The Connection Between PMDD And ADHD For Women With ADHD

For many people, attention deficit hyperactivity disorder (ADHD) and premenstrual dysphoric disorder (PMDD) go hand in hand. 

What is Premenstrual Dysphoric Disorder or PMDD?

Premenstrual Dysphoric Disorder (PMDD) is known as the more extreme version of premenstrual syndrome (PMS) with "psychological features" such as irritability and depressed mood. While there is no known cause of PMDD, findings suggest a neurodevelopmental connection with dysphoric disorder. As a neurodevelopmental disorder, many menstruating people may find that their ADHD symptoms worsen during their menstrual cycle. 

Treating PMDD may involve addressing both ADHD and Premenstrual Dysphoric Disorder (PMDD). 

Hoping to find ways to navigate symptoms?

Speaking to a licensed therapist can help

PMDD and ADHD (premenstrual dysphoric disorder)

Research indicates that there is a significantly higher prevalence of hormone-related mood symptoms in women with ADHD, suggesting a link between premenstrual dysphoric disorder and ADHD. The study, the first one to suggest that "ADHD patients suffer from significant PMDD symptoms" is further corroborated by surveys and first-hand accounts of severe symptoms of PMS and/or PMDD. 

Other findings also point to a link expressed by those who are affected. For example: ADDitude, a magazine focused on ADHD concerns, indicates that all of their readers who menstruate claim to have experienced severe PMS or PMDD.  

Attention-deficit hyperactivity disorder (ADHD)

ADHD is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity. A person may predominantly display inattention or hyperactivity-impulsivity, or can share features of both. For adolescent or adult ADHD, symptoms should be present for at least six months, have manifested before the age of 12, be present in more than one setting, and interfere with daily functioning. 

Main features of inattention include:

• Difficulty sitting still.
• Challenges with organization.
• Difficulty paying close attention or following instructions.
• Being easily distracted.
• Being easily forgetful

Hyperactivity features can include:

• Fidgeting or tapping hands and feet
• Excessive talking
• Interrupting or intruding on others
• Acting or feeling as though "being driven by a motor"

Premenstrual dysphoric disorder (PMDD)

As the more severe form of PMS, PMDD may affect 46% of women with ADHD and autism, as compared to 3% to 9% of the general population. A combination of factors including genetics, reduced dopamine levels, and sensitivity may make those with neurodevelopmental conditions more prone to experiencing PMDD. 

The fifth edition of the Diagnostic and Statistical Manual (DSM-5) for mental disorders characterizes PMDD as a disorder consisting of at least five symptoms during menstrual cycles in the previous year. 

Premenstrual dysphoric disorder symptoms 

The list of premenstrual syndrome symptoms include:

• Irritability
• Anxiety
• Tension
• Mood swings
• Difficulty concentrating
• Depression
• Feeling of overwhelm
• Insomnia or sleepiness
• Fatigue or decreased energy
• Food cravings or appetite changes
• Physical symptoms such as bloating and tenderness in the abdomen and/or breasts

PMDD may also increase the risk of suicidality. *

*If you are experiencing suicidal thoughts or urges, contact the National Suicide Prevention Lifeline at 988. Support is available 24/7.

For a diagnosis, symptoms must interfere with daily life activities, relationships, work, or school. They also cannot be considered a cyclical worsening of symptoms of another disorder. 

Serotonin reuptake inhibitors: Medication used to treat PMDD

Typically, medications used to treat PMDD are serotonin reuptake inhibitors such as selective serotonin reuptake inhibitors (SSRIs) or a norepinephrine reuptake inhibitor (SNRI). Dosages may be either intermittent or as part of daily usage. Hormone therapy with birth control pills may also be used as an alternative form of treatment. 

Alleviating PMDD for women with ADHD

Other ways to alleviate PMDD may include learning to manage stress, dietary changes, aerobic exercise such as walking, and taking some supplements such as Vitamin B6, evening primrose oil, magnesium, and calcium. Many women also find that warm baths and heating pads can help induce a sense of relaxation and relieve pain. 

Aromatherapy, yoga, and meditation may also be key in helping to ease physical and psychological symptoms. Mindfulness meditation, for example, has been shown to help reduce core symptoms of PMDD such as depression, anxiety, and irritability as well as an increase in pain tolerance. 

ADHD medication and PMS

Case studies suggest that the fluctuations in sex hormones during the menstrual cycle may influence the effectiveness of stimulant medications used to treat ADHD. These studies also point to an increase in mood-related symptoms and worsening of depression and ADHD during the premenstrual week. Such findings indicate that dosages of psychostimulant medication may need to be adjusted during the premenstrual period. 

If you are currently taking medication and notice worsening ADHD symptoms during your premenstrual period, it may be helpful to speak to your doctor about managing premenstrual ADHD. Depending on your individual case and the medication(s) you are taking, your doctor might adjust your dosage during that period. 

Mental health therapy for premenstrual dysphoric disorder and ADHD

Whether or not you have a dual diagnosis of ADHD and PMDD, grappling with symptoms can be quite challenging. If you perceive that you may benefit from mental health support, it's advisable to consider therapy—whether in person or online. If it isn't convenient to go to appointments, online therapy could be a healthy option for you. With a platform like BetterHelp, it's possible to have sessions with a licensed therapist by phone, videoconferencing, and in-app messaging. The ease of communication allows you to easily connect with a therapist to manage symptoms you may be experiencing. Many therapists working through the platform employ cognitive behavioral therapy (CBT) and mindfulness—approaches that have been shown to be effective in addressing many symptoms of PMDD, such as depression and anxiety. 

Effectiveness of online therapy

A randomized controlled trial that examined women with PMDD found that internet-delivered cognitive behavioral therapy (iCBT) suggests that it may be "highly effective in reducing the burden of PMDD." The researchers stressed the importance of coping styles and stress management in treatment outcomes.