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ADHD is a significant risk factor for the development of premenstrual dysphoric disorder (PMDD) and postpartum depression (PPD), both of which are debilitating and potentially life-threatening conditions that disproportionately impact women with ADHD. Premenstrual Dysphoric Disorder (PMDD) is a more serious form of premenstrual syndrome (PMS) that causes clinically significant and impairing depression, anxiety, mood swings, and uncomfortable physical symptoms in the week leading up to the onset of a period. PMDD impacts about 2% of the general population of women (though actual prevalence rates may be higher)1, often requires medication (typically, hormonal birth control and antidepressants), and is associated with an elevated risk for suicidality and suicide attempts. Research on PMDD and ADHD is limited. In a 2021 study of 209 women with ADHD, more than 45% reported having symptoms suggestive of PMDD.2 A recent ADDitude survey revealed that a staggering 66% of women with ADHD said they have suffered from PMS and/or PMDD beginning, on average, around age 14 — with nearly 60% of respondents reporting symptoms that lasted 20 years or longer. PMDD is caused by decreasing levels of estrogen and progesterone after ovulation and before menstruation. These hormones also drop markedly following childbirth, contributing to postpartum depression in 10% to 15% of women.3 Among women with ADHD, the risks for postpartum mood disorders are elevated. A 2023 study found that about 25% of women with ADHD who gave birth were diagnosed with anxiety disorders postpartum compared to 4.6% of women without ADHD. In addition, about 17% of women with ADHD met the criteria for PPD compared to 3.3% of women without ADHD who had given birth.4 Another study found that women with ADHD, even those without a history of depression, are 24% more likely to be diagnosed with PPD than are women without ADHD.5 A survey of ADDitude readers found an even higher prevalence — 61% of women with ADHD who had given birth reported experiencing symptoms of PPD, at least a fourfold increase over the rate found in the general population of birthing individuals. ADDitude readers who said they suffered with PMDD reported that symptoms lasted roughly one year, and included the following: Why do women with ADHD face an outsized risk for PMDD and PPD, and why are the symptoms they experience more severe and longer lasting than those of their neurotypical peers? Research has not yet explained the disproportionate links between ADHD and both PMDD and postpartum mood disorders. We do not know why women with ADHD appear more sensitive to the hormonal fluctuations of the menstrual cycle and the hormonal changes following childbirth. Research on these associations would help us answer these essential questions: To that last question, J.J. Sandra Kooij, M.D., Ph.D., adds: "Why do women with ADHD suffer more frequently with polycystic ovarian syndrome (PCOS), associated with fertility problems and hormonal disturbances, and with premature ovarian insufficiency (POI), associated with early menopausal symptoms?" "These conditions are commonly not recognized or treated, and they can invalidate women severely at an early age," says Kooij, who has published more than 100 peer-reviewed international papers and more than 20 books or book chapters on ADHD in adults. PMDD is a serious risk factor for depression and self-harm. Postpartum depression is also potentially life-threatening. When researchers and medical professionals fail to address the high comorbidity rates between ADHD and these conditions, they put women's lives at risk unnecessarily. PMDD often co-occurs with other psychiatric disorders, including major depressive disorder (MDD) and anxiety disorder.6 7 Individuals with PMDD are also at greater risk for suicide and suicidal behavior.8 Despite the known association between ADHD and PMDD, and the serious health risks associated with PMDD, very few physicians screen girls with ADHD for signs and symptoms of premenstrual dysphoric disorder. Even worse, ADDitude readers regularly tell us that their early complaints of PMDD symptoms were dismissed or ignored by healthcare professionals. "I have exhibited significant PMDD symptoms since puberty," wrote one ADDitude reader. "My symptoms were ignored, and I was mistreated more times than I could count. There was always an excuse — whether it came from other women, my family doctor, or other doctors." Likewise, women with ADHD are known to face a higher risk for PPD, however routine screenings are rare. In an ADDitude webinar poll, about 70% of respondents said their doctor missed their symptoms of postpartum depression. In a separate poll, about 45% of ADDitude readers said they wouldn't be able or aren't sure if they'd be able to identify postpartum depression in themselves or in others. Almost half of ADDitude survey respondents said they were not offered any treatment for their postpartum depression, while 41% were prescribed antidepressants and 20% received therapy. "The nurses I spoke to did not recognize my postpartum depression and told me it was probably a normal hormonal drop, but things never improved," said a 36-year-old mother with ADHD in Pennsylvania. Research into the root causes, key indicators, and effective treatments for hormonal health conditions associated with ADHD would improve the quality of life and healthcare for women with ADHD by… PMDD is a serious health condition that impacts daily functioning, relationships, and mental health every month for decades. What's worse, many women with PMDD report feeling dismissed, ignored, and left to suffer by healthcare practitioners who did not take their concerns seriously and failed to offer treatment options. "The first two to three days of my cycle were always full of painful cramping and nausea," wrote one ADDitude reader with PMDD. "I was completely miserable and sometimes doubled over in pain. Then I'd have heavy bleeding for 7 to 10 days… Doctors just scoffed and said, 'I couldn't possibly be in that much pain.'" "Treatment-resistant PMDD has affected my whole life," said Ray, an ADDitude reader in Canada. "I have struggled with physical symptoms and social stigma. The severity of my symptoms has destroyed my social and work relationships… I have hurt many people, just trying to experience a life worth wanting." "Seven to 10 days before my cycle starts, I get irritable and sad. I rage out. I feel like nothing can contain me or calm the storm. I hurt the people around me, the people I love," said an ADDitude reader with PMDD. "It scares my kids and frustrates my husband. I was finally diagnosed last month and have been taking Zoloft. I was amazed this last pre-cycle time that I could remain calm. I used to think it was me; that I was born 'bad.' It's been a relief to feel my true loving self." "For one week a month, I turn into a different person. I have outbursts of laughter, tears, and anger," said Stacey in Kenya. "I feel like combusting. My sensory issues are heightened. I'm irritated by everything. My stimming gets way worse." "I thought it was normal to feel suicidal four to five days leading up to my period," said Kristy, an ADDitude reader with PMDD in Australia. Support for postpartum women with ADHD is inadequate. "My anxiety level skyrocketed and I felt like I might be losing myself," wrote an ADDitude reader in California who suffered symptoms of postpartum depression for 7 to 9 months. "There was a lot of time spent in my head wondering if I was going crazy." "My postpartum depression continued after the birth of my third child, and I was hospitalized eight times for severe depression," wrote an Australian reader who had persistent PPD. "I didn't want to hold my child and actively sought to hand him off to others in the early weeks," wrote an ADDitude reader in Washington who also suffered from PPD for 7 to 9 months. "I still feel robbed of that miraculous time if I think on it too much, so I try to focus on the good parts and the happy moments instead. And my son and I are closer now than ever. He's awesome and gives great hugs. Maybe that makes up for it a little." Devising better screening protocols and treatment strategies for PMDD and PPD in women with ADHD should be a top medical priority given the high risk of adverse outcomes and the established connections between these conditions. "We need studies on how cycling hormones impact all aspects of female behavior and impairment, underscoring the importance of new research based on awareness of the hormone/neurotransmitter connection," says Ellen Littman, Ph.D. "After acceptance of the centrality of hormonal involvement, specific areas of needed research include post-partum, perinatal, climacteric, menopause, PMS, PMDD, and PCOS." "We need treatment studies investigating what is most helpful for women with PMDD: an antidepressant (SSRI), increased stimulant dosage in the last week of the cycle, or the pill continuously, or maybe even a progesterone antagonist (Sundstrom)," asks Kooij. "Because not estrogen but progesterone seems related to the negative effect on mood in the last phase of the cycle." Intro: Top 10 Research Priorities ADDitude is dedicated to honoring gender diversity and fluidity. For the purposes of this reporting, we use the terms "girls" and "women" to refer to individuals assigned female at birth and/or who identify as female. 1Reilly, T. J., Patel, S., Unachukwu, I. C., Knox, C. L., Wilson, C. A., Craig, M. C., Schmalenberger, K. M., Eisenlohr-Moul, T. A., & Cullen, A. E. (2024). The prevalence of premenstrual dysphoric disorder: Systematic review and meta-analysis. Journal of affective disorders, 349, 534-540. https://doi.org/10.1016/j.jad.2024.01.066 2Dorani, F., Bijlenga, D., Beekman, A. T. F., van Someren, E. J. W., & Kooij, J. J. S. (2021). Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of psychiatric research, 133, 10-15. https://doi.org/10.1016/j.jpsychires.2020.12.005 3Bauman, B. L., Ko, J. Y., Cox, S., D'Angelo Mph, D. V., Warner, L., Folger, S., Tevendale, H. D., Coy, K. C., Harrison, L., & Barfield, W. D. (2020). Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression - United States, 2018. MMWR. Morbidity and mortality weekly report, 69(19), 575-581. https://doi.org/10.15585/mmwr.mm6919a2 4Andersson, A., Garcia-Argibay, M., Viktorin, A., Ghirardi, A., Butwicka, A., Skoglund, C., Bang Madsen, K., D'onofrio, B.M., Lichtenstein, P., Tuvblad, C., and Larsson, H. (2023). Depression and Anxiety Disorders During the Postpartum Period in Women Diagnosed with Attention Deficit Hyperactivity Disorder. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2023.01.069 5Bartelt K, Piff A, Vitek G, Barkley E. Maternal ADHD Correlated with Increased Risk of Postpartum Depression. Epic Research. https://epicresearch.org/articles/maternal-adhd-correlated-with-increased-risk-of-postpartum-depression. 6Eisenlohr-Moul, T., Divine, M., Schmalenberger, K. et al. (2022). Prevalence of lifetime self-injurious thoughts and behaviors in a global sample of 599 patients reporting prospectively confirmed diagnosis with premenstrual dysphoric disorder. BMC Psychiatry 22, 199. https://doi.org/10.1186/s12888-022-03851-0 7Tiranini, L., & Nappi, R. E. (2022). Recent advances in understanding/management of premenstrual dysphoric disorder/premenstrual syndrome. Faculty reviews, 11, 11. https://doi.org/10.12703/r/11-11 8Eisenlohr-Moul, T., Divine, M., Schmalenberger, K. et al. (2022). Prevalence of lifetime self-injurious thoughts and behaviors in a global sample of 599 patients reporting prospectively confirmed diagnosis with premenstrual dysphoric disorder. BMC Psychiatry 22, 199. https://doi.org/10.1186/s12888-022-03851-0What We Know
What We Don't Know
Why It Matters
What ADDitude Readers Tell Us About PMDD
What ADDitude Readers Tell Us About PPD
What ADHD Experts Say
Next Steps
Related Reading
We Demand Attention: A Call for Greater Research on ADHD in Women
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