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TLDR: Someone made the mistake of asking a question about ADHD and hormones…


Ever since getting a couple of personal training certifications for menopause and post pregnancy I have been interested in hormones and why they matter in our everyday lives. In the last year I had been to a couple of talks on ADHD in relation to hormone health but they never seemed to answer my questions. If you want a nice introduction this neurospicynonsense blog covers some of the basics about hormones and ADHD and they have some lovely images on their website that explain things like this:



But I wanted to know more and understand the WHY,


In the week leading up to my period:

Why does my dyspraxic coordination?

Why do my ADHD meds stop being notably effective?

Why is doing paperwork at it's most impossible?


It wasn't enough for me to know that progesterone was dominant in that time. I wasn't understanding what progesterone was doing or how it was interacting with other functions within my brain. I don’t fully understand the sciency witchcraft behind all this because neurotransmitters and endocrine system are essentially magic, and I have the intellectual ability of someone who thinks if I can't lift up a plane, how can it fly.


So given Pixar haven't made an easy to understand film about it I had no choice but to do some reading of studies.


Just to note this is covering oestrogen and progesterone in relation to menstruation cycles and menopause. There is some info out there about testosterone but I have yet to look at that in detail. Also, none of the research is neuroaffirmative and the only research looking at what helps is focused on an increase in ADHD meds.


All the below is with the caveat.. there is lots we don’t know. But here’s the low down on what we do know ADHD and oestrogen and progesterone.


Hormones:


Hormones are chemical messengers produced by endocrine glands (such as the thyroid, adrenal glands, ovaries and pancreas) and released into the bloodstream. They travel throughout the body to target organs and tissues.


Oestrogen is a group of hormones produced in ovaries, adrenal glands and some fat tissue. It has a wide variety of functions. Its very involved in the processes in the first half of a menstrual cycle.  


Progesterone is produced in the ovaries and a small amount in the adrenal glands. Again multiple functions but not as many/ as well known as oestrogen.  In the menstruation cycle it is involved in the second half preparing the uterus and during pregnancy supports the uterus lining.


Neurotransmitters:


Hormones and neurotransmitters are both essential chemical messengers in the body, but they operate in different ways and have distinct functions. Neurotransmitters are chemical messengers that play a crucial role in transmitting signals in the brain and throughout the body. Think of them as the texts or emails of your nervous system, delivering messages from one neuron (nerve cell) to another. This communication network is essential for everything from your mood and emotions to muscle movements and heart rate.


Glutamatergic synapses:

  • Glutamate is the “Master neurotransmitter”. It is “excitatory” and  is like the “gas pedal” making other neurotransmitters more likely to fire. AKA it makes the neurotransmitters more effective.

  • The Glutamateric synapse is  the connection which transmits the glutamate.

  • It (through what I can only assume is magic) helps neurones talk effectively to each other.

  • It does things around, learning , memory and sensory processing as it helps amplify and relay sensory information around the brain because glutamate regulates dopamine activity in:

    • basil ganglia (movement / coordination)

    • nucleus accumend (reward/ pleasure area).

  • Glutamate not only has a role in modulating the release of noradrenaline  but the two systems are interconnected and work together to regulate cognitive functions such as attention, memory, and executive function.

  • Depending on brain area Progesterone is thought to decrease glutamatergic excitability or decrease it.

  • Oestrogen is thought to modulate Glutamate.


Serotonic  synapses:

  • Serotonin = happy hormone. Stuff with sleep, mood etc.

  • Serotonic synapses the connection which transmits the serotonin.

  • Serotonin modulates release of dopamine.

  • Serotonin can interact with Noradrenaline as they both play a role in arousal/ attention.

  • Oestrogen binds to serotonin and alters the response to serotonin signals. It also influences the overall availability of serotonin.

  • Progesterone modulates the serotonin receptor and its uptake.


Gabaergic synapses:

  • GABA= Gamma-aminobutyric acid: reduces and inhibits (blocks) neurone activity. Regulates neuron activity and regulates muscle tone, sleep and mood (particularly anxiety). We know it has a role in impulsivity, executive functioning and attention.

  • Might have a role in ADHD- We don’t know.

  • Gabaegenic synapses are located in hippocampus, thalamus, basal ganglia, hypothalamus, and brainstem.

  • Gaba can decrease dopamine and noradrengenic production

  • Oestrogen modulates GABA’s activity.

  • Progesterone does stuff we don’t understand to GABA but might include influencing the expression and function.

Dopaminergic synapses:

  • Dopamine= Role in motor control, reward processing, pleasure, reward and learning.

  • Dopaminic synapses are located throughout the brain.  Role in motor control, reward processing, pleasure, reward and learning.

  • Oestrogen has been shown to enhance the activity of enzymes involved in dopamine synthesis, leading to increased dopamine production. Additionally, oestrogen can influence the release of dopamine from presynaptic terminals, leading to changes in dopaminergic neurotransmission.

  • Progesterone does stuff we don’t understand to dopamine.


Research shows executive function can improve when oestrogen levels are higher and ADHD traits worsen when oestrogen is lower . Also, the issue seems to not be that one hormone is depleted but when there is an imbalance between oestrogen and progesterone. (So one being dominant)





So what does this mean:


  • The reason my clumsiness is worse: The neurotransmitters that help my motor planning aren't able to be as efficient.

  • ADHD meds aren't as effective because they are still doing what they are designed to do which is about increasing the level of dopamine available... but they are working with less dopamine.

  • All the things we consider executive functions: that ability to pay attention and focus on things even if they are dull...

  • Many neurotypical folk experience executive function and emotional differences during their period or whilst experiencing perimenopause. They may feel they have dementia or ADHD when what they are experiencing is menopause. For an ADHDer there is some emerging evidence that during menopause is likely to hit harder and because the baseline was already in a different place so the coping strategies that where in place for any challenges will be harder to maintain.


My personal experience:

  • It may be completely unrelated but contraceptive hormone made me ill. (I was clinically depressed, fatigued when on a combined contraceptive) I was paranoid and extra anxious and extra clumsy when on a progesterone contraceptive.)

  • Dyspraxia, restlessness  and inattention gets worse 2 days before my period. ADHD medication does not make a difference during this time. (This seems to be indicative of lower dopamine)

My personal view:

  • Firstly it is not all doom and gloom. These things are cyclical and pass. Even if we are thinking about the unpredictable perimenopause years things can and do stabilise.

  • Rather than fight it, acknowledge it is happening and try to adapt your expectations and routines.

  • Also for those of us that are sensitive to our sensations: we may find less things overwhelming.

  • What looks like ADHD may be endocrine conditions such as PCOS. That’s why during an adult ADHD assessment taking a developmental history is important.

  • I suspect there is probably a connection between ADHD and endocrine conditions so it might be more likely they co-occur.

  • I imagine trans women who take HRT will have protective factor in oestrogen helping boost the production and modulation of dopamine / noradrenaline.

  • There’s a theory about ADHD and the default network mode (DNM)/task positive network (TPN)  in the brain. There are studies that have looked at the TPN AND DNM in relation to sex hormones. These studies have not then considered ADHD, It will be interesting to see if more research starts to show relationships.

 


 

 

Below are studies that are relevant.

  1. Lifetime ADHD symptoms highly prevalent in women with cardiovascular complaints. A cross-sectional study

  2. Perinatal Outcomes of Women Diagnosed with Attention-Deficit/Hyperactivity Disorder: An Australian Population-Based Cohort Study

  3. ADHD Symptoms in Females of Childhood, Adolescent, Reproductive and Menopause Period

  4. Reproductive Steroids and ADHD Symptoms Across the Menstrual Cycle

  5. Menstruation and menopause in autistic adults: Periods of importance?

  6. Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage

  7. Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women

  8. Annual Research Review: Perspectives on progress in ADHD science – from characterization to cause

  9. Sex Differences in ADHD: Review and Priorities for Future Research

  10. Polymorphism of Estrogen Receptor Genes and Its Interactions With Neurodevelopmental Genes in Attention Deficit Hyperactivity Disorder Among Chinese Han Descent

  11. Oestrogen modulation of noradrenaline neurotransmission

  12. Oestrogen upregulates noradrenaline release in the mediobasal hypothalamus and tyrosine hydroxylase gene expression in the brainstem of ovariectomized rhesus macaques

  13. Prevalence of hormone-related mood disorder symptoms in women with ADHD

  14. PMDD

  15. PCOS

  16. Relationship between sex hormones, reproductive stages and ADHD: a systematic review  


I have written about exercise and menopause here.

Sarah is an Occupational Therapist and personal trainer who is passionate about helping people flourish @MoodLifterPT She is always happy to be contacted if you want to find out more.

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