Females represent a growing proportion of adults with ADHD yet remain understudied in the literature compared to males. An important aspect of the experience of females with ADHD is the impact of the menstrual cycle and ovarian hormones on both the symptoms of ADHD and effects of stimulant medications on treating these symptoms.
Method:
In the present pilot study, female participants being treated with amphetamine salts for ADHD (n = 30) were recruited to complete 35 daily online surveys to track ADHD symptoms, mood, and medication use through the menstrual cycle.
Results:
Results indicated that the degree of ADHD symptoms was significantly associated with menstrual cycle phase with ADHD symptoms being most severe in the menstruation phase and comparatively milder ADHD symptoms in the mid-follicular phase. This difference was positively correlated with subjective changes in negative mood.
Conclusion:
These results indicate that ADHD symptoms vary across the menstrual cycle among females being treated with amphetamine salts for their ADHD, a finding that could inform clinical and prescribing practices for physicians caring for females with ADHD.
AndersonK. N.AilesE. C.DanielsonM.LindJ. N.FarrS. L.BroussardC. S.TinkerS. C. (2018). Attention-deficit/hyperactivity disorder medication prescription claims among privately insured women aged 15-44 years - United States, 2003-2015. Morbidity and Mortality Weekly Report, 67(2), 66–70. https://doi.org/10.15585/mmwr.mm6702a3
4.
ArnoldL. E.HodgkinsP.CaciH.KahleJ.YoungS. (2015). Effect of treatment modality on long-term outcomes in attention-deficit/hyperactivity disorder: A systematic review. PLoS ONE, 10(2), e0116407. https://doi.org/10.1371/journal.pone.0116407
5.
AttoeD. E.ClimieE. A. (2023). Miss. Diagnosis: A systematic review of ADHD in adult women. Journal of Attention Disorders, 27(7), 645–657. https://doi.org/10.1177/10870547231161533
6.
BarkleyR. A.MurphyK. R. (2006). Attention-deficit hyperactivity disorder: A clinical workbook. The Guilford Press.
7.
BauermeisterJ. J.ShroutP. E.ChavezL.Rubio-StipecM.RamirezR.PadillaL.AndersonA.GarciaP.CaninoG. (2007). ADHD and gender: Are risks and sequela of ADHD the same for boys and girls?Journal of Child Psychology and Psychiatry, 48(8), 831–839. https://doi.org/10.1111/j.1469-7610.2007.01750.x
BergJ. M.LatzmanR. D.BliwiseN. G.LilienfeldS. O. (2015). Parsing the heterogeneity of impulsivity: A meta-analytic review of the behavioral implications of the UPPS for psychopathology. Psychological Assessment, 27(4), 1129. https://doi.org/10.1037/pas0000111
10.
BölteS.NeufeldJ.MarschikP. B.WilliamsZ. J.GallagherL.LaiM.-C. (2023). Sex and gender in neurodevelopmental conditions. Nature Reviews Neurology, 19(3), 136–159. https://doi.org/10.1038/s41582-023-00774-6
11.
BrodM.AdlerL. A.LipsiusS.TanakaY.HeinlothA. N.UpadhyayaH. (2015). Validation of the adult attention-deficit/hyperactivity disorder quality-of-life scale in European patients: Comparison with patients from the USA. ADHD Attention Deficit and Hyperactivity Disorders, 7, 141–150. https://doi.org/10.1007/s12402-014-0160-z
12.
BrodM.JohnstonJ.AbleS.SwindleR. (2006). Validation of the adult attention-deficit/hyperactivity disorder quality-of-life scale (AAQoL): A disease-specific quality-of-life measure. Quality of Life Research, 15, 117–129. https://doi.org/10.1007/s11136-005-8325-z
13.
BürgerI.ErlandssonK.BorneskogC. (2024). Perceived associations between the menstrual cycle and attention deficit hyperactivity disorder (ADHD): A qualitative interview study exploring lived experiences. Sexual & Reproductive Healthcare, 40, Article 100975. https://doi.org/10.1016/j.srhc.2024.100975
14.
Chronis-TuscanoA.BounouaN. (2024). ADHD prevalence rose, yet disparities remain: Commentary on the 2022 national survey of children’s health. Journal of Clinical Child & Adolescent Psychology, 53(3), 361–372. https://doi.org/10.1080/15374416.2024.2359075
15.
CorteseS.FaraoneS. V.BernardiS.WangS.BlancoC. (2016). Gender differences in adult attention-deficit/hyperactivity disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Journal of Clinical Psychiatry, 77(4), e421–e428. https://doi.org/10.4088/JCP.14m09630
16.
de JongM.WynchankD.MichielsenM.BeekmanA. T.KooijJ. (2024). A female-specific treatment group for ADHD—Description of the programme and qualitative analysis of first experiences. Journal of Clinical Medicine, 13(7), 2106. https://doi.org/10.3390/jcm13072106
17.
de JongM.WynchankD.van AndelE.BeekmanA.KooijJ. (2023). Female-specific pharmacotherapy in ADHD: Premenstrual adjustment of psychostimulant dosage. Frontiers in Psychiatry, 14, Article 1306194. https://doi.org/10.3389/fpsyt.2023.1306194
Di LorenzoR.BalducciJ.PoppiC.ArcolinE.CutinoA.FerriP.D’AmicoR.FilippiniT. (2021). Children and adolescents with ADHD followed up to adulthood: A systematic review of long-term outcomes. Acta Neuropsychiatrica, 33(6), 283–298. https://doi.org/10.1017/neu.2021.23
20.
DickD. M.SmithG.OlaussonP.MitchellS. H.LeemanR. F.O’MalleyS. S.SherK. (2010). Understanding the construct of impulsivity and its relationship to alcohol use disorders. Addiction Biology, 15(2), 217–226. https://doi.org/10.1111/j.1369-1600.2009.00190.x
EndicottJ.NeeJ.CohenJ.HalbreichU. (1986). Premenstrual changes: Patterns and correlates of daily ratings. Journal of Affective Disorders, 10(2), 127–135. https://doi.org/10.1016/0165-0327(86)90035-2
23.
EngA. G.NirjarU.ElkinsA. R.SizemoreY. J.MonticelloK. N.PetersenM. K.MillerS. A.BaroneJ.Eisenlohr-MoulT. A.MartelM. M. (2024). Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and Behavior, 158, Article 105466. https://doi.org/10.1016/j.yhbeh.2023.105466
24.
EvansS. M.FoltinR. W. (2006). Exogenous progesterone attenuates the subjective effects of smoked cocaine in women, but not in men. Neuropsychopharmacology, 31(3), 659–674. https://doi.org/10.1038/sj.npp.1300887
25.
EvansS. M.HaneyM.FoltinR. W. (2002). The effects of smoked cocaine during the follicular and luteal phases of the menstrual cycle in women. Psychopharmacology, 159(4), 397–406. https://doi.org/10.1007/s00213-001-0944-7
26.
EvansS. M.HaneyM.LevinF. R.FoltinR. W.FischmanM. W. (1998). Mood and performance changes in women with premenstrual dysphoric disorder: Acute effects of alprazolam. Neuropsychopharmacology, 19(6), 499–516. https://doi.org/10.1016/S0893-133X(98)00064-5
27.
EvansS. M.LevinF. R. (2011). Response to alcohol in women: Role of the menstrual cycle and a family history of alcoholism. Drug and Alcohol Dependence, 114(1), 18–30. https://doi.org/10.1016/j.drugalcdep.2010.09.001
28.
FarhatL. C.FloresJ. M.BehlingE.Avila-QuinteroV. J.LombrosoA.CorteseS.PolanczykG. V.BlochM. H. (2022). The effects of stimulant dose and dosing strategy on treatment outcomes in attention-deficit/hyperactivity disorder in children and adolescents: A meta-analysis. Molecular Psychiatry, 27(3), 1562–1572. https://doi.org/10.1038/s41380-021-01391-9
29.
FedeleD. A.LeflerE. K.HartungC. M.CanuW. H. (2012). Sex differences in the manifestation of ADHD in emerging adults. Journal of Attention Disorders, 16(2), 109–117. https://doi.org/10.1177/1087054710374596
30.
Haimov-KochmanR.BergerI. (2014). Cognitive functions of regularly cycling women may differ throughout the month, depending on sex hormone status; A possible explanation to conflicting results of studies of ADHD in females. Frontiers in Human Neuroscience, 8, Article 191. https://doi.org/10.3389/fnhum.2014.00191
31.
HampsonE. (2020). A brief guide to the menstrual cycle and oral contraceptive use for researchers in behavioral endocrinology. Hormones and Behavior, 119, Article 104655. https://doi.org/10.1016/j.yhbeh.2019.104655
32.
HarrisP. A.TaylorR.ThielkeR.PayneJ.GonzalezN.CondeJ. G. (2009). Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010
33.
HinshawS. P.NguyenP. T.O’GradyS. M.RosenthalE. A. (2022). Annual research review: Attention-deficit/hyperactivity disorder in girls and women: Underrepresentation, longitudinal processes, and key directions. Journal of Child Psychology and Psychiatry, 63(4), 484–496. https://doi.org/10.1111/jcpp.13480
34.
JespersenC.LauritsenM. P.FrokjaerV. G.SchrollJ. B. (2024). Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder. Cochrane Database of Systematic Reviews, 2024(8), Article CD001396. https://doi.org/10.1002/14651858.CD001396.pub4
35.
JusticeA. J.de WitH. (1999). Acute effects of d-amphetamine during the follicular and luteal phases of the menstrual cycle in women. Psychopharmacology, 145(1), 67–75. https://doi.org/10.1007/s002130051033
36.
KesslerR. C.AdlerL.BarkleyR.BiedermanJ.ConnersC. K.DemlerO.FaraoneS. V.GreenhillL. L.HowesM. J.SecnikK.SpencerT.UstunT. B.WaltersE. E.ZaslavskyA. M. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716–723. https://doi.org/10.1176/ajp.2006.163.4.716
37.
KokF. M.GroenY.FuermaierA. B. M.TuchaO. (2020). The female side of pharmacotherapy for ADHD-A systematic literature review. PLoS ONE, 15(9), e0239257. https://doi.org/10.1371/journal.pone.0239257
38.
LeJ.ThomasN.GurvichC. (2020). Cognition, the menstrual cycle, and premenstrual disorders: A review. Brain Sciences, 10(4), 198. https://doi.org/10.3390/brainsci10040198
39.
LundinC.WikmanA.WikmanP.KallnerH. K.Sundström-PoromaaI.SkoglundC. (2023). Hormonal contraceptive use and risk of depression among young women with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 62(6), 665–674.
40.
MarjoribanksJ.BrownJ.O’BrienP. M. S.WyattK. (2013). Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database of Systematic Reviews, 2013(6), Article CD001396. https://doi.org/10.1002/14651858.CD001396.pub3
41.
MatzaL. S.JohnstonJ. A.FariesD. E.MalleyK. G.BrodM. (2007). Responsiveness of the adult attention-deficit/hyperactivity disorder quality of life scale (AAQoL). Quality of Life Research, 16, 1511–1520. https://doi.org/10.1007/s11136-007-9254-9
42.
NadeauK. G.QuinnP. O. (2002). Understanding women with AD/HD. Advantage books.
43.
OehrleinE. M.BurcuM.SaferD. J.ZitoJ. M. (2016). National trends in ADHD diagnosis and treatment: Comparison of youth and adult office-based visits. Psychiatric Services, 67(9), 964–969. https://doi.org/10.1176/appi.ps.201500269
44.
OhnishiT.KobayashiH.YajimaT.KoyamaT.NoguchiK. (2019). Psychiatric comorbidities in Adult Attention-deficit/Hyperactivity Disorder: Prevalence and patterns in the routine clinical setting. Innovations in Clinical Neuroscience, 16(9-10), 11–16.
PletzerB.HarrisT. A.OrtnerT. (2017). Sex and menstrual cycle influences on three aspects of attention. Physiology & Behavior, 179, 384–390. https://doi.org/10.1016/j.physbeh.2017.07.012
47.
QuinnP. O. (2005). Treating adolescent girls and women with ADHD: Gender-specific issues. Journal of Clinical Psychology, 61(5), 579–587. https://doi.org/10.1002/jclp.20121
48.
QuinteroJ.Gutiérrez-CasaresJ. R.AlamoC. (2022). Molecular characterisation of the mechanism of action of stimulant drugs lisdexamfetamine and methylphenidate on ADHD neurobiology: A review. Neurology and Therapy, 11(4), 1489–1517. https://doi.org/10.1007/s40120-022-00392-2
49.
RapoportI. L.GroenmanA. P. (2025). A review of sex and gender factors in stimulant treatment for ADHD: Knowledge gaps and future directions. Journal of Attention Disorders, 29(8), 602–616. https://doi.org/10.1177/10870547251315601
50.
ReedS. C.LevinF. R.EvansS. M. (2008). Changes in mood, cognitive performance and appetite in the late luteal and follicular phases of the menstrual cycle in women with and without PMDD (premenstrual dysphoric disorder). Hormones and Behavior, 54(1), 185–193. https://doi.org/10.1016/j.yhbeh.2008.02.018
51.
RobertsB.Eisenlohr-MoulT.MartelM. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015
52.
RucklidgeJ. J. (2008). Gender differences in ADHD: Implications for psychosocial treatments. Expert Review of Neurotherapeutics, 8(4), 643–655. https://doi.org/10.1586/14737175.8.4.643
53.
SchmalenbergerK. M.TauseefH. A.BaroneJ. C.OwensS. A.LiebermanL.JarczokM. N.GirdlerS. S.KiesnerJ.DitzenB.Eisenlohr-MoulT. A. (2021). How to study the menstrual cycle: Practical tools and recommendations. Psychoneuroendocrinology, 123, Article 104895. https://doi.org/10.1016/j.psyneuen.2020.104895
54.
SestiA.-M. (2000). State Trait Anxiety Inventory (STAI) in medication clinical trials. Quality of Life Newsletterm, 25, 15–16.
55.
SibleyM. H.KennedyT. M.SwansonJ. M.ArnoldL. E.JensenP. S.HechtmanL. T.MolinaB. S.HowardA.GreenhillL.Chronis-TuscanoA. (2024). Characteristics and predictors of fluctuating attention-deficit/hyperactivity disorder in the multimodal treatment of ADHD (MTA) study. Journal of Clinical Psychiatry, 85(4), 57313. https://doi.org/10.4088/JCP.24m15395
56.
SobanskiE. (2006). Psychiatric comorbidity in adults with attention-deficit/hyperactivity disorder (ADHD). European Archives of Psychiatry and Clinical Neuroscience, 256 Suppl 1, i26–i31. https://doi.org/10.1007/s00406-006-1004-4
57.
SofuogluM.BabbD. A.HatsukamiD. K. (2002). Effects of progesterone treatment on smoked cocaine response in women. Pharmacology, Biochemistry, and Behavior, 72(1–2), 431–435. https://doi.org/10.1016/s0091-3057(02)00716-5
58.
SofuogluM.MitchellE.KostenT. R. (2004). Effects of progesterone treatment on cocaine responses in male and female cocaine users. Pharmacology Biochemistry & Behavior, 78(4), 699–705. https://doi.org/10.1016/j.pbb.2004.05.004
59.
SpielbergerC. D. (1970). Manual for the State-Trait Anxiety Inventory (self-evaluation questionnaire). Consulting Psychologists Press.
60.
StaleyB. S. (2024). Attention-deficit/hyperactivity disorder diagnosis, treatment, and telehealth use in adults—National Center for Health Statistics Rapid Surveys System, United States, October–November 2023. Morbidity and Mortality Weekly Report, 73, 890–895. https://doi.org/10.15585/mmwr.mm7340a1
61.
Van MeterA. R.SibleyM. H.VandanaP.BirmaherB.FristadM. A.HorwitzS.YoungstromE. A.FindlingR. L.ArnoldL. E. (2024). The stability and persistence of symptoms in childhood-onset ADHD. European Child & Adolescent Psychiatry, 33(4), 1163–1170. https://doi.org/10.1007/s00787-023-02235-3
62.
VasconcelosA. G.Malloy-DinizL.CorreaH. (2012). Systematic review of psychometric proprieties of Barratt Impulsiveness Scale Version 11 (BIS-11). Clinical Neuropsychiatry: Journal of Treatment Evaluation, 9(2), 61–74.
63.
WangY.-P.GorensteinC. (2013). Psychometric properties of the Beck Depression Inventory-II: A comprehensive review. Brazilian Journal of Psychiatry, 35, 416–431. https://doi.org/10.1590/1516-4446-2012-1048
64.
WhiteT. L.JusticeA. J.de WitH. (2002). Differential subjective effects of D-amphetamine by gender, hormone levels and menstrual cycle phase. Pharmacology Biochemistry and Behavior, 73(4), 729–741. https://doi.org/10.1016/s0091-3057(02)00818-3
65.
WhitesideS. P.LynamD. R. (2001). The five factor model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and Individual Differences, 30(4), 669–689. https://doi.org/10.1016/S0191-8869(00)00064-7
66.
YoungS.AdamoN.AsgeirsdottirB. B.BranneyP.BeckettM.ColleyW.CubbinS.DeeleyQ.FarragE.GudjonssonG.HillP.HollingdaleJ.KilicO.LloydT.MasonP.PaliokostaE.PerecherlaS.SedgwickJ.SkirrowC. . . .WoodhouseE. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry, 20(1), 404. https://doi.org/10.1186/s12888-020-02707-9
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
