For years, ADHD in women has been underdiagnosed and misunderstood. Now, new research suggests those with the condition are also at significantly higher risk for a debilitating menstrual mood disorder: PMDD.
PMDD — or premenstrual dysphoric disorder — shares similarities with premenstrual syndrome, but its symptoms are far more intense.
Sufferers can experience severe emotional, cognitive, and physical distress in the days before menstruation. Depression is common, and PMDD is recognised as a serious mental health condition associated with increased risk of suicide. While the exact cause remains unknown, hormonal fluctuations are thought to play a key role. Treatments range from pain relief to antidepressant medications.
The study, led by Queen Mary University of London and published in the British Journal of Psychiatry, collected responses from more than 700 women in the UK via online questionnaires. Participants were asked about ADHD diagnoses and symptoms, PMDD symptoms, and co-occurring mental health conditions such as anxiety and depression.
The researchers found that women with a clinical ADHD diagnosis were more than 3 times as likely to meet the criteria for PMDD compared to those without ADHD. The risk was even higher — over four times — among women who reported high levels of ADHD symptoms and impairment, even without a formal diagnosis.
Risk was greatest in women with ADHD who also had a co-diagnosis of depression or anxiety.
There’s a growing awareness that ADHD is underdiagnosed in women, in part because diagnostic criteria and clinical attention have historically focused on boys. This has led to gaps in care and research — particularly when it comes to hormonal changes throughout the menstrual cycle.
“Because ADHD was historically considered a condition that mainly affected boys, many issues specific to females have been overlooked, including associations between ADHD and times of hormonal change,” says Dr Jessica Agnew-Blais, a senior lecturer at Queen Mary University of London.
“Our findings emphasise the need to consider issues affecting adult women with ADHD, and more specifically how females with ADHD may be at higher risk for experiencing PMDD.”
“Our findings also suggest that further research is needed to improve understanding of the link between ADHD and times of hormonal change, including the menstrual cycle, and to reduce health inequalities and diagnostic bias in women and girls with ADHD,” says co-author Dr Thomas Broughton, a postdoctoral researcher.
The researchers say their findings highlight the need for greater PMDD screening among women with ADHD — including those without a formal diagnosis but who experience significant symptoms.