Menstruation and the menstrual cycle can be associated with numerous challenges that women face under the influence of hormones.
Some of them include variable energy levels, mood changes, pain, increased need for rest and withdrawal, changes in the skin, bloating, headaches, PMS, and more.
Hormonal changes are mainly monitored through changes in the levels of estrogen, progesterone, and testosterone.
The role of estrogen is to prepare the uterus for the acceptance of the egg cell, and its effect is an increase in energy levels. Testosterone is an energizing hormone and is responsible for sexual drive, while progesterone has a calming effect.
If you also have an associated diagnosis of ADHD, the challenges are even more pronounced due to variable dopamine levels in different parts of the cycle.
The reason for this is that dopamine binds and is produced more effectively in the presence of estrogen, which decreases in the second part of the cycle.
Dopamine is responsible for numerous functions of the prefrontal cortex, such as planning, learning, and emotional self-regulation. It is not unusual for ADHD symptoms to worsen in the second half of the menstrual cycle.
Additionally, people with ADHD are more prone to PMS and PMDD (premenstrual dysphoric disorder).
There is a term called menstrual cycling, i.e., planning according to one’s cycle
What does this mean in the context of ADHD and the menstrual cycle, and what are its advantages?
The cycle lasts between 24 and 43 days, typically 28 days, and is divided into the following phases:
Menstrual (1st-7th day)
Follicular (7th-14th day)
Ovulatory (14th-16th day)
Luteal (16th-28th day)
Menstrual phase
Hormones are at their lowest levels, which leads to reduced energy levels and executive functions. During this period, you may experience the most unpleasant symptoms such as cramps, bloating, headaches, bad mood, fatigue, but also increased forgetfulness, focus problems, and sudden mood changes.
If you feel more tired and less efficient than usual during this part of the cycle, the reason is lower dopamine levels due to reduced estrogen levels.
During this phase of the cycle, the main focus should be on rest and replenishing energy through light activities such as walking, stretching, and yoga. Sleep hygiene and daytime rest are important. Avoid screens right before bed.
This is a good phase for planning the upcoming phases of the cycle, as well as for reflecting on what you want less of in your life and daily routine. Keeping a journal is a good idea.
Nutritionists recommend reducing the intake of caffeine, saturated fats, salt, and sugar, as they are associated with more intense cramps, while omega-3 reduces them.
Folicular phase
All hormones are on the rise, including testosterone. As a result, during this phase of the menstrual cycle, you have the highest energy levels and feel like you can do anything.
When you have ADHD, you often make the mistake in this phase of overbooking yourself with commitments and plans for the rest of the month, when lower energy levels follow that you ultimately can’t meet. Sound familiar?
You can overcome this by planning less interesting, boring tasks and duties during this phase of the cycle, when you need much more energy to get started. Save easier tasks for the second half of the cycle.
For example, household chores, washing laundry, ironing, routine check-ups, and large grocery shopping are things that are good to do during this period.
Also, within these two weeks, it’s a good idea to arrange social gatherings, events, business collaborations, and outings or dates. You can challenge yourself to try new hobbies and activities and increase the intensity of your workouts.
It is important to consciously slow down and take breaks so you don’t drain all the energy needed for the second part of the cycle.
Ovulatory phase
During this phase of the menstrual cycle, energy levels, focus, and libido are at their highest due to elevated levels of estrogen and testosterone. Most women feel the most satisfied and open to others during this phase of the cycle.
As in the follicular phase, this is the best phase for socializing, dating, more intense physical activities, artistic creation, fun and entertainment, and of course – sexual activities.
You will have the urge to say ‘yes’ to everything and spread yourself in all directions. However, take a breath and be mindful of your capacity and which commitments you will actually be able to follow through on.
Luteal phase
In the luteal phase, progesterone levels rise, which gives us a sense of calm and the need for rest and slowing down. Estrogen and testosterone levels decrease, leading to a drop in energy and cognitive abilities.
Common symptoms in this phase, along with ADHD, include mood swings, anxiety, irritability, sadness, changes in appetite, sleep problems and/or insomnia, headaches, poor concentration, and worsened ADHD symptoms.
You might notice that you’re resorting to emotional overeating, procrastination, you’re more sensitive to criticism, easily feel overwhelmed, and prone to black-and-white thinking.
People who take medication for ADHD say they notice a reduced effectiveness of the medication during this part of the cycle.
Try to be gentler with yourself and set realistic expectations, giving priority to more frequent rest and breaks. It’s a good idea to monitor your body’s capacity and reduce the intensity of your workouts.
Definitely finish any tasks and obligations before entering the menstrual phase of your cycle. Avoid planning major meetings or projects during this part of your cycle.
Inform your friends, family, and partner about the worsening symptoms during this phase so they can be prepared. This way, your potential emotional outbursts and “existential crises” can be put into perspective and not taken too seriously.
Seek support in remembering important tasks and responsibilities, in doing household chores, and in reminding yourself to be kinder to yourself.
In this phase, it can be beneficial to increase your ADHD medication dosage in consultation with a psychiatrist. Some women also opt for contraceptive pills to maintain consistent symptoms throughout their cycle and reduce PMS symptoms. This decision requires collaboration with a gynecologist and endocrinologist.
Additionally, support from a therapist and coach can be significant in reminding you of the importance of patience and understanding with yourself.
In conclusion, hormones significantly affect the characteristics of ADHD in women during different phases of the menstrual cycle.
If you notice that PMS symptoms significantly impact your quality of life, it is important to seek support through consultations with a gynecologist, endocrinologist, and psychiatrist.
If you want to learn how to align your ADHD with your pace of life and life values, and embrace your uniqueness, contact me for psychotherapy and coaching here.