The Lifespan of ADHD Symptoms: Hormonal Changes and Their Impact

May 1, 2023

Hormonal changes exacerbate the symptoms of attention deficit hyperactivity disorder (ADHD) in both men and women, with the severity increasing as one ages, according to a recent survey conducted by ADDitude involving 1,829 adult ADHD participants. Among both males and females, ADDitude's survey participants cited increasing challenges associated with significant hormonal shifts during puberty, pregnancy, postpartum period, perimenopause, menopause, and andropause.

These survey results challenge the traditional perception of ADHD as a disorder that only manifests during childhood and dissipates after pubescence.

ADHD's most severe manifestations, according to both genders, occur from ages 50 to 59, coinciding with menopausal and andropausal stages. Women rated the impact of ADHD during this age bracket as 4.24 out of 5, while men gave it a 4.14 rating, in contrast to much lower ratings during childhood. The reason behind these higher ratings might be the fading of memories, late diagnosis, or recency bias. However, the narratives provided by ADDitude readers corroborate that ADHD symptoms become more noticeable with age.

A 62-year-old woman from California diagnosed with ADHD explains that the lack of diagnoses until menopause is due to the drop in estrogen levels, which is essential for dopamine, key to executive function, to move from the brain's center to the frontal lobe.

An additional finding that contradicts conventional beliefs is that nearly identical proportions of men and women, 36.6% and 37.9% respectively, suffer from the inattentive type of ADHD.

Despite the similarities, there are striking and crucial differences between males and females with ADHD. For example, women with ADHD are much more prone to experiencing debilitating comorbidities, as evidenced by the ADDitude study.

Hormonal fluctuations also contribute to other gender-based differences, as revealed in the ADDitude survey.

Men reported that their ADHD became prevalent during puberty, leading to a variety of symptoms, thanks to the nearly 30-fold1 increase in testosterone production.

For women diagnosed with ADHD, adolescence was characterized by several distinguishing factors:

A shocking 66% of female respondents disclosed that they suffered from premenstrual syndrome (PMS) and/or premenstrual dysphoria disorder (PMDD), significantly exceeding the general population's prevalence rate. Survey participants reported experiencing specific symptoms of PMS and PMDD.

As one 39-year-old female participant diagnosed with ADHD, anxiety, and autism disclosed, for her, PMDD involved suicidal tendencies, increased meltdowns and shutdowns, a decrease in emotional regulation, extreme sensitivity to rejection, and intrusive thoughts.

Participants also reported that women were more likely to experience social anxiety, self-harm, and eating disorders during their teenage years. Men, in contrast, were more likely to report engaging in illicit drug use, displaying hypersexuality, and experiencing difficulties with anger management during adolescence.

During pregnancy, more estrogen and progesterone are produced than at any other time in a woman's life. According to 20% of the surveyed women, an upsurge in pregnancy hormones resulted in heightened focus, motivation, organization, and better sleep.

One participant, a 34-year-old woman from the UK noted that her sleeping issues disappeared during pregnancy, and she felt more productive than ever before.

However, 44% of females reported no changes in ADHD symptoms during their pregnancy. This lack of noticeable changes could be due to discontinuing stimulant medication (reported by 98% of pregnant women) which was offset by the increasinh hormone levels. As per a study by ADDitude, 36% of women reported a worsening of ADHD symptoms during pregnancy such as fatigue, poor memory, emotional dysregulation, and sensitivity.

Post-birth, levels of estrogen and progesterone drop off steeply, leading to postpartum depression in about 15% of females. Our survey discovered a much higher rate of self-reported postpartum depression at 61%. Participants narrated that their postpartum depression lasted roughly a year which was depicted by the following symptoms:

A 49-year-old female with inattentive ADHD narrated her postpartum depression experience, expressing her regret on not having been able to enjoy those precious moments with her newborn. She tells us she didn't feel the desire to hold her child and often handed him off to others in the early days. But now, her son is her greatest supporter, which perhaps compensates for the missed moments early on.

Our survey further revealed that nearly half of the participants were not offered treatment for their postpartum depression. Among those who received treatment, 41% were prescribed antidepressants and 20% underwent therapy. One of the mothers from Colorado admitted to hiding her postpartum symptoms due to her guilt about feeling inadequate as a mother.

In 2022, ADDitude conducted another survey focusing on nearly 4,000 women and their ADHD symptoms during menopause, a period where estrogen and progesterone levels drop significantly. The results showed that 70% of women considered ADHD to have a "life-altering" impact during their 40s and 50s. Half the women even called menopause's ADHD symptoms "extremely severe".

A 55-year-old woman who was diagnosed with ADHD just four years ago spoke about her concurrent menopause and ADHD experiences. She revealed that her life improved after starting medication for ADHD and therapy. She expressed her lingering sadness but also highlighted the wisdom, self-acceptance, and awareness she gained over her journey.

In men, testosterone levels gradually decrease with age, causing andropause in their 40s and 50s. Almost three-quarters of ADDitude survey participants aged 40 and above reported experiencing andropause, which led to certain symptoms. However, many found it difficult to pinpoint whether decreasing testosterone levels or other life issues (like divorce, death of parents, job loss, health issues, or persistent low self-esteem) were to blame.

A 61-year-old man shared his experience with andropause and its impact on his mental health. He reported heightened frustration, attempts to please others, and a struggle with substance use and sexual insecurities. Another 58-year-old man expressed his burden of self-doubt, lack of pride or confidence in himself, and difficulty in accepting and moving on from his past failures.

The article's author is Anni Layne Rodgers, the general manager at ADDitude.

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