Female-specific pharmacotherapy in ADHD: Premenstrual adjustment of psychostimulant dosage
Open accessAbstract
Objective: Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition which is underdiagnosed and undertreated in women. For decades, the ADHD field has called for more insight into female-specific therapy. Preliminary findings postulate that changes in sex hormones during the menstrual cycle may influence the effectiveness of psychostimulant medication. Yet, pharmacotherapeutic interventions tailored to women with ADHD remain scarce. Previously, our group showed an increase in mood symptoms in the premenstrual week in women with ADHD. Premenstrual worsening of depressive and ADHD symptoms represent a treatment challenge. In our adult ADHD clinic, we noted several women describing exacerbation of their ADHD and depressive symptoms in the premenstrual week and/or insufficient effect of their established dosage of psychostimulant. We responded to the need expressed by these women by increasing their stimulant dosage in the premenstrual week, while monitoring the response and side effects. Methods: This community case study of nine consecutive women being treated for ADHD and co-occurring conditions (including depression and premenstrual dysphoric disorder), reports our local experience of increasing the individually prescribed psychostimulant dosage during the premenstrual period. We methodically monitored the effect of this increased dosage on ADHD symptoms, mood and somatic symptoms for the following 6-24 months. Results: With premenstrual dose elevation, all nine women experienced improved ADHD and mood symptoms with minimal adverse events. Premenstrual inattention, irritability and energy levels improved, and now resembled the other non-premenstrual weeks more closely. All women decided to continue with the elevated premenstrual pharmacotherapy. Discussion: Our preliminary results demonstrate potential benefits of increasing premenstrual psychostimulant dosage in women with ADHD, experiencing premenstrual worsening of ADHD and mood symptoms. The results concur with previous findings of diminished response to amphetamines in the late luteal phase. Increased dosage may help combat premenstrual worsening of cognitive and emotional symptoms in women with ADHD, with significant clinical implications. Better management of premenstrual ADHD and mood symptoms in vulnerable women can improve treatment outcome and meet an unmet need. However, implementation should be individually explored. Further investigation of luteal phase psychostimulant dose adjustment is required for safe, optimal and individualised treatment for women with 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 [137]
The Discussion (page not provided) links hormonal fluctuations to dopaminergic transmission and reports increased ADHD symptoms during low-oestrogen phases. It also mentions postpartum depression and perimenopausal symptoms during other low-oestrogen periods. Our copy does not establish an effect on noradrenergic signaling, and its reports across reproductive transitions are not specifically reports of worsening ADHD symptoms. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSymptom exacerbation premenstrually, postpartum, and during menopause may require adjustments to stimulant timing or adjunctive strategies.
“symptom exacerbation premenstrually, postpartum, and during the menopause may require adjustments to stimulant timing or adjunctive strategies [137]”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [137]
The Discussion’s Clinical implications section recommends individualized premenstrual stimulant dosing and timing, with an SSRI as a possible complement when mood symptoms persist (page unavailable). The Discussion mentions postpartum depression and perimenopausal symptoms, and one patient considered hormone replacement therapy, but the paper does not recommend stimulant-timing adjustments or adjunctive strategies for postpartum symptoms or menopause generally. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIncreasing psychostimulant dosage in the premenstrual week benefits women with ADHD and premenstrual worsening of ADHD and/or mood symptoms.
“In addition, we recently described the benefits of increasing psychostimulant dosage in the premenstrual week for nine women with ADHD and premenstrual worsening of ADHD and/or mood symptoms [42].”
From A Female-Specific Treatment Group for ADHD—Description of the Programme and Qualitative Analysis of First Experiences (2024) · cites this paper as [42]
During periods of low oestrogen, increased ADHD symptoms and decreased response to psychostimulant medication have been described.
“Additionally, during periods of low oestrogen, increased ADHD symptoms [30,41,91,92] and decreased response to psychostimulant medication [25,42,93,94,95] have been described.”
From A Female-Specific Treatment Group for ADHD—Description of the Programme and Qualitative Analysis of First Experiences (2024) · cites this paper as [42]
Increased psychostimulant dosage in the premenstrual phase relieved worsening ADHD and mood symptoms in all nine consecutive cases in a published case series.
“We reported relief of worsening ADHD and mood symptoms premenstrually in all nine consecutive cases [42].”
From A Female-Specific Treatment Group for ADHD—Description of the Programme and Qualitative Analysis of First Experiences (2024) · cites this paper as [42]
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- Authors
- de Jong, M., Wynchank, D. S. M. R., van Andel, E., Beekman, A. T. F., & Kooij, J. J. S.
- Affiliations
- PsyQ (NL)
- GGZ inGeest (NL)
- Corresponding author
- Wynchank, D. S. M. R.
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2023-12-13
- Volume
- 14
- Pages
- 1306194-1306194
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC10751335
- OpenAlex
- W4389678734
- Cited by
- 39
- References
- 45
- Citations by year
- 2026: 19 · 2025: 19 · 2024: 1
- FWCI
- 7.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- adult ADHD, women with ADHD, luteal phase, menstrual cycle, sex hormones, premenstrual dysphoric disorder, depression, mood symptoms, inattention, individualized drug therapy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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