Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence

Eng, Ashley G.; Nirjar, Urveesha; Elkins, Anjeli R.; Sizemore, Yancey J.; Monticello, Krystina N.; Petersen, Madeline K.; Miller, Sarah A.; Barone, Jordan; Eisenlohr-Moul, Tory A.; Martel, Michelle M.

doi:10.1016/j.yhbeh.2023.105466

Cited by 42Attention Deficit Hyperactivity DisorderSexual Differentiation and DisordersHypothalamic control of reproductive hormones

Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence

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Eng, Ashley G., Nirjar, Urveesha, Elkins, Anjeli R., Sizemore, Yancey J., Monticello, Krystina N., Petersen, Madeline K., Miller, Sarah A., Barone, Jordan +2 more·2024·Hormones and Behavior

DOI 10.1016/j.yhbeh.2023.105466PMC PMC10872410

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Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that exhibits striking sex differences in symptoms, prevalence, and associated problems across development. Etiological factors and mechanisms underlying these sex differences remain one of the most understudied aspects of this disorder. The current paper seeks to provide a novel theoretical framework for understanding this phenomenon by reviewing evidence that females with ADHD may experience a "double whammy" of organizational and activational pubertal hormonal effects. We propose a novel theory of activational effects of cyclical circulating ovarian hormones on ADHD with increasing risk at times of rapid declines in estrogen. These declines may decrease executive function and trait control at two points of the cycle characterized by biphasic affective risk: (1) increases in approach/risk-taking behaviors at mid-cycle (periovulatory) and (2) increases in avoidance/negative affect perimenstrually. Low estrogen and control may then interact with increases in positive and negative affect, respectively, to increase hyperactivity-impulsivity symptoms post-ovulation and inattention symptoms perimenstrually. These interactions may be exacerbated by organizational pubertal effects on relatively overdeveloped limbic circuitry and adolescent-specific social pressures magnified in females with ADHD.

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The menstrual cycle probably influences ADHD and mood symptoms in women, especially women with ADHD.
“For women [18], and women with ADHD especially [19,20], the menstrual cycle probably influences these symptoms.”
From A Female-Specific Treatment Group for ADHD—Description of the Programme and Qualitative Analysis of First Experiences (2024) · cites this paper as [19]
There is a dire need for female-specific treatment options for ADHD expressed by many, including patients.
“We developed this female-specific treatment option in response to the dire need expressed by many [1,17,19,23,24,25,26,28,41,55,85], including patients.”
From A Female-Specific Treatment Group for ADHD—Description of the Programme and Qualitative Analysis of First Experiences (2024) · cites this paper as [19]

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Authors: Eng, A. G., Nirjar, U., Elkins, A. R., Sizemore, Y. J., Monticello, K. N., Petersen, M. K., Miller, S. A., Barone, J., Eisenlohr-Moul, T. A., & Martel, M. M.
Affiliations: University of Kentucky (US)
University of Illinois Chicago (US)
Corresponding author: Eng, Ashley G.
ORCID: Eng, Ashley G.
Nirjar, Urveesha
Elkins, Anjeli R.
Petersen, Madeline K.
Miller, Sarah A.
Barone, Jordan
Eisenlohr-Moul, Tory A.
Martel, Michelle M.
Venue: Hormones and Behavior
Publisher: Elsevier BV
Published: 2024-02
Volume: 158
Pages: 105466
ISSN: 0018-506X (ISSN-L)
DOI: 10.1016/j.yhbeh.2023.105466
PMC: PMC10872410
OpenAlex: W4389158381
Cited by: 42
References: 119
Citations by year: 2026: 19 · 2025: 18 · 2024: 5
FWCI: 1.91
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (am, 303 d)
doi.org/10.15223/policy-017 (stm-asf)
doi.org/10.15223/policy-037 (stm-asf)
doi.org/10.15223/policy-012 (stm-asf)
doi.org/10.15223/policy-029 (stm-asf)
doi.org/10.15223/policy-004 (stm-asf)
Locations: Hormones and Behavior (acceptedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
UKnowledge (University of Kentucky) (submittedVersion)
Funders: National Institute of Mental Health and Neuro Sciences
National Institutes of Health
National Institute of Mental Health (R01-MH119119, RF1-MH120843, T32MH067631)
National Institute on Alcohol Abuse and Alcoholism (T32 AA027488)
American Psychological Foundation
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
Keywords: attention deficit hyperactivity disorder, menstrual cycle, sex differences, estrogen, pubertal hormones, organizational effects, activational effects, executive function, hyperactivity/impulsivity, inattention, periovulatory period, limbic system
MeSH terms: Adolescent, Attention Deficit Disorder with Hyperactivity, Cognition, Estrogens, Female, Humans, Male, Menstrual Cycle, Executive Function

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Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence

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