What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental  disorder of childhood that continues to affect women and men of all ages. 

In the UK, it is estimated that around 1.5 million individuals live with Attention Deficit Hyperactivity Disorder (ADHD). Many of these people do not have a formal diagnosis.

What are the symptoms of ADHD?

Symptoms of ADHD can include inattentiveness, hyperactivity and/or impulsivity. It is a chronic condition that can impact an individual in many aspects of their life (including their education, relationships and occupational functioning). Typically ADHD is diagnosed in childhood and often lasts into adulthood. The severity and impact of ADHD symptoms tend to vary across the lifespan.

ADHD was originally defined based on the observed behaviours of young boys, and it has long been thought to primarily affect males.

Modern day research tells us, however, that ADHD is not gender biased. Although males are still more likely to be diagnosed with ADHD in practice, the reality is that women experience the same type, number, and severity of symptoms as do males with the condition.

Women may be even more affected by their ADHD as it can remain undiagnosed for a longtime. Research and practice are both improving in an attempt to address the imbalance.

The challenges of identifying ADHD in women

Inattentive ADHD: Women are more likely to experience inattentive symptoms to a greater extent than the hyperactive and/or impulsive symptoms, which are more commonly associated with the male presentation. The inattentive sub-type can be subtle and more difficult to recognise. If you have inattentive ADHD, you’re more likely to have difficulties with concentration, organisation, and memory.

Internalising emotions: masking, and compensatory behaviours: Women often internalise how they feel, and they can ‘mask’ their symptoms in an effort to adhere to social norms and expectations. By doing so, they soon learn to compensate for many of their challenges. Although compensatory behaviours can be helpful, women with ADHD may appear as though they are in control of things, and as such, their challenges often remain hidden from others. This, in turn, complicates inner feelings and emotions for women with ADHD.

The mean age of ADHD diagnosis in women that have not been diagnosed as children is 36 to 38 years of age. This may be because of other disorders, or their children being diagnosed with ADHD.

ADHD and female hormones

Studies show that hormonal fluctuations and transitional periods in a woman’s life appear to influence the symptoms of ADHD.

ADHD and Menopause

Oestrogen is a key hormone that impacts the neurotransmitters in the brain required for attention, emotional regulation, organisational skills, and memory.

When you go through menopause, your oestrogen levels decline. This can, in turn, impact the neurotransmitters in your brain required for attention, regulating your emotions, organisational skills, and memory. 

Women without ADHD may experience this, but for women with an ADHD diagnosis, the peri/menopause can make your symptoms more severe, and the need for specialised treatment more likely.

Reduced oestrogen levels during the menopause also include a drop in dopamine levels, which are already lower in women with ADHD.

Will hormone levels impact my response to medication?

Everybody responds to medication differently. Generally, lower levels of oestrogen are often associated with less effectiveness from or less response to stimulant medications. Progesterone may also limit the potency of some medications.

ADHD and the menstrual cycle

Oestrogen is a key hormone that impacts the neurotransmitters in the brain required for attention, emotional regulation, organisational skills, and memory.

Studies have shown that the first two weeks of the menstrual cycle are smoother for ADHD women (due to a rise in oestrogen) compared to the end of the cycle (when progesterone increases).

Progesterone ultimately decreases the beneficial effects of oestrogens on the brain and may even decrease the effectiveness of ADHD medication as well.

It has also been suggested that women with ADHD may experience more severe premenstrual symptoms than women without ADHD.

Potential outcomes for undiagnosed women

Oestrogen is a key hormone that impacts the neurotransmitters in the brain required for attention, emotional regulation, organisational skills, and memory.

Women with undiagnosed ADHD can experience significant challenges in daily life without identifying the cause. They often fail to understand themselves, and societal expectations, particularly regarding gender norms, which can make women feel misunderstood by others too. This can significantly impact self-esteem, mental and emotional wellbeing, physical health, and social avenues. If ADHD is misdiagnosed, it is likely that women will not receive the treatment that they need to experience meaningful change in their lives.

What are the common adult symptoms of ADHD?

Common adult symptoms associated with ADHD are carelessness and a lack of attention to detail, continually starting new tasks before finishing old ones, poor organisational skills, inability to focus or prioritise, forgetfulness, losing or misplacing things, restlessness, speaking out of turn, blurting out answers and interrupting others, emotion dysregulation, irritability and a quick temper, impatience, an inability to deal with stress and risk taking. 

The symptoms may lessen, change, or take a different form, and can be influenced by several factors – for example, life demands and hormonal changes.

What can you do to help yourself as a woman with ADHD?

• Address myths: The easiest thing you can do is educate yourself about ADHD in women
• If you’re comfortable, be open about your diagnosis. Talk to others about how it affects you
• Know your cycle and your symptoms. Use an app (e.g., ‘Me v PMDD’) to monitor symptom severity throughout your monthly cycle. Identifying when you are at your best and worst will help you make important lifestyle adjustments. If you feel that your hormones are severely impacting your ADHD, talk to a doctor to discuss treatment options
• Seek professional support. Specialist ADHD services understand the challenges faced by women with ADHD and will be able to offer medical and/or psychological support

ADHD and the workplace

• Common symptoms causing problems within the workplace include:
  • Working memory
  • Time management
  • Regulation of emotions
  • Planning
  • Forethought
  • Learning from consequences 
  • Organisation 
  • Reconstitution of information

How is ADHD diagnosed?

At The Female Health Clinic our best practice diagnostic process is fully comprehensive, considering various factors that might be contributing to/explaining some of the symptoms experienced. 

A doctor Psychologist is required to complete an initial clinical screen prior to your ADHD assessment. Not everyone is clinically suitable to proceed with an ADHD clinical assessment.

Our assessments consist of:

• An extended clinical interview (undertaking clinical history and a diagnostic interview – DIVA-5)
• A review of standardised questionnaires
• A computerised task
• Information obtained from sources such as a partner, close friend, school reports, or health service reports. 

Your follow up consultation with one of our psychologists will ensure you understand the assessment findings and are offered the opportunity to consider and discuss the next steps if you would like further support in managing your symptoms. This might include self-directed learning, psychological therapy and/or coaching and medication.