Click on each image below to explore the science, expert insight, lived experiences, and camaraderie that surrounds women with ADHD.

Women with ADHD who report significant negative mood symptoms just before and during menstruation tend to experience similar-magnitude increases in ADHD symptoms at this time, found a new study in Journal of Attention Disorders.¹ Building upon a modest foundation of previous research that found ADHD symptoms vary across the menstrual cycle, the researchers studied women of reproductive age with ADHD treated with amphetamine salts, the most commonly used medication among members of this demographic, 60% of whom use Adderall of Mydalis.²

The 30 study participants were required to complete daily surveys measuring their ADHD symptoms as well as the severity of 17 mood symptoms. Participants reported their total daily dose of amphetamine salts, as well as use of other medications, alcohol, tobacco, or cannabis.

The study found:

• ADHD symptoms were most severe in the menstruation phase of the monthly cycle
• Negative mood symptoms were most severe in the menstruation and luteal phases
• The magnitude of increase in ADHD symptoms and negative mood was similar, leading researchers to conclude that mood and ADHD symptoms co-vary between menstrual cycle phases

These findings validate the anecdotal experience of many women with ADHD.  “Fluctuating estrogen and progesterone across the menstrual cycle invariably impact ADHD symptoms, emotions, and functioning. We know this to be true, but there is almost no research validating this relationship,” explained Lotta Skoglund Ph.D., in her recent ADDitude article, “The Menstrual Cycle Impacts ADHD Symptoms in Disparate Ways.”

“The entire week leading up to my period is where my ADHD symptoms get even more intrusive than usual,” says Chloe, an ADDitude reader. “My executive functioning dips even lower, distractibility and difficulty focusing is increased, and my mood/energy level is much lower, causing me to feel badly about all the things I’m not being successful at that week.”

Charlie, a reader in Australia, echoes this experience: “A week before I am due for my period, my brain goes to complete peanut butter. It is an utter mission to focus and stay on task. Sensory overload is at its peak. Impatience rules the days, and I get so overwhelmed.”

In addition, many women report lower efficacy of ADHD medication during the luteal and menstrual phase. One ADDitude reader shares “My ADHD meds are significantly less efficacious for about 10 days per month; two days before menstruation I am a barely functional zombie.” Norma, an ADDitude reader in Wisconsin, describes a similar experience, “The week leading up to my cycle, I might as well not even take my ADHD meds. It’s like my body overrides them.”

Based on similar anecdotal reports, the study’s researchers sought to uncover whether women with ADHD were exploring cycle syncing, increasing their dose of stimulants during the late luteal and menstruation phases to address intensified ADHD symptoms. They found, however, that women maintained constant daily medication dosing throughout their menstrual cycles.

“This may reflect prescribing practices for stimulant medications, which often do not encourage ‘flexible’ or ‘symptom-based’ dosing regimens, as well as potential inexperience of providers or patients regarding the effects of menstrual cycle phase on medication metabolism and efficacy,” the researchers reflect. The authors refer to an earlier study that found many women with ADHD were hesitant to ask doctors about the effect of their menstrual cycle on ADHD medication and often reported invalidating responses from their practitioners when they did inquire.³

Skoglund advises women to use a menstrual cycle tracking log to record and report specific data to aid these conversations with doctors: “Tracking your cycle will give you powerful insights into how hormonal fluctuations influence your ADHD symptoms, medication effectiveness, and overall functioning. With this data, you’ll be in a better position to talk to your doctor about enhancements to your treatment plan to improve your health and wellbeing.”

The study had several limitations, including its small sample size; 16 of the 46 initial participants were excluded for failure to complete daily surveys, leaving 30 participants, and the authors note it is possible the individuals who successfully completed the surveys had milder ADHD symptoms. In addition, unlike other studies,⁴ the researchers did not measure ovarian hormone levels, relying on participants’ reporting of menstruation for this information. Individuals who were taking other psychiatric medications were excluded, thus excluding women who receive medication for mood disorders and/or Premenstrual Dysphoric Disorder, both of which are significantly more likely in people with ADHD.

Sources

¹Zaritsky, R., Reed, S. C., & Evans, S. M. (2025). Changes in ADHD Symptoms and Mood Across the Menstrual Cycle in Females Treated With Stimulants: A Pilot Study. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547251400038

²Anderson K. N., Ailes E. C., Danielson M., Lind J. N., Farr S. L., Broussard C. S., Tinker S. 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

³Bürger I., Erlandsson K., Borneskog C. (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

⁴Roberts B., Eisenlohr-Moul T., Martel M. 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

Perimenopause begins up to 10 years earlier in women with ADHD, who report more severe perimenopausal symptoms than do women without ADHD.

This finding comes from a new population-based study published in European Psychiatry¹ that found the highest prevalence of severe perimenopause symptoms occurred between the ages of 35 and 39 among women with ADHD and between the ages of 45 and 49 among women without ADHD.

Slightly more than half (54.2%) of women with a self-reported ADHD diagnosis experience debilitating symptoms during perimenopause (the period of years before menopause) compared to one-third of women without ADHD, the study reported.

“Our findings suggest a considerably higher symptom burden, including impairing psychological and somatic symptoms, among women with ADHD, compared to those without ADHD,” the researchers wrote. “These differences were most pronounced at age 35 to 39 years, suggesting an onset of perimenopause up to 10 years earlier in women with ADHD than in the average.”

The study examined data from 5,392 women, aged 35 to 55 years, who participated in the Icelandic Stress-and-Gene-Analysis (SAGA) cohort in 2018 and a follow-up survey in 2024. The researchers assessed perimenopausal symptoms using the Menopause Rating Scale (MRS). They found that women with a self-reported ADHD diagnosis encountered more physical symptoms, such as headaches and digestive problems, compared to women without the disorder. Women with ADHD also had higher MRS measurements in all perimenopausal symptom categories, including:

• somatic (hot flushes/sweating, heart discomfort, sleeping problems, and muscle and joint problems)
• psychological (depressive mood, irritability, anxiety, and tiredness)
• urogenital (sexual problems, bladder problems, and vaginal dryness)

Given the cross-sectional nature of measurements, the researchers could not confirm a causal relationship between ADHD and more severe perimenopausal symptoms.

“However, since ADHD develops in childhood, we could assert that the symptoms of the disorder precede perimenopausal symptoms in time,” the researchers wrote.

Impact of Hormonal Fluctuations During Perimenopause

Hormonal fluctuations in perimenopause could exacerbate existing ADHD symptoms or could lead to a diagnosis of previously unrecognized ADHD, the researchers also noted. In the study, about 8% of women without diagnosed ADHD, aged 35 to 44 years, reported having severe ADHD symptoms that decreased as they aged.

“We were unable to determine whether the women who had not been diagnosed with ADHD, but reported severe ADHD symptoms, had impairing ADHD symptoms in childhood, whether the symptoms emerged in later years, or what caused severe ADHD symptoms in these age groups,” the researchers wrote.

This is the first study assessing the differences in perimenopausal symptoms among women with and without ADHD. Emerging research and anecdotal reports have suggested that women with ADHD are more vulnerable to challenges before and after menopause.^{2, 3} “As estrogen vacillates wildly in perimenopause, many women find that their ADHD symptoms grow significantly worse,” says Lotta Borg Skoglund, M.D., Ph.D., an associate professor at Uppsala University in the Department for Women’s and Children’s Health and leader of the pioneering research group GODDESS ADHD.

In an ADDitude survey of nearly 5,000 women with ADHD, 63% of respondents aged 45 and older said ADHD had the greatest impact on their lives during perimenopause and menopause. (In contrast, less than 6% said ADHD had the biggest impact before age 20.)

More than 93% said they noticed a difference in the severity of some ADHD symptoms during perimenopause and/or menopause.

“Everything flared up in perimenopause. I feel the worst I have ever felt, and my life is in disarray,” wrote one respondent. “I am unemployed, without a fixed address, lonely, anxious, depressed, and can’t think straight. I’ve turned my life, which appeared to be running well enough, into a blazing dumpster fire.”

“In perimenopause, the brain fog and memory, inattention, distractibility, perfectionism, hyperactivity, and restlessness issues become progressively worse,” wrote a 52-year-old woman diagnosed with ADHD at age 50. “I have always had these symptoms, but I was able to manage them with systems that I created for myself. My ability to manage them has declined significantly, and this makes these symptoms seem like they are the worst they have ever been.”

More recently, a systematic review published in Frontiers in Global Women’s Health found that hormonal fluctuations significantly impact the way ADHD symptoms present and progress across the female lifespan.⁴

More Research Needed on Perimenopausal Women with ADHD

The Frontiers in Global Women’s Health study also highlighted six significant gaps in scientific research that are crucial for improving the diagnosis and treatment of ADHD in women. It concluded that women with ADHD remain underdiagnosed, under-researched, and undertreated despite growing awareness of their unique challenges during hormonal changes across the lifespan.

“We need research investigating the role of hormones in ADHD symptom expression in girls and women,” says Julia Schechter, Ph.D., of the Duke Center for Girls and Women with ADHD. “This research should examine hormonal levels across the reproductive lifespan, including puberty onset, menstrual cycle, pregnancy, postpartum period, and menopause, and post-menopause.”

“Whether it’s ADHD or perimenopause or ADHD and perimenopause, the impact of perimenopause and menopause on presentation of ADHD symptoms is an enormously unrecognized and important topic in global female health,” said Jeanette Wasserstein, Ph.D., during her 2023 ADDitude webinar “Hormonal Fluctuations and ADHD.” “We’re half the world, and this is a significant issue, and it should be recognized and addressed.”

Findings from the European Psychiatry study echoed the demands of other ADHD experts for more research on the impact of hormonal replacement therapy and/or stimulant treatment on the connection between ADHD and perimenopausal symptoms. The study also underscored the importance of developing guidelines for the treatment and care of perimenopausal women with ADHD.

Sources

¹Jakobsdóttir Smári, U., Valdimarsdottir, U.A., Wynchank, D., de Jong, M., Aspelund, T., Hauksdottir, A., Thordardottir, E.B., Tomasson, G., Jakobsdottir, J., Lu, D., Nevriana, A., Larsson, H., Kooij, S., Zoega, H. (2025). Perimenopausal symptoms in women with and without ADHD: A population-based cohort study. Eur Psychiatry. https://doi.org/10.1192/j.eurpsy.2025.10101
²Weber, M.T., Maki, P.M., & McDermott, M.P. (2014). Cognition and mood in perimenopause: A systematic review and meta-analysis. The Journal of Steroid Biochemistry and Molecular Biology. https://doi.org/10.1016/j.jsbmb.2013.06.001
³Dorani, F., Bijlenga, D., Beekman, A.T.F., van Someren, E.J.W., Kooij, J.J.S. (2020). Prevalence of hormone-related mood disorder symptoms in women with ADHD. J Psychiatr Res. https://doi.org/10.1016/j.jpsychires.2020.12.005
⁴Kooij, J.J.S., de Jong, M., Agnew-Blais, J., Amoretti, S., Bang Madsen, K., Barclay, I., Bölte, S., Borg Skoglund, C., Broughton, T., et al. (2025). Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women’s Health. https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2025.1613628

The intersection of ADHD, hormones, and menopause is more nuanced than previously understood and requires more research, according to two new studies. A systematic review published in Frontiers in Global Women’s Health found that hormonal fluctuations significantly impact the way ADHD symptoms present and progress across the female lifespan.¹ At the same time, women with ADHD do not report more severe symptoms of menopause than women do without ADHD, according to a recent study published in the Journal of Attention Disorders.²

Both studies emphasize that women with ADHD remain underdiagnosed, under-researched, and undertreated despite growing awareness of their unique challenges during hormonal changes across the lifespan, particularly during menopause.

According to an ADDitude survey of nearly 5,000 women with ADHD, 63% of respondents aged 45 and older said ADHD had the greatest impact on their lives during perimenopause and menopause. More than 93% said they noticed a difference in the severity of some ADHD symptoms during perimenopause and/or menopause.

The authors of the Frontiers in Global Women’s Health study analyzed data collected from the ADDitude survey as well as other existing literature to “identify what we know and what we need to know about people assigned female at birth having ADHD.”

Their findings suggest that:

• Hormonal transitions exacerbate ADHD symptoms and mood disturbances, yet pharmacological research and tailored treatments are lacking.
• Executive function deficits manifest differently in girls and women with ADHD.
• Diagnostic practices and sociocultural factors contribute to delayed diagnoses, increasing the risk of comorbidities, impaired functioning, and reduced quality of life.
• Undiagnosed women are at an increased risk for premenstrual dysphoric disorder (PMDD), postpartum depression (PPD), and cardiovascular disease during perimenopause.

The review also highlighted six significant gaps in scientific research that are crucial for improving the diagnosis and treatment of ADHD in women.

Research Gap #1: Executive Function

What’s Missing: Large, inclusive, long-term studies tracking the impact of changing estrogen and progesterone levels in females with ADHD across puberty, pregnancy, and menopause.

Research Needed:

• longitudinal cohort studies including diverse gender and hormonal profiles
• studies timed to menstrual cycle phases or accounting for ovulation suppression
• brain imaging and neuropsychological testing across hormonal changes to better understand symptom variability in women and girls with ADHD

Research Gap #2: Puberty, Hormones, and Pharmacological Treatment

What’s Missing: Research on how puberty and hormonal changes impact ADHD symptoms and stimulant medication effectiveness in girls. Also unclear is how stimulant use may affect physical or hormonal changes during adolescence.

Research Needed:

• longitudinal case-control studies on puberty’s effects on ADHD symptoms and treatment, and the impact of stimulant use on pubertal development in girls
• studies (including brain imaging) assessing how hormonal changes influence medication metabolism in both sexes
• mixed-methods research exploring societal expectations and gender norms shaping adolescent ADHD experiences

Research Gap #3: Sexual Health and Risky Behaviors

What’s Missing: Research exploring the role of co-occurring conditions (e.g., autism, substance use) and environmental factors, or how treatment might reduce the risks that girls and women with ADHD face for risky sexual behaviors.

Research Needed:

• long-term studies investigating sexual health outcomes among diverse ADHD populations
• trials assessing how hormonal birth control methods affect ADHD symptoms, mood, and quality of life
• studies exploring the effectiveness of non-pharmacological and pharmacological interventions in reducing risky sexual behaviors and their consequences
• comprehensive studies that address both reproductive health and mental health aspects of contraceptive use

Research Gap #4: Maternal ADHD in the Peripartum Period

What’s Missing: The peripartum period is under-researched for women with ADHD, despite potential heightened risks of postpartum depression and anxiety.

Research Needed:

• studies on pregnancy and birth outcomes in women with ADHD
• research on pregnancy and birth complications, peripartum anxiety, and depression in women with ADHD
• trials of safe, effective perinatal pharmacological and psychological interventions
• research identifying potential targets for prevention and early intervention to mitigate adverse outcomes associated with perinatal and early infancy risk factors in children with a genetic predisposition to ADHD

Research Gap #5: Hormonal and Gynecological Disorders in ADHD

What’s Missing: Substantial research is needed to bridge the gaps in the understanding of hormonal and gynecological disorders in female ADHD. Limited evidence exists about the relationship between ADHD and coexisting conditions like polycystic ovary syndrome (PCOS), endometriosis, or premenstrual dysphoric disorder (PMDD). These conditions may influence how ADHD presents and is treated.

Research Needed:

• epidemiological studies exploring whether women with ADHD are at greater risk of hormonal or gynecological disorders
• investigations into how inflammation and hormonal dysregulation intersect with ADHD symptoms and comorbidities
• research into how these disorders may explain individual differences in ADHD presentation and outcomes

Research Gap #6: Menopause, Cognitive Decline, and Late Diagnosis

What’s Missing: ADHD symptoms may change or intensify during menopause, but research is lacking on neurocognitive outcomes during this transition. Additionally, many women are diagnosed late in life, often after years of misdiagnosis or masking.

Research Needed:

• longitudinal cognitive and neuroimaging studies of women with and without ADHD across menopause stages
• trials testing the impact of menopausal hormone therapy on ADHD symptoms and cognition
• research investigating why girls and women are still underdiagnosed or diagnosed late, and what symptoms of female ADHD should prompt proper diagnostic measures and improve early identification
• mixed-method longitudinal studies involving women with lived ADHD experiences

The Journal of Attention Disorders study addresses some of these research gaps.

Menopause May Not Be Worse Than Expected

That study compared the menopausal experiences of 656 women aged 45 to 60 with and without ADHD between October 2023 and June 2024. Findings reveal that women with diagnosed ADHD did not report worse menopausal symptoms than women without ADHD at any stage of menopause. This suggests that, while hormonal changes can worsen ADHD symptoms, this doesn’t necessary translate into a perception of aggravated menopause. That said, ADHD symptoms did correlate with poorer quality of life during menopause, with medication potentially influencing these correlations.

“Arguably, these findings are unexpected because ADHD is associated with several difficulties that overlap with menopausal complaints,” the study’s authors wrote.

One potential explanation for the results, the researchers suggest, involves how women interpret their symptoms. Women with ADHD may attribute memory problems and concentration difficulties to their existing condition rather than to menopause, leading to different reporting patterns. They may also be more accustomed to these symptoms than are other women experiencing them for the first time in menopause, thus skewing their self-reports.

Medication Doesn’t Significantly Change the Picture

In addition, the study did not find a significant difference in menopausal experiences between women with ADHD who use stimulant or non-stimulant medication and those who do not. The researchers explained that current ADHD treatments may not specifically address menopause-related symptom changes and may need to be adjusted. Women may also need additional support during hormonal transitions.

The study sample included 245 women with existing ADHD diagnoses (107 on medication, 138 not on medication) and 411 women without ADHD. (Women currently using menopausal hormone therapy or contraceptive pills were excluded from participating.)

Similar to the Frontiers in Global Women’s Health study, the authors of the Journal of Attention Disorders stressed the importance of more research.

“Much more research is needed to understand the relationships between ADHD and menopausal symptoms and explore other methods to support valid assessments, such as comprehensive clinical interviews or objective evaluations by clinicians,” the study’s authors wrote.

Sources

¹ Kooij, J.J.S., de Jong, M., Agnew-Blais, J., Amoretti, S., Bang Madsen, K., Barclay, I., Bölte, S., Borg Skoglund, C., Broughton, T., et al. (2025). Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women’s Health. https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2025.1613628

² Chapman, L., Gupta, K., Hunter, M. S., & Dommett, E. J. (2025). Examining the link between ADHD symptoms and menopausal experiences. Journal of Attention Disorders. https://doi.org/10.1177/10870547251355006

And I wasn’t alone.

Many women I speak to on The ADHD Women’s Wellbeing Podcast share similar stories: lifelong overwhelm, unexplained fatigue, inability to switch off, emotional hypersensitivity, and chronic anxiety. We now understand that these aren’t isolated symptoms — they’re the direct result of a dysregulated nervous system that’s been stuck in survival mode for years, often since childhood.

Signs of a Dysregulated Nervous System

If your nervous system is dysregulated, you may experience the following:

• A need to stay constantly busy or productive, even when exhausted
• Restlessness or fear of rest, driven by guilt or internal pressure
• People-pleasing, boundary-blurring behaviors
• Emotional hypersensitivity, including rejection sensitive dysphoria (RSD)
• Shutdowns, task paralysis, and detachment
• Chronic fatigue, burnout, functional freeze, or what feels like nervous exhaustion

For women with ADHD, especially those undiagnosed or unsupported for decades, these symptoms become embedded into our identities. We often assume we’re just “too emotional,” “lazy,” or “bad at coping.” But, in reality, our systems have been working overtime to protect us, and they’ve been doing it for far too long.

Dysregulated Nervous System Causes: Trauma, Stress, and Hypervigilance

Scientific understanding of the ADHD-nervous system connection is still emerging. But lived experience paints a compelling picture. Many of us carry unresolved trauma — from childhood adversity, academic rejection, health misdiagnoses, or growing up feeling misunderstood or “too much.” These experiences prime our nervous system to stay on high alert, scanning for danger even in safe environments.

[Take This Self-Test: 14 Questions That Reveal Symptoms of Burnout]

This chronic hypervigilance — constantly waiting for the next stressor, deadline, or criticism — takes its toll. We become anxious, disconnected, and reactive. Our sense of internal safety erodes. And because ADHD brains are wired to seek stimulation (hello, dopamine!), we often self-soothe through overworking, perfectionism, tech scrolling, or people-pleasing, which only fuels the cycle further.

Dysregulation and the Polyvagal Theory: The Ladder of Stress

When I discovered the teachings of Deb Dana, LCSW, based on the polyvagal theory posited by Stephen Porges, Ph.D., it helped me understand how our body reacts to perceived threat. Think of the nervous system as a ladder with three rungs or “states:”

• Top (Ventral Vagal): Safe, connected, regulated. You feel creative, open, and calm.
• Middle (Sympathetic): Fight-or-flight mode. You feel anxious, irritable, reactive, hyper-alert, and restless. Racing thoughts, emotional outbursts, compulsive phone use, and panic are common in this stress state.
• Bottom (Dorsal Vagal): Shutdown. You feel numb, frozen, withdrawn, or hopeless. Other signs of this freeze state include exhaustion, disconnection, numbness, depression, and inability to start tasks.

Escape Functional Freeze: Learning Your Unique Nervous System Language

We all move through these nervous system states, but ADHD brains often get stuck in the middle or bottom rungs. The key to healing? Learning how to notice what state you’re in and building tools to move back into the calm and connected “ventral” state.

[Read: 9 Calming Strategies for a Racing, Restless Mind]

We can’t will ourselves out of these states with logic alone. We need somatic tools — daily practices that engage the body — to send safety signals to the brain.

One helpful practice is identifying your glimmers (small things that make you feel safe and regulated) and triggers (things that push you into stress states).

Glimmers might include:

• Morning sunshine or a walk with your dog
• A phone call with a loved one
• Yoga, somatic movement, crying, or journaling
• Turning off social media and news alerts
• Cold water splashes on the face or neck
• A bath, music, or essential oils

Triggers might include:

• Poor sleep, hormonal upheaval, PMDD
• Over-caffeinating or skipping meals
• Social rejection or RSD
• Multitasking, sensory overwhelm, doom-scrolling
• Unstructured time or looming deadlines

Knowing your nervous system patterns helps you prepare, support, and respond rather than react blindly. Try writing down your glimmers and triggers to become more aware.

More Ways to Soothe Your Dysregulated ADHD Nervous System

1. Reclaim Your Right to Rest
Rest is not a reward — it’s medicine. But ADHD guilt can make us feel lazy for slowing down. Practice reframing rest as active regulation and allow micro-moments of pause: a quiet cup of tea, a 5-minute body scan, or a short lie-down with your eyes closed.

2. Reduce Tech-Induced Overload
Our phones are dopamine playgrounds — but they also keep us in fight-or-flight. Turn off unnecessary notifications, especially in the morning and evening. Consider screen-free “bookends” to your day to give your brain some peace.

3. Try Cold Water Therapy
Gently introducing cold water can stimulate the vagus nerve and promote calm. Start by splashing your face or using a cold compress on your neck. Over time, you might work up to a short cold shower at the end of your warm one.

4. Embrace Somatic Support
Our bodies hold our stories. Practices like stretching, dancing, EFT tapping, or even just grounding your feet on the floor can bring you back into the present. Notice how your body feels in moments of stress and soothe it accordingly.

5. Explore Your Window of Tolerance
This is the emotional range where we feel balanced and functional. The more tools you use to stay within it — or gently expand it — the more resilient you’ll feel during life’s inevitable challenges.

Please know that your nervous system is doing its best to protect you. You aren’t failing, nor do you need to push yourself to do more. What you need is to step back and rest. Understanding this truth changed how I relate to myself. It helped me forgive the past, soften in the present, and build healthier rhythms for the future.

Regulating your ADHD nervous system doesn’t require perfection. Just awareness, self-compassion, and small, consistent actions.

Want to learn more?
Preorder The ADHD Women’s Wellbeing Toolkit (available in August 2025) — a practical, compassionate guide to self-regulation, hormonal balance, and healing. (UK readers: Preorder the book here, available in July 2025.) Tune in to The ADHD Women’s Wellbeing Podcast for weekly insights from ADHD experts, mental health professionals, and women like you.

Dysregulated Nervous System & Functional Freeze: Next Steps

• Read: How I Calm Down My ADHD Brain — 14 Quick De-Stressors
• Read: Rising from ADHD Burnout — A Recovery Kit for Women
• Read: Overstimulated by Life? 20 Ways to Give Your ADHD Senses a Break

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

The ramifications of abuse are dire and, in some cases, life-threatening: half of female homicide victims are killed by current or former partners.² The consequences of psychological abuse — the most frequent kind of IPV and often a precursor to physical violence — are no less critical. Research shows that psychological abuse is an even stronger predictor of post-traumatic stress disorder and depression than is physical abuse.³

Though intimate partner violence is startlingly common and harmful, many avenues can lead victims to help and health care providers are instrumental in connecting patients to these paths. Though traditional IPV screening is an effective intervention, it’s not the only one. For some providers, distributing safety cards may be a better fit.

The size of business cards, these safety cards contain information about the red flags and health consequences of IPV. They share contact information for hotlines as well as guidance for safely seeking help, and they let people know they’re not alone.

“It takes 30 to 45 seconds to share the card, and it can change someone’s life,” says Tami Sullivan, Ph.D., director of Family Violence Research and Programs and professor at Yale University’s School of Medicine. “We hear from women with lived experience of violence: ‘Why didn’t anyone ever give me something like this? It could have made all the difference to me.’”

[Read: Why Do Toxic Relationships Swallow People with ADHD?]

Obstacles to IPV Screening

With traditional IPV screening, a provider uses a survey like the HITS (Hurt, Insult, Threaten, Scream) to detect if a patient is experiencing violence. This can be transformative.

“If you trust your provider, it can be a very empowering experience to connect with someone who can listen, make you feel less alone, talk to you about making decisions,” Sullivan says.

But several significant obstacles stand in the way of effective screening for IPV. Survivors may be hesitant to disclose their experiences of violence, fearful of retaliation by their partners, or of being reported to police and potentially losing custody of their children. They may worry they’ll be judged, blamed, or shamed. These concerns may be particularly salient for women with ADHD who receive near-constant criticism, correction, and judgement.

[Watch: “How to Avoid Toxic Relationships and Find Your Ideal Match”]

These obstacles contribute to relatively low rates of disclosure in IPV screenings; less than a quarter of women who have experienced IPV report disclosing this to a health care provider.⁴

The efficacy of screenings also relies on a meaningful response from the provider. Many providers don’t feel comfortable addressing such a sensitive and personal revelation because they’ve not received training in IPV.

“We shouldn’t expect people to develop expertise in responding,” Sullivan explains. “But we want the provider to feel comfortable enough so that they’re not being judgmental, so they can let the person know they’re heard, and connect them to someone who does have expertise.”

If a survivor reveals abuse on a survey and her disclosure is never addressed, or if it’s met with judgement, Sullivan explains, it can discourage her from revealing the abuse to others in the future.

Safety Cards: A Universal Approach

The part of IPV screening that helps survivors most, research has found, is the engagement with support services that happens after disclosure.⁵ This is where safety cards come in.

IPV safety cards, which are distinct from screening methods, bypass surveys altogether and take a direct path to offering help.

The method is simple: Providers order safety cards like these for free and hand them out to every female patient they see (without their partner present). The cards come in 10 languages and contain information about the red flags and health consequences of IPV. They also connect patients to support and resource hotlines

For providers looking for guidance on how to distribute the cards, Sullivan suggests the following language:

“We’ve started talking with all of our patients about relationship health and abuse in relationships, in case it’s ever an issue for them or for their friends and family. This card talks about healthy and safe relationships, ones that aren’t — and how relationships affect your health.”

Safety cards offer myriad benefits, including:

• Getting help to the people who need it, no questions asked. Offering resources to everyone, a universal education model, ensures that the women who need help will get access to it – regardless of whether they disclose abuse.
• Empowering women to help others. Many of the patients who receive cards may not be experiencing IPV, but they may know people who are. Safety cards enable these individuals to recognize abuse in the lives of loved ones, and empower them to offer helpful resources. Research found that people who received universal education were twice as likely as those who did not to share the number for an IPV hotline to someone in need.⁶
• De-stigmatizing conversations about IPV. Broaching the topic of intimate partner violence to all patients helps to break the taboo which often keeps women silent about their experience.
• Planting a seed for future action. It’s important for providers to distribute safety cards at every visit because it may take more than one interaction for patients to recognize abuse in their own lives, or to prepare themselves to consider next steps.  “Often, the cards plant a seed for future action. You give it to patients every time they come in so that it’s routine and becomes comfortable,” Sullivan says. “They come to understand that their relationships affect their health.”

While disclosures aren’t necessary in this IPV intervention, they may happen. When responding, providers should use non-judgmental, validating language, and avoid directing patients to take specific action. “It should never be a provider, trained or not, telling people what they should do,” Sullivan explains. “Though it’s likely well-intentioned, this prescriptive approach mimics the dynamics of abuse and disempowerment.”

Instead, follow the patient’s lead. “Let people know the supports available to them and listen to them,” suggests Sullivan. “You might ask: ‘Have you thought about what you want to do? Do you want help thinking about what makes sense? Would you like to call a helpline from this office?’”

What survivors of abuse need from providers, Sullivan explains, is autonomy, empathy, and information about their options for getting help.

To Order Free Safety Cards

• Visit Futures Without Violence.

Get Help

If you, or someone you love, is experiencing intimate partner violence, these resources may help

• National Domestic Violence Hotline, Call 800-799-7233 or text START to 8878
• Love Is Respect, for people aged 13-26, Call 866-331-9474 or text LOVEIS to 2252
• National Sexual Assault Helpline, Call 1-800-656-HOPE

Abusive Relationships and IPV Screening: Next Steps

• Read: “What Are the Signs of a Controlling Relationship?”
• Quiz: “Is My Relationship Toxic?” A Quiz for Adults with ADHD
• Read: How to Respond to Gaslighting — In Your Relationship and In Yourself

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Guendelman MD, Ahmad S, Meza JI, Owens EB, Hinshaw SP. Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. J Abnorm Child Psychol. 2016 Jan;44(1):155-66. doi: 10.1007/s10802-015-9984-z. PMID: 25663589; PMCID: PMC4531111.

²Jack SP, Petrosky E, Lyons BH, et al. Surveillance for Violent Deaths — National Violent Death Reporting System, 27 States, 2015. MMWR Surveill Summ 2018;67(No. SS-11):1–32.

³Mechanic MB, Weaver TL, Resick PA. Mental health consequences of intimate partner abuse: a multidimensional assessment of four different forms of abuse. Violence Against Women. 2008 Jun;14(6):634-54. doi: 10.1177/1077801208319283. PMID: 18535306; PMCID: PMC2967430.

⁴Black MC, Basile KC, Breiding MJ, et al. The national intimate partner and sexual violence survey: 2010 summary report. Atlanta, GA Natl Cent Inj Prev Control Centers Dis Control Prev. 2011;19:39-40.

⁵US Preventive Services Task Force; Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW Jr, Grossman DC, Kemper AR, Kubik M, Kurth A, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: US Preventive Services Task Force Final Recommendation Statement. JAMA. 2018 Oct 23;320(16):1678-1687. doi: 10.1001/jama.2018.14741. PMID: 30357305.

⁶Miller E, Tancredi DJ, Decker MR, et al. A family planning clinic-based intervention to address reproductive coercion: a cluster randomized controlled trial. Contraception. 2016;94(1):58-67. doi:10.1016/j.contraception.2016.02.009

ADHD symptoms are impacted by changes in sex hormone levels in females across the lifespan, finds a new systematic review published in the Journal of Attention Disorders.¹ The review included 11 studies that investigated puberty, pregnancy, postpartum, and the menstrual cycle and tracked changes in symptomology and in the efficacy of ADHD medication during these times.

“There is an ADHD experience that is unique to females,” the study’s authors concluded. “Recognizing potential influences of sex hormones on ADHD symptoms in females may have key implications to clinical management and treatment of ADHD.”

The study included several key findings.

Sex Hormones and ADHD During Menstrual Cycle

The research reviewed four studies that explored the fluctuation of ADHD symptoms during the menstrual cycle. The following associations were identified:

• Early luteal phase: increased impulsivity and hyperactivity²
• Mid-luteal phase: increased emotional dysregulation, executive dysfunction, inattention³
• Late luteal phase: increased inattention and executive dysfunction, and mental health symptoms such as depression, irritability and anxiety⁴

Linking these symptom trends to increase and decrease of specific female hormones, the authors wrote: “Inattention symptoms may be related to decreasing estrogen and moderated by progesterone, whereas hyperactive/impulsivity symptoms may similarly be driven by reducing estrogen levels, though without effect of progesterone.” ⁵

These significant shifts in symptom severity were vividly described by Chloe, an ADDitude reader, in an article titled “Menstrual Cycle Phases and ADHD.” “The entire week leading up to my period is where my ADHD symptoms get even more intrusive than usual,” she wrote. “My executive functioning dips even lower, distractibility and difficulty focusing is increased, and my mood/energy level is much lower, causing me to feel badly about all the things I’m not being successful at that week.”

The review found that increasing stimulant dosage premenstrually resulted in improvement of ADHD and mood symptoms, including emotional dysregulation. This point was echoed in the lived experience of many ADDitide readers, who reported that their typical medication dosage seems less effective in the luteal phase of their cycle. Norma, a reader from Wisconsin wrote: “The week leading up to my cycle, I might as well not even take my ADHD meds. It’s like my body overrides them.”

Sex Hormones and ADHD in Pregnancy and Postpartum

The review included one study investigating ADHD in pregnancy.⁶ Three groups of pregnant women were included: those who discontinued ADHD medication, those who continued, and those who took medication as needed.

The study found hyperactivity symptoms were significantly lower and both mood and family functioning were better among the women who continued medication compared to those who discontinued. Other ADHD symptoms did not differ between the groups, leading researchers to theorize that, for some, the high estrogen of pregnancy may ameliorate certain ADHD symptoms. Because just one study was reviewed, and its sample size was small, the authors stressed that more research is required to contextualize the results.

Allison Baker, M.D., lead author for the study included in the review, wrote about her findings in an article for ADDitude, “Treating for Two:” “Women who discontinued stimulant treatment during pregnancy were more likely to experience conflict within their family, rate parenting as more difficult, and report feeling more isolated. Those who discontinued stimulants but did not stop taking their antidepressant medication, experienced a clinically significant increase in depression.”

While the study did not investigate an association between ADHD and postpartum depression, other studies have found that 17% of women with ADHD experience PPD compared to 3.3% of women without ADHD. and 25% experience postpartum anxiety disorders, compared to 4.61% of women without ADHD.⁷

“New mothers with ADHD face distinct postpartum challenges that are as ubiquitous as they are unstudied,” wrote Baker in “Postpartum Care for Mothers with ADHD.” “The months following the birth of a baby are uniquely difficult, and women with ADHD do not usually receive the medical support and treatments they need during this time.

Future Research on Hormones and ADHD

Understanding the role that sex hormones play on ADHD symptoms in women has far-reaching implications for diagnosing the condition and treating it. The review’s authors put forth the following interventions as possible ways to improve ADHD symptoms exacerbated by female hormones:

• premenstrual adjustment of stimulant dose ⁸
• use of hormonal therapies to stabilize estrogen and progesterone levels during menopause⁹ for those who struggle with PMDD ¹⁰

The main limitation of the review, authors acknowledged, is the small number of studies included, many of which include small sample sizes. “To advance our understanding of ADHD in females, research that seeks to understand the mechanisms underlying how sex hormones may influence ADHD symptoms is essential,” they wrote, calling for a multi-disciplinary approach that combines assessments of hormone levels with neurocognitive, brain imaging, genetic, or neurophysiological investigations.

This call for research was echoed in the ADDitude magazine article “Hormonal Changes in Women with ADHD: 4 Gaping Holes in Research,” written by five leading experts on ADHD in women, including Michelle M. Martel, Ph.D., a lead author of several of the studies included in the review. “We know that hormones collide with ADHD to cause heightened mood dysregulation, memory problems, and impulsivity each month,” the authors explained. “But we don’t yet see the big picture of how symptoms manifest during different reproductive stages because research is scant and leaves more questions than answers.”

Sources

¹Osianlis, E., Thomas, E. H. X., Jenkins, L. M., & Gurvich, C. (2025). ADHD and Sex Hormones in Females: A Systematic Review. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547251332319

²Roberts B., Eisenlohr-Moul T., Martel M. 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

³Bürger I., Erlandsson K., Borneskog C. (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

⁴de Jong M., Wynchank D. S. M. R., van Andel E., Beekman A. T. F., Kooij J. J. S. (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

⁵Eng A. G., Nirjar U., Elkins A. R., Sizemore Y. J., Monticello K. N., Petersen M. K., Miller S. A., Barone J., Eisenlohr-Moul T. A., Martel M. 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

⁶Baker, A. S., Wales, R., Noe, O., Gaccione, P., Freeman, M. P., & Cohen, L. S. (2020). The Course of ADHD during Pregnancy. Journal of Attention Disorders, 26(2), 143-148. https://doi.org/10.1177/1087054720975864

⁷Andersson, 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

⁸de Jong M., Wynchank D. S. M. R., van Andel E., Beekman A. T. F., Kooij J. J. S. (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

⁹Herson M., Kulkarni J. (2022). Hormonal agents for the treatment of depression associated with the menopause. Drugs & Aging, 39(8), 607–618. https://doi.org/10.1007/s40266-022-00962-x

¹⁰Appleton S. M. (2018). Premenstrual syndrome: Evidence-based evaluation and treatment. Clinical Obstetrics and Gynecology, 61(1), 52–61. https://doi.org/10.1097/GRF.0000000000000339

First, I would encourage you not to be defensive during your visit. Clinicians have to follow a process to give you a diagnosis. This may seem like a waste of time, but a full differential diagnosis requires more than just asking neurodivergent-related questions. You may be asked questions that you feel are irrelevant, but that are important nonetheless.

There might be something you can learn, and something that you can teach the clinician. I have thanked patients for correcting me about certain things and I think that those interactions have been transformative for them too. I know I’ve learned from them.

[Take the Autism in Women Self-Test]

Having said that, it is important for all of us to feel respected, and that includes respect from your clinician. If you feel your provider is cynical or not listening to you, or they’re not acting in a collaborative way, then you can say thank you and move on.

Q: “What are the common misdiagnoses given to girls and women with ADHD and autism?”

Autistic girls and women with ADHD are often diagnosed with borderline personality disorder. This is a difficult differential diagnosis because it entails so much — dichotomous thinking, emotional reactivity, and fears of rejection and abandonment.

They also get misdiagnosed with bipolar disorder and, more commonly, with obsessive-compulsive disorder (OCD). This is because many neurodivergent individuals like repetitiveness, or like to systematize things, and have trouble interrupting a sequence, but that doesn’t necessarily mean they have OCD. It’s also not uncommon to have co-occurring conditions.

Q: “Are autistic girls with ADHD more likely to experience emotional dysregulation than their neurotypical peers?”

Emotional dysregulation is not part of the diagnostic criteria for ADHD or autism, but it is very much a part of the lived experience for both conditions — and it can be very impairing. Rejection sensitivity (the tendency to intensely react to real or perceived rejection), along with spiraling emotions or thoughts, impairs a person’s functioning and ability to interact and listen.

[Get This Free Download: Your Autism Evaluation Checklist]

According to society’s gender roles, girls and women are not supposed to get upset or display anger. When faced with rejection, we may hold it in and mask — only to eventually explode. So being unable to understand our emotions and know when we need to breathe, or step away, is important.

AuDHD Diagnosis: Next Steps

• Take These Self-Tests:
  • ADHD in Women
  • Autism in Women
• Learn: How to Get Evaluated for Autism as an Adult
• Read: Autism and ADHD in Adults
• Read: “Women Need Better, More Accurate Diagnostic Tools for ADHD”
• Read: “What to Expect After Your AuDHD Diagnosis”
• Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus
• Read: “A Living Contradiction” — The AuDHD Experience
• Free eBook: The Truth About Autism in Adults
  

Karen Saporito, Ph.D., is a licensed clinical psychologist who has been in private practice for more than 20 years.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

In research examining eating disorder symptoms among women aged 45 to 61, body dissatisfaction was cited as a key risk factor.¹ I have seen this firsthand. In 2024, more than 21% of calls to the National Alliance for Eating Disorders, a support and advocacy organization I founded in 2000, were from individuals (primarily women) age 40 and older.

Eating disorders are serious, brain-based mental illnesses with a strong genetic link.² They have the second-highest mortality rate among all psychiatric disorders.³ Yet many middle-aged and older women may not even recognize that they’re struggling with eating disorders due to misconceptions about these conditions and who they affect.

[Self-Test: Do I Have an Eating Disorder?]

An adult might have an eating disorder if they:

• experience extreme weight loss or dramatic weight fluctuations
• refuse to eat certain foods or skip meals
• exercise excessively
• show signs of purging

Calorie restriction, or bingeing and purging, can have a particularly adverse effect on an older body, possibly leading to poor health outcomes. When eating disorders go untreated, they can lead to bone loss, heart problems, and, in people who force themselves to vomit, lung conditions. And research shows that 11% of women with ADHD, compared to 1% of women without it, have a history of bulimia nervosa, a common eating disorder that involves gorging followed by vomiting or laxative use.
Other eating disorders common in older adults include:

• anorexia nervosa (extreme food restriction)
• binge eating (consuming large amounts of food beyond the point of feeling full)

Eating Disorder Triggers

For some women, the battle with eating disorders began in childhood. For others, body image struggles may be triggered by later-in-life events. These include:

• Perimenopause and menopause. The transition to menopause is now recognized as a high-risk time for eating disorders to develop or redevelop, in part because women are seeking ways to “control” their changing bodies amid significant estrogen shifts.⁴
• Aging and unrealistic ideals. The anxiety and stress of aging in a society that values youthfulness provides fertile ground for increased symptoms of disordered eating and dysfunctional attitudes, beliefs, and behaviors around food and physical appearance.
• Transitions. Divorce, an empty nest, widowhood, and other life events may lead to or reactivate disordered eating.

[Watch: “Eating Disorders Comorbid with ADHD — ARFID, Anorexia, and Others”]

“Too Old” for an Eating Disorder

Eating disorders are considered diseases of the young, and, consequently, they often go unrecognized in older women. Many clinicians believe their mature patients are “too old” to have such conditions.

If you suspect that you or a loved one may have an eating disorder, talk with a doctor trained in this area. The National Alliance for Eating Disorders offers guidance, resources, and referrals for treatment and care. It provides free, therapist-led virtual support groups for women at midlife and older to connect with others who are experiencing or recovering from eating disorders.

Do I Have an Eating Disorder: Next Steps

• Free Download: Types of Eating Disorders Associated with ADHD
• Read: We Demand Attention! A Call for Greater Research on Women with ADHD
• Read: ADHD and Eating Disorders: Research, Diagnosis & Treatment Guidelines
• Watch: “Eating with ADHD: Improving Your Relationship with Food”

Johanna Kandel is the founder and CEO of the National Alliance for Eating Disorders and the author of Life Beyond Your Eating Disorder: Reclaim Yourself, Regain Your Health, Recover for Good. (#CommissionsEarned)

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Kilpela, L.S., Hooper, S.C., Straud, C.L., Marshall, V.B., Verzijl, C.L., Stewart, T.M., Loera, T.T., Becker, C.B. (2023) The longitudinal associations of body dissatisfaction with health and wellness behaviors in midlife and older women. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph20247143

²Berrettini W. (2004). The genetics of eating disorders. Psychiatry (Edgmont), Nov;1(3):18–25. PMID: 21191522; PMCID: PMC3010958

³van Hoeken, D., & Hoek, H. W. (2020). Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden. Current opinion in psychiatry. https://doi.org/10.1097/YCO.0000000000000641

⁴Khalil, J., Boutros, S., Kheir, N., Kassem, M., Salameh, P. et al. (2022). Eating disorders and their relationship with menopausal phases among a sample of middle-aged Lebanese women. BMC Women’s Health. https://doi.org/10.1186/s12905-022-01738-6

No, it’s not cancer. In fact, the number of worldwide deaths from all types of cancer combined is equivalent to half the number of fatalities caused by heart disease in women.

More than 60 million women in the United States have heart disease — and for the large majority, serious cardiac problems begin in perimenopause when estrogen, which protects the heart, decreases dramatically.

While the risk for cardiovascular disease increases in all women during perimenopause, women with ADHD may face an even greater risk than their non-ADHD peers. Research has revealed that the prevalence of heart disease is higher among adults with ADHD of both genders compared to adults without ADHD: 38% vs 23%.¹

While research investigating the prevalence of heart disease among women with ADHD, specifically, remains incomplete, it is reasonable to hypothesize that rates are high because this population faces myriad heart disease risk factors including chronic stress, anxiety, depression, substance use disorders, sleep disorders, obesity, and diabetes.

To test this hypothesis, I partnered with the HeartLife Cardiology Clinic in the Netherlands. Included in the study were 300 women, the majority of whom were of perimenopausal age, as this is commonly the age at which women seek treatment for cardiac complaints.²

[Read: Let’s Talk About Perimenopause and ADHD]

We found that 35% of these patients met criteria for lifetime ADHD symptoms: a rate that is nearly 10 times that found among women in general. We also found that the women with ADHD symptoms experienced cardiac complaints two years earlier than their non-ADHD peers, suggesting that their cardiac problems may be relatively more severe.

This exploratory study indicated to us that further research is needed. To that end, my colleagues and I have launched the Women with ADHD Health Study, which has enrolled more than 3,000 female participants from across the world and is investigating the relationship between female hormones and cardiovascular issues, among other physical conditions. The ongoing research survey is accepting responses until the end of June 2025, and all women with ADHD or who identify as having ADHD symptoms are invited to participate.

Today, research shows that just 44% of women in the U.S. correctly identify heart disease as the greatest threat to their health.³ This lack of awareness is due, in part, to the fact that women often experience significantly different symptoms of cardiovascular disease than men. If patients, and their doctors, aren’t educated about how heart disease presents in women, potentially deadly health repercussions may result.

[Download: Free Guide to Hormones & ADHD in Women]

So, while we wait for research to be completed, we seek to equip at-risk women with the information necessary to protect their hearts from harm.

The Big Impact of Small Vessel Disease

When people think of heart disease, what usually comes to mind is coronary artery disease (CAD). In this disorder, plaques build up in the larger coronary arteries, causing a narrowing that may lead to an obstruction and possible heart attack. CAD is associated with risk factors such as high cholesterol, high blood pressure, obesity, diabetes, smoking, and lack of exercise.

Seldom discussed is another type of coronary heart disease that predominantly affects women, called coronary microvascular disease (CMD). Unlike CAD, which affects the heart’s large arteries and reduces blood flow due to obstruction, CMD also affects the heart’s smallest blood vessels, and reduces blood flow due to spasms.

Symptoms of CAD tend to occur after physical effort, whereas signs of CMD are more erratic in nature. Symptoms frequently occur during rest, even during sleep. They are also more commonly associated with chronic stress, depression, and anxiety.

Heart Attacks in Women Look Different

We are all familiar with the “classic” symptoms of a heart attack; sudden pain in the chest, often after physical effort, sometimes accompanied by pain in the left arm and jaw. These symptoms are real and serious, for women as well as men — but they are not the only signs of a heart attack.

For many women, signs of a heart attack include:

• tightness in the chest, the feeling of being in a harness or too-tight bra
• shortness of breath
• pain in the back
• indigestion
• nausea or vomiting

Though these symptoms are sometimes called “atypical,” the truth is that they are only atypical for men. They are quite common, and often under-recognized, in women.

Microvascular disease is much more difficult to diagnose than is CAD. Because it involves the heart’s smallest vessels, it’s not visible via routine angiography. Unlike blockages in the arteries that are fixed and persistent, the spasms associated with CMD come and go. It can be diagnosed through a provocative acetylcholine challenge test, however this is an invasive and uncomfortable procedure that is not often used.

Women with cardiac complaints frequently report going to the emergency room, where an angiogram is performed and finds no evidence of blockage in the arteries. These women are often misdiagnosed with anxiety, and told the problem is not in their heart, but in their head. They’re sent home, their cardiovascular disease unrecognized and untreated.

Female-Specific Risk Factors for Heart Disease

In addition to heart disease risk factors that impact both men and women (high cholesterol, hypertension, smoking, obesity), there are several heart disease risk factors specific and exclusive to women. These include:

• gestational diabetes
• a history of preeclampsia
• endometriosis
• polycystic ovarian syndrome
• autoimmune disorders
• oral contraceptive use
• premature menopause

Menopause most commonly occurs when a woman is in her early 50s. When it occurs before the age of 40, it’s considered premature menopause, which is a risk factor for cardiovascular disease. This is because the early drop in estrogen exposes the heart to more harm over a longer period.

Women with ADHD may experience premature menopause at relatively higher rates, according to a recent study in Nature Genetics.⁴ While the reasons for early menopause remain largely unclear, we do know that smoking can be a contributing factor. Surgeries that impact the ovaries can also result in early menopause.

Tailoring Treatment to ADHD Patients

When treating patients with cardiac problems, doctors often start with lifestyle changes. This can prove especially challenging for patients with ADHD. Unless their ADHD, sleep problems, and mood disorder are treated first, they will likely be too exhausted, forgetful, or disorganized to make changes to their lifestyle. For this reason, I advise addressing ADHD and other symptoms first to lay the groundwork for successful changes to diet, exercise, and other habits. Blood pressure and heart rate should be monitored during ADHD treatment, as stimulants may increase both.

I also urge perimenopausal women to address hormonal complaints that may be at play and to consider the protective effect of estrogen on heart function.

Heart Disease in Women: Next Steps

• Read: Falling Estrogen, Soaring ADHD: Menopause Care for Neurodivergent Women
• Read: Hormonal Changes in Women with ADHD: 4 Gaping Holes in Research
• Learn: Menopause, Hormones & ADHD – What We Know, What Research is Needed

The content for this article was derived, in part, from a plenary address at the 2025 Annual Conference of the American Professional Society for ADHD and Related Disorders (APSARD) delivered by prof. J.J. Sandra Kooij, M.D., Ph.D., titled, “Gender & Endocrine Issues in ADHD.” J.J. Sandra Kooij is a professor on Adult ADHD at Amsterdam UMC/VUMc, the Netherlands.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Li L, Chang Z, Sun J, Garcia-Argibay M, Du Rietz E, Dobrosavljevic M, Brikell I, Jernberg T, Solmi M, Cortese S, Larsson H. Attention-deficit/hyperactivity disorder as a risk factor for cardiovascular diseases: a nationwide population-based cohort study. World Psychiatry. 2022 Oct;21(3):452-459. doi: 10.1002/wps.21020. PMID: 36073682; PMCID: PMC9453905.

²Ter Beek LS, Böhmer MN, Wittekoek ME, Kooij JJS. Lifetime ADHD symptoms highly prevalent in women with cardiovascular complaints. A cross-sectional study. Arch Womens Ment Health. 2023 Dec;26(6):851-855. doi: 10.1007/s00737-023-01356-7. Epub 2023 Aug 18. PMID: 37594562; PMCID: PMC10632230.

³Cushman M, Shay CM, Howard VJ, Jiménez MC, Lewey J, McSweeney JC, Newby LK, Poudel R, Reynolds HR, Rexrode KM, Sims M, Mosca LJ; American Heart Association. Ten-Year Differences in Women’s Awareness Related to Coronary Heart Disease: Results of the 2019 American Heart Association National Survey: A Special Report From the American Heart Association. Circulation. 2021 Feb 16;143(7):e239-e248.

⁴Demontis, D., Walters, R.K., Martin, J. et al. Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nat Genet 51, 63–75 (2019).

The night Rollins left her husband, he knew what she was planning. “He had his hand on the gun in his holster and he threatened me,” says Rollins. “I remember trying to be strong and saying to my daughter, ‘What is happening now should never happen.’”

Rollins is focused now on trying to heal and cut herself some slack. Getting an ADHD diagnosis in adulthood has been an illuminating part of her journey. “It explains everything,” she says. “How self-critical I was, never feeling good enough, always feeling like, ‘Why can’t I just get it right?’ I think, in hindsight, I wouldn’t have chosen who I chose to marry if I’d known I had ADHD.”

IPV and ADHD

IPV can include physical, sexual, and/or psychological abuse executed by a current or former partner. It does not discriminate, and can affect people of any gender, race, socioeconomic status, or level of education, explains psychologist Tami Sullivan, Ph.D., director of Family Violence Research and Programs and professor at Yale University’s School of Medicine. Women, however, are far more likely to be victims. Intimate partner violence is more common among women than breast cancer, diabetes, or depression.

Among women with ADHD, rates of IPV are even higher. Recent research from Berkeley Girls with ADHD Longitudinal Study (BGALS) found that women aged 17-24 who had received a childhood diagnosis of ADHD were five times more likely than their neurotypical peers to experience physical IPV. Greater ADHD symptom severity in childhood was associated with increased risk for IPV. ¹

[Read: Why Adults with ADHD Are Particularly Vulnerable to Gaslighting]

“It’s underappreciated how difficult ADHD can be for girls and women because the consequences are more internal,” says Stephen Hinshaw, Ph.D., lead researcher of BGALS and professor of psychology at the University of California, Berkeley. “Girls with ADHD are smart, but they can’t get it together. As they age, the tendency is depression, very low self-image, unplanned pregnancy, intimate partner violence, and non-suicidal self-injury.”

Risks, however, are not predetermined outcomes, and information is empowering. Below, learn what intimate partner violence looks like, how its impacts are felt, and what help is available.

The Truth About IPV

What IPV Looks Like

• Psychological: threatening, intimidating, humiliating, criticizing, insulting, belittling, blaming, invading privacy, extreme jealousy/possessiveness, dismissing feelings
• Physical: hitting, pushing, slapping, punching, restraining, choking, dragging
• Sexual: coercing victim to have sexual acts or watch pornography, drugging victim
• Technological: tracking location, demanding check-ins, excessive texting, monitoring communications
• Financial: withholding access to bank accounts and credit cards, ruining the victim’s credit, taking the victim’s paycheck

[Read: Why Do Toxic Relationships Swallow People with ADHD?]

Psychological Abuse Is Rampant—and Overlooked

“Media depictions focus on physical and sometimes sexual abuse, showing a woman fearing for her life on a daily basis,” Sullivan says. “By promoting only that stereotype, we do a disservice to women who experience IPV differently, because they think, ‘Well, that’s not me. I’ve never had a bruise or a broken bone.’”

While patterns and specifics of abusive behavior vary widely, psychological abuse is pervasive. Explains Sullivan: “You almost never see physical and sexual abuse alone, without psychological abuse.” Sullivan and her research team collected data from victims of IPV for 90 days and found that psychological violence occurred on 27% of days — 13 times more often than physical, psychological, and sexual violence together. ²

It’s critical to identify psychological abuse because it often appears first, and can lead to physical and sexual abuse, not to mention dire health consequences on its own.

IPV Has Far-Reaching Impact

The health implications of IPV are often severe:

• 51% of female homicide victims were killed by intimate partners ³
• 80% of IPV survivors display trauma symptoms
• 30% of survivors meet criteria for post-traumatic stress disorder (PTSD)

Survivors are at an increased risk for:

• diabetes: +51%
• total mortality: +44%
• cardiovascular disease: +31% ⁴

IPV is also associated with an increased risk for substance use disorders, depression, anxiety, suicidality, traumatic brain injuries, working memory declines later in life ⁵, and issues of the gastrointestinal, reproductive, and musculoskeletal systems.⁶

And, to be clear, psychological abuse can be as serious and detrimental as physical abuse — even more so, in some cases. “Psychological abuse erodes self-worth and self-efficacy, that feeling of, ‘I’ve got this,’” says Sullivan. “It can be a stronger predictor of PTSD and depression than physical abuse.” ⁷

Healing from Abuse

“Twenty years ago, the mentality was, How do we get her to leave? The approach now is survivor-centered: What does she want to have happen?” explains Sullivan. “Not every person wants the abusive relationship to end; some just want the violence to stop. Providers need to ask, ‘Have you thought about what you want to do?’ This gives the person voice, something that’s often taken away from them.”

Evidence-based therapeutic interventions should be present-centered with a focus on empowerment, Sullivan says. These include Cognitive Behavior Therapy (CBT), STAIR (Skills Training in Affective and Interpersonal Regulation), Interpersonal Psychotherapy (IPT), HOPE (Helping to Overcome PTSD through Empowerment).

Get Help

If you, or someone you love, is experiencing intimate partner violence, these resources may help:

• National Domestic Violence Hotline, Call 800-799-7233 or text START to 88788
• Love Is Respect, for people aged 13-26, Call 866-331-9474 or text LOVEIS to 22522
• National Sexual Assault Helpline, Call 1-800-656-HOPE

*Name has been changed to protect the person’s privacy

Intimate Partner Violence and ADHD: Next Steps

• Read: “We Demand Attention on Self-Harm, Intimate Partner Violence, and Substance Abuse Among Women with ADHD
• Self Test: Is My Relationship Toxic? A Quiz for Adults with ADHD
• Q and A: “What Are the Signs of a Controlling Relationship?”
• Read: “Women Need Better, More Accurate Diagnostic Tools for ADHD”

Nicole C. Kear is Consumer Health Editor at ADDitude magazone.

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Sources

¹Guendelman MD, Ahmad S, Meza JI, Owens EB, Hinshaw SP. Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. J Abnorm Child Psychol. 2016 Jan;44(1):155-66. doi: 10.1007/s10802-015-9984-z. PMID: 25663589; PMCID: PMC4531111.

²Sullivan TP, McPartland T, Armeli S, Jaquier V, Tennen H. Is It the Exception or the Rule? Daily Co-occurrence of Physical, Sexual and Psychological Partner Violence In a 90-Day Study of Substance-Using, Community Women. Psychol Violence. 2012 Apr 1;2(2):10.1037/a0027106. doi: 10.1037/a0027106. PMID: 24349863; PMCID: PMC3859524.

³Jack SP, Petrosky E, Lyons BH, et al. Surveillance for Violent Deaths — National Violent Death Reporting System, 27 States, 2015. MMWR Surveill Summ 2018;67(No. SS-11):1–32.

⁴Chandan JS, Thomas T, Bradbury-Jones C, Taylor J, Bandyopadhyay S, Nirantharakumar K. Risk of Cardiometabolic Disease and All-Cause Mortality in Female Survivors of Domestic Abuse. J Am Heart Assoc. 2020;9:e014580. doi: 10.1161/JAHA.119.014580.

⁵Baker JS, Greendale GA, Hood MM, Karlamangla AS, Harlow SD. Self-reported history of physical intimate partner violence and longitudinal cognitive performance in midlife women. Womens Health (Lond). 2024 Jan-Dec;20:17455057241309782. doi: 10.1177/17455057241309782. PMID: 39707890; PMCID: PMC11663271.

⁶Stubbs, A., & Szoeke, C. (2022). The Effect of Intimate Partner Violence on the Physical Health and Health-Related Behaviors of Women: A Systematic Review of the Literature. Trauma, Violence, & Abuse, 23(4), 1157-1172. https://doi.org/10.1177/1524838020985541

⁷Mechanic MB, Weaver TL, Resick PA. Mental health consequences of intimate partner abuse: a multidimensional assessment of four different forms of abuse. Violence Against Women. 2008 Jun;14(6):634-54. doi: 10.1177/1077801208319283. PMID: 18535306; PMCID: PMC2967430.

During my psychiatry residency from 1987 to 1991, I only treated one adult with ADHD, a young man who was having difficulty in his medical school classes. After completing my child and adolescent psychiatry fellowship, however, I joined the United States Air Force, where I saw many enlisted members who had untreated ADHD and could not pass testing to get promoted to the next rank. Clearly, ADHD in adults was real.

ADHD in Women Gains Attention

Still, adult ADHD did not land on the national radar until 2006, when Ronald Kessler, Ph.D., and his colleagues published data from a study in the International Journal of Methods in Psychiatric Research that estimated a prevalence of 4.4 percent in adults. Of those, 38.4 percent were women. ¹

[Self-Test: Could You (or Your Daughter) Have ADHD?]

According to that study, only one in 10 adults had been treated for ADHD in the last 12 months. Over the next decade, clinical trials were conducted with amphetamine, methylphenidate, and atomoxetine. More than 40 percent of trial participants were women; clinical studies on ADHD began to show that females were just as impaired as males, and they responded just as well to medication.², ³, ⁴

Despite all of this, there was no clinical emphasis on evaluating ADHD in women even a decade ago. Often, I would diagnose mothers with ADHD after diagnosing their children. These patients’ symptoms were typically missed in childhood because they did not include outward hyperactivity. As young adults, many had been misdiagnosed and treated for anxiety and depression. These conditions often did not improve with treatment because ADHD symptoms were not addressed.

In 2020, after experts convened to evaluate data on ADHD in females across the lifespan, Susan Young, Ph.D., and her colleagues published an expert consensus statement “providing guidance for the identification and treatment” of ADHD in girls and women. It cited, in part, a lack of understanding or recognition among clinicians regarding gender differences in ADHD symptom presentation and functioning.⁵

ADHD Research on Women Falls Short

Today, ADHD diagnoses in women continue to increase — and with good reason. Of the roughly 15.5 million adults with an ADHD diagnosis, 44.2 percent are women, according to recent data by the Centers for Disease Control and Prevention (CDC). Yet, of the 1,737 studies involving ADHD listed on ClinicalTrials.gov, only four were evaluating females only. The research has been slow to catch up.

As a result, there is still much we don’t know about ADHD in women. In recent years, the largest increases in stimulant prescriptions were for women of childbearing age. ⁶

[Free Download: Women, Hormones, and ADHD]

Research is needed to guide better treatment of this cohort, as well as midlife and older women with ADHD. The opportunity to unlock meaningful improvements to patients’ lives is real — and really overdue.

ADHD Research Studying Gender Differences: Next Steps

• Free Download: The Facts About Major Depressive Disorder in Women
• Read: We Demand Attention! A Call for Greater Research on Women with ADHD
• Read: Hormonal Changes in Women with ADHD & 4 Gaping Holes in Research
• Read: How ADHD Gender Bias Is Slowly, Steadily Harming Females
• Watch: Girls and Women with ADHD – Gender Differences and Stigma

Ann Childress, M.D., is a past-president of the American Professional Society of ADHD and Related Disorders ( APSARD) and was the first woman elected to lead the organization.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Kessler, R.C., Merikangas, K.R. (2005) The National Comorbidity Survey Replication (NCS-R): background and aims. Int J Methods Psychiatr Res. 13(2):60-8. https://doi.org/10.1002/mpr.166
² Rasmussen, K., Levander, S. (2009). Untreated ADHD in adults: are there sex differences in symptoms, comorbidity, and impairment? J Atten Disord. https://doi.org/10.1177/1087054708314621
³ Mowlem, F. D., Rosenqvist, M. A., Martin J., Lichtenstein, P., Asherson, P., Larsson, H. (2018). Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. European Child & Adolescent. Psychiatry. https://doi.org/10.1007/s00787-018-1211-3
⁴ Platania, N.M., Starreveld, D.E.J., Wynchank, D., Beekman, A.T.F., and Kooij, S. (2025). Bias by gender: exploring gender-based differences in the endorsement of ADHD symptoms and impairment among adult patients. Front. Glob. Women’s Health. 6:1549028. https://doi.org/10.3389/fgwh.2025.1549028
⁵ Young, S., Adamo, N., Ásgeirsdóttir, B.B., Branney, P., et al. (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. https://doi.org/10.1186/s12888-020-02707-9
⁶ Danielson, M.L., Bohm, M.K., Newsome, K., et al. (2023).Trends in stimulant prescription fills among commercially insured children and adults — United States, 2016–2021. MMWR Morb Mortal Wkly Rep. https://doi.org/10.15585/mmwr.mm7213a1