welcome welcome welcome everybody back to my channel in this video I want to talk about a very important subject that has received very little research and yet I get a lot of questions about it particularly from females with ADHD and that is on the effect of female hormones on ADHD symptoms across the lifespan and as it turns out just this week a review of the literature as well as a proposal of a theory of how these hormones impact girls and women with ADHD appeared in the journal hormones and behavior you can see here multiple authors
beginning with Ashley Ang but also including my good friend Michelle Martell over at the University of Kentucky this is a very important article so if you are interested in this please have a look at the paper the hot link is over in the thumbnail SC sketch associated with this video uh but I found that it's very understandable particularly for educated people but it's I think a very important paper that sets the stage for future research that needs to be done in this area we have known for a long time based on simply the reports of
our patients that women with ADHD report fluctuations in the level of their ADH D and executive functioning deficits as a consequence of their life cycle during their reproductive years from the onset of puberty and menus through pregnancy to perimenopause and menopause but there was almost no research up until a few years ago on this topic and the research remained very small probably less than five studies I'm aware of on this topic but this paper reviews what is known not just about ADHD but the larger area of the effects of hormones and their fluctuation on uh
females their behavior their risk for comorbid disorders like depression and eating disorders uh and then looking at the relative fluctuations of estrogen with progesterone to create what they call a two-phase theory of hormonal sensitivity that they think is going to have relevance for understanding ADHD in women so uh let's have a look at this because what these authors are proposing is that there are four stages in the reproductive life cycle of women at which they are going to get hit with a whammy to double whammy when it comes to what these hormones are doing to
their not only ADHD symptoms but relatedly to their executive functioning and emotion regulation and possibly even risk for comorbid irritability and depression so they talk about this in the context of the fact that at puberty we know that there's a second burst in the incidence of ADHD in women in the population and this helps us to understand the gender differences or sex differ in ADHD that go back decades where we have known that in childhood three times more boys than girls have ADHD but by puberty that rate goes down to about 2 to one and
by adulthood the rate of men to women with ADHD is nearly equal at about one and a half males to females now what is going on across development to Al Al these sex ratios this paper I think provides a very important explanation for why this might be there are several stages at which women particularly girls and women who are sub threshold ADHD may be pushed into the clinical range of ADHD By changes in their hormones and one of those is the onset of puberty in the beginning of their menes when there is a rise in
both female hormones estrogen and progesterone and this rise triggers a sensitivity of brain networks and if those networks are particularly those in the executive brain the prefrontal cortex and its linkages throughout the brain we could see a rise in ADHD symptoms and you talk about here a preliminary pilot study that they conducted right here that suggests just that says our preliminary work suggests that there is a substantial activation of hormonal effects on ADHD across the menstrual cycle specifically in non-clinical women that they recruited between 18 and 25 they found that declines in one type of
estrogen E2 estral 2 predicted clinically significant two-fold increase in ADHD symptoms of in attention and hyperactivity during that particular change so declines in estrogen generally appear to be associated with exacerbation of ADHD symptoms the rise of ADH or excuse me the rise of these hormones at the onset our puberty also suggests an activation and a sensitivity so no wonder then that at puberty it seems like there's the strong possibility that more women than men will develop their ADHD around this time because of these hormonal effects I think it's a very very important hypothesis uh that
likely will stand up over time then the second area where this is affecting women is going to be throughout the menstrual cycle so that as these hormones rise and fall in proportion to each other we're going to see different effects on ADHD according to these writers according to their Theory so at the beginning of the month as estrogen is falling as we get toward the uh ovulation stage of the cycle but progesterone is staying the same we can expect to see a rise in hyperactive impulsive behavior risk-taking an increase in executive functioning deficits and possibly
changes in Emotion regulation as well so these changes are occurring as a result of the withdrawal of estrogen approaching the ovulation part of the cycle so that would suggest then that girls and women during mid cycle are going to be at greater risk for impulsive hyperactive executive deficits and problems with emotion regulation possibly leading to an increased risk of risk-taking behavior by the way as well as alcohol consumption then as the cycle continues and we see that estrogen May decline but progesterone levels are changing so the relative distribution of these two May then lead to
a different set of problems an increase in inattention an increase in irritability and possibly in dymic or depressive symptoms late in the cycle right around the Perry menstrual phase of their monthly cycle so that's the second place that hor hormones could be impacting ADHD changing the nature of ADHD that is exacerbating certain symptoms over others depending on the stage of their cycle and this also explains why clinicians who have worked with young women have often told me that they adjust medication and even add additional medication at different stages of the month to help women manage
their ADHD and those period related exacerbations the third place where ADHD may come into play is when pregnancy occurs and then there are radical changes in these hormones and many women talk about the onset of an ADHD brain associated with their pregnancy difficulties with working memory with concentration with attention and so on not to mention changes in Emotion regulation and mood food that all may occur during pregnancy so that women with ADHD who then become pregnant may find an exacerbation of certain aspects of their ADHD symptom profile and executive deficits and then finally the fourth
phase where these hormones may have an effect according to these authors is during per menopause and menopause proper itself when we see these hormones changing again and we often hear women talking about at this stage an exacerbation of their symptoms such as greater inattention poor working memory difficulties with emotion regulation we've even had instances where we see a rise in referrals of women to clinics that is coincident with the onset of per menopause or menopause where women who weren't necessarily ADHD previously or were able to cope with elevated symptoms that may not have been in
the clinical range Now find themselves fully clinically ADHD as they approach mid to late life so uh again a very important paper that sets the stage for how we can do further research to test out their theory of this multiphasic impact of ADHD or excuse me of female symptoms or hormones on ADHD symptoms and what we can expect to see within each of these ages such as during the menstrual period in these alterations in ADHD symptoms so I thought a very important review of the literature here but particularly a presentation of a theory based on
a lot of evidence from non-clinical samples from other disorders that we might be able to extrapolate over to ADH to better understand what our female patients are telling us about symptom fluctuations during and after the reproductive lifespan that they have so uh I hope that you found this informative I hope you'll go and have a look at this paper uh it's easily understandable in my opinion uh and then uh I hope that you will along with me encourage further research on this very important topic of a sex difference between men and women with ADHD on
the role that female hor hormones may have in generating some of these sex differences in symptoms so thanks for joining me everybody I hope you found this informative I'll see you again with another uh video and research update later in the week take care and be well
