Syncing Menstrual Cycle Phases with ADHD

There’s the menstrual cycle, and then there’s the menstrual cycle when you have attention deficit hyperactivity disorder (ADHD).

ADDitude readers have already told us what researchers have yet to adequately explore: That the menstrual cycle directly impact ADHD symptoms. Budding research suggests that premenstrual syndrome (PMS) and its more severe form, premenstrual dysphoric disorder (PMDD), may disproportionately impact individuals with ADHD — a finding that surprises very few ADDitude readers.

That’s why so many women with ADHD track their menstrual cycles and use the information to make informed decisions and navigate life — or at least to maintain perspective on how hormonal fluctuations affect their ADHD symptoms, energy levels, and functioning.

“I 100% schedule my life around my cycle,” said Misha, an ADDitude reader. “I try to do as much as I can while my energy and mood are at their best so it’s easier to have quieter, less productive days later in my cycle.”

Here, we’ll break down the phases of the menstrual cycle, what you can expect to experience at each stage, and ideas for cycle syncing according to your changing ADHD symptoms and energy levels (with tips from ADDitude readers*).

The menstrual cycle — the time from the first day of your period to the day before your next one — lasts an average of 28 days. We can split the cycle into two phases: the follicular phase and the luteal phase. Fluctuating estrogen and progesterone levels through these phases explain ever-changing energy, mood, and productivity levels. A good rule of thumb: High-estrogen states equate to better mood and greater executive functioning (EF) — you’re generally at your best here. In low-estrogen states, mood and EF worsen — as do ADHD symptoms.1

The follicular phase lasts approximately two weeks, starting on the first day of your period and ending with ovulation.

Estrogen levels remain low during menstruation, which can last anywhere from two to eight days, though the average is four to six days.2 You can expect to experience typical symptoms — cramps, headaches, bloating, fatigue, moodiness — during your flow, and aggravated ADHD symptoms like forgetfulness, trouble focusing, and emotional dysregulation.

Estrogen levels start to rise about a week after the start of your period, and continue to climb for about seven days, shooting up and peaking just before ovulation (i.e., when an egg is released from one of the ovaries).9 Many ADDitude readers recognize that the week after their period is when they feel most productive, focused, and energetic. ADHD symptoms are also more manageable.

“After my period I usually have a day where I wake up and it suddenly feels easier to breathe. I feel lighter.” — An ADDitude Reader

“At peak ovulation. I think I am a superhero and push and over-estimate everything that I want to do and can do.” Michelle, New York.

“I find that as my first week (flow) subsides, my ADHD symptoms are so much better. I feel like I get so much more done on those days. I’m much more stable, motivated, focused, and mentally competent.” —An ADDitude Reader

What to Do After Your Period

The luteal phase — also lasting about two weeks — starts after ovulation and ends the day before your period. Estrogen levels plummet after ovulation (assuming fertilization has not occurred), and rise slightly during the mid-luteal phase before dropping off again in the days leading up to menses.9 Progesterone levels, meanwhile, rise in the days after ovulation before falling in the lead up to menstruation.

Changing hormone levels in this phase are thought to explain the range of symptoms that appear for many in the weeks before menstruation, collectively known as PMS. Symptoms of PMS include (but are not limited to) mood swings, anxiety, irritability, sadness, changes in appetite, trouble sleeping and/or insomnia, headaches, and poor concentration.10 The luteal phase, according to ADDitude readers, wreaks havoc on ADHD symptoms.

“The entire week leading up to my period is where my ADHD symptoms get even more intrusive than usual. My executive functioning dips even lower, distractibility and difficulty focusing is increased, and my mood/energy level is much lower, causing me to feel badly about all the things I’m not being successful at that week.” —  Chloe

“About six days prior to my menstruation my rejection sensitive dysphoria (RSD) is at its worst. I cry a lot, I binge eat, and I see mainly/only the dark side of things.” — Chiara, Italy

“From day 14 to 25, my symptoms of inattentive ADHD are worse. It certainly feels like my working memory is the most severely affected three days before my period. I just can’t remember what I’m doing, I’ll walk into the kitchen 100 times, and forget each time that I’m trying to get something to eat.” — Kay, Scotland

Even ADHD medications seem to lose their effectiveness during the luteal phase.

“My ADHD meds are significantly less efficacious for about 10 days per month; two days before the bleed I am a barely functional zombie.” — An ADDitude Reader

“The week leading up to my cycle, I might as well not even take my ADHD meds. It’s like my body overrides them.” — Norma, Wisconsin

For readers with PMDD — a condition that, according to one study, may be more prevalent in people with ADHD than in the general population11 — this phase of the menstrual cycle is when severe symptoms appear, affecting all aspects of life.

“It’s debilitating. I’m unable to concentrate on work, my marriage, or just my overall mindfulness because I’m plagued with thoughts of anxiety and overwhelm. For me, it feels like I take one step forward during the one or two weeks before/after PMDD and five steps back during the week of PMDD.” — Angelina, California

*Reader quotes edited for brevity and clarity.

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