How to help your daughter with ADHD manage her period & PMS

If you’re a parent of a daughter with ADHD, you know that puberty, periods, and PMS can be especially challenging for her. The menstrual cycle has a significant impact on ADHD symptoms, but ADHD medication also makes it more likely that she’ll have premenstrual syndrome (PMS). However, there are things you can do to help her manage her emotions and prepare for her period.

In this blog, we lay out why ‘that time of the month’ can be an emotional rollercoaster for her, and what you can do as a parent to provide her with the extra love, understanding, and support she needs.

The impact of estrogen on ADHD symptoms

Speaking to CHADD¹, Dr Patricia Quinn, author of Understanding Women with AD/HD, explains that changes in estrogen (female sex hormone) levels at puberty and during the menstrual cycle can worsen both ADHD symptoms and PMS symptoms. The ADHD support website reports this could be due to hormone sensitivity: people with ADHD have reduced dopamine levels, and the hormone fluctuations may be more likely to reduce dopamine to critically low levels, leading to more severe feelings of exhaustion, moodiness, and lack of motivation.

Consequently, some women find that their symptoms may flare and their medications don’t work as well. Since women with ADHD are more likely to have predominantly inattentive ADHD, you may notice your daughter having more difficulty paying attention, getting organized and sticking to tasks, difficulty controlling her emotions, and losing or forgetting things.

PMS & PMDD

PMS usually includes physical and emotional discomfort and affects about 48% of women. There is also a subgroup of women (between 3 and 8%) that experience a severe form of PMS – with extreme mood and behavioral symptoms – called premenstrual dysphoric disorder (PMDD). PMDD disproportionately affects women with ADHD (est. almost 50%) and autism (est. 90%). In the week before a period, women can feel depressed, anxious, and have mood swings.

The effect of ADHD medication on PMS symptoms

Not only does the menstrual cycle affect ADHD, but ADHD medication can also have an effect on periods:

• The stimulants, dextroamphetamine and amphetamine, list painful menstrual cramps as a possible side effect.
• The stimulant, methylphenidate, might cause heavier menstrual bleeding.
• The non-stimulant SNRI, atomoxetine, also includes heavy, irregular, or painful periods as a possible side effect.

How to help your daughter

As your daughter enters puberty, she may be embarrassed by what’s happening to her body. Therefore, it’s important to speak to her openly about menstruation so that she develops a healthy, more confident attitude towards her body.

Here are a few preparation tips to help her reduce stress every month:

• If she has projects or papers due during or shortly after her period, suggest that she gets a head start on them to avoid unnecessary stress.
• If PMS is making her feel over-emotional or extra tired, suggest that she rests and not make plans with friends for those few days each month.
• Make sure that she gets enough sleep and even suggest an earlier bedtime if you feel that she needs more sleep.
• Buy pads or tampons ahead of time, and ask her to note down when she’s about to run out.
• Ensure that she has a toiletry bag with extra sanitary products and underwear with her before and during her period – in her school bag and/or a bag that she uses out of school.
• Set a reminder on her phone to change her pad/tampon at regular times during the day.
• Use extra pads/tampons at night to avoid waking up to an accident in the morning.

Treatment

Some girls find that their ADHD medications don’t work as well during their period. If your daughter is struggling to cope with her ADHD symptoms during PMS or her period, speak to your doctor about adjusting her medication during that time.

If PMDD becomes an issue, Dr. Quinn says that stimulants may be combined with other therapies including antidepressants, such as serotonin reuptake inhibitors (SSRIs), and hormonal contraceptives. Furthermore, lifestyle changes – improved diet and exercise – may also improve some symptoms.

Helping your daughter understand how her fluctuating hormones affect her ADHD symptoms – whether during the menstrual cycle or at different life stages – may help her cope better, which ultimately leads to better outcomes as she matures.