When Hormones Hijack Your ADHD Brain (And What Helps)

Gina, 42, was diagnosed with ADHD two years ago. Shortly after, she sought therapy to understand the diagnosis and how it’s affected her development and her life now. 

Inviting her to reflect on the lifetime of experiences and symptoms that could have been ADHD related, she remembered how symptoms seemed to heighten during phases of emotional and physical change. Recent research shows hormone changes in puberty, menstrual cycles, pregnancy, postpartum and perimenopause/menopause have a significant impact on ADHD symptoms. 

The Estrogen-Dopamine Connection

One hormone that is most studied in women and ADHD is estrogen, as it plays an important role in regulating dopamine, one of the brain neurotransmitters that is altered in people with ADHD. For many women, estrogen plummets during the luteal phase of their cycle, changes drastically during pregnancy and postpartum and when perimenopause and menopause takes place. That’s a fair share of time in a woman’s life. Gina resonated with recent research.

She also recalled consistently feeling different, or fear of being perceived as different. She would overcompensate or adjust her appearance and behaviors to fit in with her peers. In her teens and early 20s, she thought people might not like her yet she didn’t have any real evidence this was true. Any constructive feedback sent her into a shame spiral that could last for days. Gina chuckled at an early memory with her first romantic partner. He asked her to return his favorite sweatshirt because he wanted to wear it. What she heard was “you stole my sweatshirt and I will break up with you now!” Gina remembered these types of interactions were fairly frequent.

Gina's experience echoed many other women with ADHD. There are links between the neurotype and intensification of symptoms during hormone changes. One overlooked and misunderstood symptom of ADHD consistently reported is Rejection Sensitivity Dysphoria (RSD). Understanding the link between hormone changes and RSD could help those with a diagnosis (or suspected diagnosis) increase acceptance of themselves and how the interplay of hormones and symptoms impact their life. 

Rejection Sensitivity Dysphoria: A Closer Look

Rejection Sensitivity Dysphoria is a distressing experience that includes feelings of rejection from family, friends, colleagues and partners, fear of disappointing others, and avoiding others for fear of overwhelming interactions. Many are aware that the people love them just the same during any phase of life, but sometimes naming it is not enough to prevent it from devastating their day or consuming their mind. The autonomic nervous system is more sensitive to flight-fight responses, in return, past rejections or anticipated fear of rejection can be activated more readily - particularly during hormone shifts. It can happen suddenly and be quite jarring. Common reports include feeling energized and balanced one day, to feeling completely disconnected and distracted the next without any clear situation to activate drastic shifts. To make things even more complicated, RSD can be invalidated by the person experiencing it and their loved ones.  

How to Support Yourself When RSD Hits

1. Get clear on what rejection truly is to you. It’s OK if the cashier at your local grocer doesn’t smile and ask how you are. 

2. Utilize shame resilience skills - what am I afraid will happen right now? Do I fear disconnection from someone? How can I nurture connection in a small way?

3. Plan to not function at your best - ask for help and do more organizing and planning on days or weeks when hormones and emotions are more leveled.

4. Talk to others in your life, utilize resources like ADDitudemagazine, ADHD podcasts and support tools.

5. Utilize mindful self-compassion - move toward the experience with curiosity and acceptance - remind yourself “what we resist, persists”.

6. Gently remind yourself that your experience is common among others with ADHD.

7. Use kind language when speaking to yourself. This is hard at times. The body and brain like to take the drivers wheel when all you want to do is go for a peaceful walk.

Angie Martin, LPC is a mental health therapist at North Star Therapy Collective licensed in Oregon California and Washington state. She supports people with ADHD and women who have difficulty identifying and expressing thoughts, emotions and experiences.