ADHD, hormones and the cyclical nature of women’s brains

For years, ADHD has been understood primarily through a male lens - one that assumes a linear experience of symptoms, where focus, energy, and executive function remain relatively stable. But women’s brains are not linear.

We are cyclical beings shaped by the ebb and flow of hormones that directly impact dopamine and executive function. For those of us with ADHD, this constant hormonal flux means that our experience of ADHD is anything but stable. One day, we might feel focused and capable; the next, it feels like our brain has been unplugged.

This isn’t inconsistency, laziness, or 'bad time management'. It’s biology.

Biologically, men’s hormonal cycles operate on a 24-hour rhythm - testosterone levels peak in the morning and gradually decline throughout the day, repeating the same pattern every single day. Their dopamine regulation is more stable, meaning ADHD symptoms in men tend to be more consistent over time.

Women, however, operate on a 28-day cycle. Our hormones - oestrogen, progesterone, testosterone, and cortisol - rise and fall at different points throughout the month, profoundly influencing mood, energy, and cognitive function. This means:

• Some weeks, we feel sharp, productive, and in control.
• Other weeks, our ADHD symptoms are unbearable - brain fog, forgetfulness, emotional dysregulation, and being overwhelmed.

ADHD symptoms fluctuate in direct response to hormonal shifts - something that has been largely ignored in medical research until recently.

The role of oestrogen and progesterone in ADHD

While dopamine is the neurotransmitter most linked to ADHD, oestrogen is the hormone that regulates dopamine levels in the female brain. The more oestrogen we have, the more dopamine we produce - meaning focus, memory, and motivation improve.

Oestrogen and dopamine: The ADHD power duo

High oestrogen (mid-cycle/ovulation)

• Better executive function - Increased focus, productivity, and motivation.
• Enhanced mood stability - Fewer emotional crashes.
• Improved working memory - Less brain fog.

Low oestrogen (before menstruation/postpartum/menopause)

• Dopamine drops significantly - More forgetfulness, procrastination, impulsivity
• Mood instability worsens - Higher emotional sensitivity, irritability.
• Executive function tanks - More difficulty with planning, organisation, and task initiation.

This explains why so many women with ADHD experience extreme highs and lows throughout the month - it’s not just about the ADHD itself, but about how ADHD interacts with our changing hormonal landscape.

Progesterone: The ADHD saboteur

While oestrogen helps ADHD brains function better, progesterone does the opposite. High progesterone levels (which peak in the second half of the cycle) can:

• suppress dopamine production - increasing brain fog and forgetfulness
• heighten anxiety and emotional sensitivity - make rejection sensitivity worse
• decrease motivation and energy - leading to lethargy and apathy

For women with ADHD, the week before menstruation (when progesterone is highest and oestrogen crashes) is often the worst - it’s when executive dysfunction spikes, emotional regulation collapses, and daily life feels impossible.

Ever felt like a completely different person at different times of the month? This is why.

ADHD, puberty, pregnancy, and menopause: The big hormonal transitions

For many women, ADHD symptoms worsen dramatically during major hormonal transitions - when oestrogen levels shift dramatically, and the brain struggles to adjust.

Puberty and adolescence

As oestrogen levels rise during puberty, ADHD symptoms may appear to improve temporarily. However, for many girls, increased progesterone sensitivity means higher emotional dysregulation, anxiety, and mood swings, leading to misdiagnosis as depression or borderline personality disorder.

Pregnancy and postpartum

During pregnancy, oestrogen skyrockets, meaning many women experience a temporary reduction in ADHD symptoms. But after birth, oestrogen plummets overnight, leading to a severe worsening of ADHD symptoms, which can contribute to postpartum depression and being overwhelmed.

Perimenopause and menopause: The ADHD crisis no one talks about

Perimenopause (the years leading up to menopause) is when oestrogen levels become erratic before eventually dropping permanently. Many women only discover they have ADHD in their 40s or 50s when the loss of oestrogen suddenly makes symptoms unbearable.

For those of us who undergo surgical menopause (hysterectomy), this happens overnight.

My experience with sudden menopause and ADHD

For me, the impact of a hysterectomy was immediate and brutal. One day, I had hormones. The next, I didn’t. There was no gradual transition - just a sudden crash into menopause, taking my executive function and emotional regulation with it.

• Brain fog became unbearable – I’d forget conversations mid-sentence and struggle to complete tasks.
• Energy plummeted – Even small tasks felt overwhelming.
• Emotional dysregulation skyrocketed – I felt raw, anxious, overstimulated, and hypersensitive.
• Impulsivity became harder to manage – Without oestrogen’s dopamine-boosting effect, my ADHD symptoms worsened dramatically.

The lack of awareness around ADHD and menopause is shocking. Women are often dismissed when they seek support, told it’s just 'normal ageing' or 'stress' - when, in reality, our brains are undergoing a massive neurochemical shift.

How psychotherapy can help: Finding the right therapist

For women navigating ADHD through hormonal changes, therapy isn’t just about managing ADHD - it’s about understanding our unique neurobiology and how it interacts with hormones.

Why relational therapy matters for ADHD and hormonal changes

Finding a therapist who understands ADHD and works relationally is crucial. Many traditional therapeutic approaches focus solely on behavioural strategies, but for women with ADHD, this misses the bigger picture.

A relational approach focuses on:

• Understanding the emotional impact of ADHD, not just time management, but how years of struggle shape self-esteem and relationships.
• Exploring hormonal influences on symptoms, validating why symptoms fluctuate and how to manage them with self-compassion.
• Building self-awareness and self-trust, instead of internalising shame - learn how to work with your brain, not against it.
• Processing grief around late diagnosis, addressing the loss of time, missed opportunities, and the struggle of feeling misunderstood.