Focus, mood, and your menstrual cycle: The ADHD-PMDD connection

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that creates challenges with focus, impulsivity, and self-regulation. It can also create challenges with mood swings and emotional regulation. Having ADHD may put you at greater risk of developing certain co-occurring mental health conditions, including PMDD.

About 45% of menstruating people with ADHD also live with a severe version of premenstrual syndrome (PMS) called premenstrual dysphoric disorder (PMDD). PMDD brings about severe emotional disturbance for one to two weeks before the menstrual cycle begins. 

Experts aren’t exactly sure why there’s so much overlap between ADHD and PMDD. But we do know that both conditions can impact a person’s mental and emotional well-being in serious ways. So, for treatment to be effective, people living with ADHD and PMDD need comprehensive care that addresses both conditions at the same time.

The relationship between ADHD and your menstrual cycle

Research suggests that PMDD might make ADHD symptoms worse, and vice versa. This is likely tied to the underlying causes behind two symptoms that these conditions share: impulsivity and emotional dysregulation. 

Impulsivity and emotional dysregulation are associated with imbalances in the brain chemical dopamine. Dopamine is a “feel-good” chemical that activates your brain’s pleasure center and sets off a happiness response. 

Low dopamine is known to negatively affect mood in people with ADHD. It may also contribute to the mood disturbances that people with PMDD experience.

What do PMDD and ADHD symptoms feel like?

People living with PMDD and ADHD can experience these conditions in various different ways. But there are a few known symptoms to be aware of:

ADHD symptoms

• Trouble staying organized
• Difficulty focusing on tasks, especially ones that you find boring
• Easily distracted
• Forgetfulness
• Difficulty with time management
• Avoiding tasks that seem overly difficult  
• Trouble staying on track in conversations
• Difficulty controlling thoughts
• Seeming careless 
• Overlooking important details
• Frequently losing personal belongings or important items
• Feeling the need to move or fidget constantly
• Interrupting people
• Feeling frequently agitated or restless
• Trouble being patient
• Injecting yourself into other people’s activities
• Trouble waiting your turn

To be diagnosed with ADHD, you must experience several of these symptoms for at least six months. They also have to interrupt your daily functioning.

PMDD symptoms

• Anxiety or panic attacks
• Frequent crying
• Mood swings
• Difficulty concentrating
• Feel sad and hopeless
• Loss of interest in activities
• Relationship strain or conflict
• Angry outbursts  
• Irritability
• Fatigue
• A change in appetite, overeating, or food cravings
• Sleep disturbances
• Feeling out of control
• Painful physical symptoms, like bloating, breast soreness, joint or muscle aches, cramps, or headaches
• Suicidal thoughts*

People with PMDD don’t experience these symptoms every day. Rather, they occur during the luteal phase of the menstrual cycle. This is the one to two weeks before the first day of your period. If you have PMDD, you’ll likely notice that your symptoms begin to subside once your period starts. Tracking your cycle can help you know when this time is about to occur.

*A note on safety: PMDD carries an increased risk of suicidality. If you’re having thoughts of harming yourself, don’t hesitate to ask for help. You can contact the National Suicide and Crisis Lifeline by dialing 988 from any phone. Their counselors will provide confidential support and resources to help keep you safe. 

Managing premenstrual dysphoric disorder and ADHD

PMDD is a relatively new diagnosis, so many medical providers don’t have extensive experience with the condition. This can make it more difficult to receive an accurate diagnosis — especially when ADHD is a complicating factor. 

One way to advocate for yourself is to keep track of your symptoms each month. Note when you start to notice a sharp decline in mood or a worsening of your ADHD symptoms. If that tends to happen during the week or two before your period starts, you might have PMDD. If you think you have PMDD, it’s important to talk to your doctor to get an accurate diagnosis.

Sharing this information with your doctor can help them better understand the changes you experience throughout the month. It can also help shape your treatment plan so you receive support for ADHD and PMDD at the same time. The care you receive should be based on your unique needs. 

Some of the most common ADHD and PMDD supports include:

• Therapy: Cognitive behavioral therapy (CBT) has been shown to reduce symptoms of PMDD and ADHD. It focuses on interrupting negative thought and behavior patterns and improving coping skills. CBT can also help with emotional regulation, executive functioning (organization, planning, focus), distress tolerance, and self-esteem.
• Medication: Sometimes, mental health providers use medication to treat ADHD. However, it’s important to talk to your doctor about how your ADHD medication might impact your PMDD symptoms. Together, you can decide which options might be right for you.
• Lifestyle changes: Taking care of your physical health by getting enough sleep, exercising, and eating a balanced diet can help you manage symptoms of PMDD and ADHD.
• Self-care: Building a consistent routine that includes time for rest and self-care can help you manage your ADHD and PMDD. Be sure to incorporate activities you enjoy and stress-reducing practices, like breathwork or gentle movement.

Find care with Rula

It can be difficult to talk about what’s going on in your mind and body when something doesn’t feel right. And if you’re living with ADHD and PMDD, you may have times when your symptoms feel overwhelming. And it can be difficult to know where to turn for help. But know that with the right support, you can manage both conditions and create more balance in your life. 

To take the first step toward getting your mental health on track, check out Rula’s therapist-matching program. In just a few clicks, you can select a provider who takes your insurance and schedule your first appointment for as soon as tomorrow.

Find a therapist with Rula