Women with ADHD three times more likely to experience premenstrual dysphoric disorder – new research

Attention-deficit hyperactivity disorder (ADHD) has historically been under-studied in women. This means we still have a limited understanding of how the condition may uniquely affect women – and what effect monthly hormonal changes may have on women with ADHD.

But a recent study conducted by me and my colleagues has shown that women with ADHD are at higher risk for mental health struggles associated with the menstrual cycle. We found that having ADHD makes women around three times more likely to experience premenstrual dysphoric disorder.

Premenstrual dysphoric disorder (PMDD), is a serious condition that affects about 3% of women worldwide. The condition can seriously interfere with a person’s everyday life, causing symptoms such as mood swings, irritability, depressed mood and anxiety.

These symptoms occur in the days before menstruation, and resolve after the period starts. For some, PMDD may lead to severe outcomes, such as being at an increased risk of attempting suicide.

Read more: Premenstrual dysphoric disorder: the frightening psychological condition suffered by Dixie D'Amelio

Get your news from actual experts, straight to your inbox. Sign up to our daily newsletter to receive all The Conversation UK’s latest coverage of news and research, from politics and business to the arts and sciences.

We conducted an online survey of 715 women aged 18 to 34 in the UK. We asked them whether they experienced different symptoms of ADHD or PMDD, whether they’d received an ADHD diagnosis from a doctor and how symptoms interfered with their lives.

We found that about 31% of women with a clinical ADHD diagnosis also had PMDD, as did around 41% of women who scored high for ADHD symptoms (whether they had been formally diagnosed with ADHD or not). In comparison, only about 9% of women without ADHD met the criteria for PMDD. We also found that women who had ADHD and a clinical diagnosis of depression or anxiety had an even greater risk of PMDD.

The research showed that the most common PMDD symptoms women experienced were irritability, feeling overwhelmed and depression. But women with ADHD may also be more likely to experience insomnia when they have PMDD.

The PMDD and ADHD link

Our study isn’t the first to show a link between the two conditions, but it is the first to identify a similar PMDD risk among women with ADHD symptoms, not just among those who were in treatment. We’re also the first to show that people who have ADHD plus depression or anxiety are at an even greater risk of PMDD.

Other research suggests that women with ADHD may also be at higher risk for mental health problems during other times of hormonal change. For instance, one study found women with ADHD experienced higher rates of depression and anxiety after starting combined oral hormonal contraceptives. Another study found that women with ADHD were more likely to experience depression after giving birth than those without the condition.

More research is now needed to understand why women with ADHD appear to be more vulnerable to PMDD, and whether this affects what treatments work best.

It should be noted that our study assesses “provisional PMDD diagnosis”. An official diagnosis requires two months of symptom tracking across the menstrual cycle. But we asked women to remember how they felt across their menstrual cycle rather than tracking how they feel in real-time.

This means we could be over- or under-estimating PMDD prevalence as we’re relying on participants to recall their symptoms.

Future research should assess PMDD symptoms among women in real-time as they experience their menstrual cycles to more accurately assess symptoms without having to rely on people’s memory. Additionally, it may be difficult to distinguish PMDD from other disorders that may worsen during the premenstrual period, such as depression or anxiety. Tracking symptoms across the menstrual cycle in real-time would help to disentangle this.

PMDD can have profoundly negative effects on women’s lives. Some women even report it can make them feel “physically unable to see the joy in things”. Although symptoms can be managed with prescription treatments, this can only happen if the condition is diagnosed by a doctor.

Our new research shows us that women with ADHD are an at-risk group for PMDD, especially if they also have depression or anxiety. This suggests doctors should consider screening for PMDD among women with ADHD to reduce distress and adverse outcomes associated with the condition.

Jessica Agnew-Blais receives funding from the UK Medical Research Council and GambleAware for her research.