Risk of premenstrual dysphoric disorder in women with attention-deficit hyperactivity disorder

Background

ADHD in women often goes unseen. It may look like constant distraction, overwhelm, or fatigue, rather than hyperactivity. We also know little about how ADHD interacts with hormonal cycles. This study asked whether ADHD and monthly hormonal shifts are linked.

Aims

The researchers wanted to know if women with ADHD are more likely to have PMDD (a severe form of premenstrual mood change). They studied women with formal ADHD diagnoses and women who showed ADHD traits but were undiagnosed.

Method (Page 1)

715 women, ages 18–34, took part. All were assigned female at birth and had regular cycles. Some had ADHD diagnoses. Others showed ADHD traits using a screening tool. PMDD was measured with a validated checklist that captures severity in daily life. The researchers compared three groups: ADHD, ADHD plus anxiety/depression, and non-ADHD.

Method (Page 2)

• Recruitment: Participants came from Prolific, an online research platform. Only UK women ages 18–34 with regular periods were included.
• Exclusions: Pregnant, menopausal, or non-cycling women were excluded. Incomplete responses were removed.
• ADHD Diagnosis: Women who reported a clinical ADHD diagnosis were put in the “diagnosed” group.
• ADHD Traits: Others completed the Adult ADHD Self-Report Scale (ASRS). If symptoms interfered with daily life, they were put in the “ASRS-based ADHD” group.
• Mood Disorders: Participants also reported past diagnoses of anxiety or depression.
• PMDD Screening: The Premenstrual Symptoms Screening Tool (PSST) identified “provisional PMDD” if mood, energy, and functioning were strongly disrupted before periods.
• Analysis: Statistical models compared the risk of PMDD across groups.

Results

• ADHD & PMDD: PMDD was more common in ADHD groups. About 1 in 3 diagnosed women and nearly 1 in 2 ASRS-based women showed signs.
• Comorbid Conditions: Risk was over 4x higher for women with ADHD plus anxiety or depression.
• ADHD Alone: Even without anxiety or depression, ADHD women had higher risk than non-ADHD women.

Conclusions

Hormonal changes affect mood, focus, and energy. ADHD may amplify this effect. For women with ADHD, premenstrual emotional crashes are real and measurable.

Limitations

• Self-selected UK sample
• Self-reported data
• Only ages 18–34

Future Directions

• Study ADHD-hormone links across the lifespan
• Examine treatment options (medication, lifestyle, hormone therapy)
• Track daily symptoms for real-time data

Clinical Implications

• Screen ADHD women for PMDD
• Normalize cycle-linked emotional crashes
• Encourage cycle tracking
• Provide layered support (ADHD strategies, mood care, body-based tools)

Lundin, C., Hindley, G. F., Lucas, N., Wernström, A., Andrén, P., Serlachius, E., Kuja-Halkola, R., & Brikell, I. (2025). Risk of premenstrual dysphoric disorder in women with attention-deficit hyperactivity disorder. The British Journal of Psychiatry, 226(6), 410–417. https://doi.org/10.1192/bjp.2025.104