Study Finds 40% of Women With ADHD May Have PMDD

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In a new study of over 700 women aged 18 to 34, investigators found that those with attention-deficit/hyperactivity disorder (ADHD) were significantly more likely to experience premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome (PMS) that causes intense mood changes, irritability, depression and anxiety before a menstrual period.

ADHD is often underdiagnosed in girls and women. This has left many questions unanswered about how female hormones may impact ADHD symptoms — or how ADHD might increase the risk for hormone-related conditions like PMDD.

“Females tend to be diagnosed with ADHD later in life, probably due, at least in part, to differences in ADHD symptom manifestation, because females may be more likely to exhibit inattentive symptoms and emotional impulsivity that may be less obvious to parents and teachers,” wrote lead investigator Thomas Broughton, Ph.D., a postdoctoral research assistant in the School of Biological and Behavioural Sciences at Queen Mary University of London.

Recent research has shed some light on the connection between ADHD and PMDD, with one study reporting that people with ADHD may be at greater risk of mental health issues, including postpartum depression, around times of hormonal change. Another study showed that 45.5% of people with ADHD met the criteria for provisional PMDD, compared with 28.7% of the general population.

In the current study, investigators identified eligible participants (both with and without ADHD) using an online research study recruitment platform. Although clinical diagnoses of ADHD were included, the team also used the Adult ADHD Self-Report Scale (ASRS) to capture those individuals who may have symptoms but have not been formally diagnosed. PMDD was assessed using the Premenstrual Symptoms Screening Tool (PSST), which examines feelings of anger, anxiety, increased sensitivity to rejection, depression, insomnia and fatigue — as well as symptom severity — in the days leading up to the beginning of the menstrual cycle.

Age, educational attainment and hormonal birth control use did not differ significantly between the ADHD group and the non-ADHD group. However, women in the ADHD group were more likely to report depression and anxiety.

Among participants with a clinical ADHD diagnosis, about one in three reported symptoms of PMDD. That number jumped to over 40% among those who met ADHD symptom criteria without a diagnosis. In comparison, fewer than 10% of women without ADHD met the criteria for PMDD.

The risk was even higher in women who had both ADHD and a diagnosis of depression or anxiety, highlighting how mental health conditions can overlap and worsen hormone sensitivity.

These findings suggest that PMDD may be more common in women with ADHD than previously recognized. They also emphasize the importance of health care providers asking about menstrual symptoms in women and girls with ADHD.

Investigators noted their research was strengthened by examining the link between ADHD and PMDD in a general population — not just people already receiving medical care. That helps avoid bias from studying only those with severe symptoms or better access to doctors. It also used standard symptom-based checklists to capture people who may not have a formal ADHD diagnosis but still experience the symptoms.

However, there were some limitations. Because this was a one-time (cross-sectional) study, the team was unable to use the gold standard for diagnosing PMDD, which requires daily tracking of symptoms across two full menstrual cycles. That means some participants may have been mistakenly classified as having PMDD, though even milder symptoms can still be distressing.

Investigators encourage future research to use more detailed, long-term tracking and larger, more diverse groups of people.

“A better understanding of the link between ADHD and times of hormonal changes may reduce health inequalities and diagnostic bias in females with ADHD,” they concluded.