There has been increasing mentions about estrogen’s important effects on the brain and how changing and low levels can worse ADHD symptoms. Clearly this is important.

Yet there are more hormones than estrogen which have important effects in the brain.

As a physician specialising in women’s hormone health, I see first-hand how hormonal changes can affect women with ADHD. Women often tell me their concentration, motivation, mood and ability to cope can change dramatically across their menstrual cycle, especially during their luteal phase (days before periods). During perimenopause and menopause, these symptoms can become overwhelming, even for women who have previously managed their ADHD well. For some, it is the first time any ADHD symptoms come to the fore.

So I welcome the fact that ADHD and hormones are finally making headlines, as this is a long overdue conversation. But when I read the recent New Scientist article exploring why some women with ADHD feel ‘controlled by their hormones’, I was struck by what was missing.

The article focuses heavily on estrogen. Progesterone is mentioned only briefly. And testosterone? Not mentioned at all.

For women with ADHD, that is a significant omission.

More than estrogen

There is good reason why estrogen is attracting attention. Estradiol (the most beneficial type of estrogen) supports thinking skills, concentration and attention, and influences serotonin and dopamine – brain chemicals involved in mood, motivation and executive function.

Estradiol can also increase dopamine activity and reduce its breakdown. This is particularly relevant to ADHD, where dopamine plays an important role in attention, motivation and executive function. When estradiol levels fluctuate and fall, particularly in perimenopause, this can make ADHD symptoms harder to manage.

But women do not only have one hormone.

Estradiol, progesterone and testosterone all have important roles in the brain and body. Their levels change throughout our lives, and those changes do not happen independently.

If we want to understand ADHD in women better, we need to look at the bigger hormonal picture.

Our emerging research also suggests that we cannot assume all hormone treatments affect ADHD-related symptoms in the same way. We examined estrogen, progesterone/progestogen and testosterone-containing treatments and found different patterns of reported response between them. That is precisely why research needs to look beyond estrogen alone.

Progesterone matters

Dubbed the ‘pregnancy hormone’, progesterone is too often pigeonholed as a hormone associated only with periods, pregnancy and contraception. Yet progesterone also has many important effects on the brain. It works to maintain and improve brain connections. Even the New Scientist article briefly acknowledges this, before moving back to estrogen.

The menstrual cycle is not simply about estrogen rising and falling. Progesterone changes substantially too, particularly before periods when levels drop very quickly. We need to understand

how these changes can affect ADHD symptoms.

For women who repeatedly notice that their ADHD becomes harder to manage at points in their cycle, this matters.

Let’s not forget testosterone

Then there is testosterone – the hormone almost completely missing from this conversation.

Testosterone is often described as a male hormone, but women produce it throughout their lives. It has important functions in the brain, including effects on mood, cognition and motivation, strengthening arteries that supply blood flow to the brain. Testosterone also stimulates the release of dopamine. Those functions are highly relevant to ADHD, yet testosterone is rarely discussed when women with ADHD seek help. Levels of testosterone usually reduce in women in their late 20s and early 30s.

So all three hormones – estradiol, progesterone and testosterone are very important for our brains to function properly. They all work to increase levels of many different neurotransmitters (naturally produced chemicals in the brain that send information to different parts of the brain and body) including noradrenaline, dopamine, acetylcholine, and melatonin. They also increase levels of nerve growth factors in the brain (so nerves and cells can grow more and survive longer), improve blood flow to the brain and also reduce inflammation in the brain.

All of these functions are so important when thinking about ADHD and brain function.

Listen to women

In my large clinical practice, women often notice these patterns long before anyone asks them about hormones. They tell me there are certain days when their focus disappears, everyday tasks become overwhelming and their emotions feel harder to regulate. These are usually in the days before their periods. Others tell me they managed their ADHD for years, only to feel everything unravel during perimenopause.

When I prescribe the right dose and type of hormones for women with ADHD, so many of their symptoms improve or even resolve. The most beneficial effects are with progesterone and testosterone bioidentical hormone treatments.

The bigger picture

ADHD and hormones in women of all ages needs to be considered, from puberty and the menstrual cycle, pregnancy, the postnatal period, perimenopause and menopause.

Contraceptive hormones are not actually hormones – they are synthetic chemicals made to be similar to hormones but can actually block the action of these hormones in the body. Many women with ADHD find that taking contraceptive hormones makes their symptoms worse. These are very different to bioidentical hormone treatments that we prescribe which are the same structure as our own hormones.

I am pleased that ADHD and hormones are finally entering mainstream conversation. Yet there needs to be more detailed conversations discussing all three hormones. More women are recognising their experiences, and more healthcare professionals are beginning to ask questions that should have been asked years ago.

But we need to make sure the conversation does not become another oversimplification.

Estrogen matters. But so do progesterone and testosterone. If we are serious about understanding ADHD in women, we need to understand the hormones that shape women’s lives – all of them.