattention and hyperactivity/impulsivity.


The Role of Hormones in ADHD


Sex hormones interact with dopaminergic, noradrenergic, serotonergic and GABAergic systems — the same neurochemical networks implicated in ADHD.


Oestrogen increases dopamine synthesis, receptor density, and prefrontal activation, improving focus and mood.


Progesterone enhances GABAergic inhibition and may cause sedation or brain fog.


Testosterone modulates motivation and energy.


Hormonal Life Stages and ADHD Symptom Variation


  • Puberty: Rapid hormonal changes can unmask or worsen ADHD as the maturing dopaminergic system becomes more hormone-sensitive.

  • Menstrual Cycle Variation: Rising oestrogen in the follicular phase may improve focus; falling oestrogen and rising progesterone premenstrually can worsen concentration and emotional regulation.

  • Pregnancy and Postpartum: High oestrogen during pregnancy can improve attention, but postpartum withdrawal often worsens ADHD and mood.

  • Perimenopause and Menopause: Declining oestrogen exacerbates cognitive symptoms such as brain fog, poor focus and low motivation.


Mechanistic Summary — Hormones, Neurotransmitters, and ADHD Symptoms


High oestrogen → Increased dopamine/noradrenaline → Improved focus and motivation.

Falling oestrogen → Reduced neurotransmission → Poor focus, emotional lability.

High progesterone → Increased GABAergic tone → Cognitive slowing or sedation.


Clinical Implications


  1. Cycle-aware management: track symptoms relative to hormonal fluctuations.

  2. Hormonal transitions: puberty, postpartum, and menopause are high-risk phases for symptom change.

  3. Medication responsiveness: stimulant efficacy can vary with cycle phase.

  4. Multimodal care: combine pharmacological therapy with behavioural strategies, CBT, and lifestyle support.

  5. Hormone-informed prescribing: consider collaboration between ADHD and menopause specialists when appropriate.


Key Takeaways

ADHD reflects neurodevelopmental differences in dopaminergic and noradrenergic systems.

- Hormones influence these systems, altering symptom expression across the lifespan.

- Recognition of hormonal sensitivity is crucial for accurate diagnosis and management

- Cycle-aware and hormone-informed care can improve outcomes for women with ADHD


Speak to our Menopause & ADHD Specialist Kate Organ or have an ADHD Assessment with us.




bottom of page