Cognitive functions of regularly cycling women may differ throughout the month, depending on sex hormone status; a possible explanation to conflicting results of studies of ADHD in females
Open accessAbstract
Attention Deficit/Hyperactivity Disorder (ADHD) is considered as a model of neuro-developmental cognitive function. ADHD research previously studied mainly males. A major biological distinction between the genders is the presence of a menstrual cycle, which is associated with variations in sex steroid hormone levels. There is a growing body of literature showing that sex hormones have the ability to regulate intracellular signaling systems that are thought to be abnormal in ADHD. Thus, it is conceivable to believe that this functional interaction between sex hormones and molecules involved with synaptic plasticity and neurotransmitter systems may be associated with some of the clinical characteristics of women with ADHD. In spite of the impact of sex hormones on major neurotransmitter systems of the brain in a variety of clinical settings, the menstrual cycle is usually entered to statistical analyses as a nuisance or controlled for by only testing male samples. Evaluation of brain structure, function and chemistry over the course of the menstrual cycle as well as across the lifespan of women (premenarche, puberty, cycling period, premenopause, postmenopause) is critical to understanding sex differences in both normal and aberrant mental function and behavior. The studies of ADHD in females suggest confusing and non-consistent conclusions. None of these studies examined the possible relationship between phase of the menstrual cycle, sex hormones levels and ADHD symptoms. The menstrual cycle should therefore be taken into consideration in future studies in the neurocognitive field since it offers a unique opportunity to understand whether and how subtle fluctuations of sex hormones and specific combinations of sex hormones influence neuronal circuits implicated in the cognitive regulation of emotional processing. The investigation of biological models involving the role of estrogen, progesterone, and other sex steroids has the potential to generate new and improved diagnostic and treatment strategies that could change the course of cognitive-behavioral disorders such as ADHD.
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Fluctuations in ovarian hormones influence dopaminergic and noradrenergic signaling, with clinical reports describing symptom worsening during low-estrogen phases and across reproductive transitions.
“fluctuations in ovarian hormones influence dopaminergic and noradrenergic signaling, with clinical reports describing symptom worsening during low-estrogen phases and across reproductive transitions [137,138,139,140]”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [138]
The Introduction’s ‘Impact of sex hormones on brain structure and function’ section says estrogen and progesterone modulate neurotransmitter systems, including norepinephrine, and that dopamine D2-receptor availability may vary across the menstrual cycle. The Introduction also identifies reproductive transitions as periods of vulnerability to mood disorders, but it does not report clinical worsening of ADHD symptoms during low-estrogen phases or those transitions; it says studies had not examined the relationship between menstrual phase, hormone levels and ADHD symptoms. No page numbers are available in our copy. (LLM, conf=0.86)
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- Authors
- Haimov-Kochman, R., & Berger, I.
- Affiliations
- Hebrew University of Jerusalem (IL)
- ORCID
- Berger, Itai
- Venue
- Frontiers in Human Neuroscience
- Publisher
- Frontiers Media SA
- Published
- 2014-04-01
- Volume
- 8
- Pages
- 191-191
- ISSN
- 1662-5161 (ISSN-L)
- PMC
- PMC3978296
- OpenAlex
- W2036554223
- Cited by
- 40
- References
- 79
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 2 · 2023: 5 · 2022: 2 · 2021: 4 · 2020: 5 · 2018: 2 · 2016: 4 · 2015: 2 · 2014: 1
- FWCI
- 0.32
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Human Neuroscience (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- attention deficit hyperactivity disorder, menstrual cycle, sex hormones, estrogen, progesterone, women with ADHD, cognitive function, sex differences, menstrual cycle phases, brain development, neurotransmitter systems, synaptic plasticity
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