If you’re a woman contending with the roller coaster that is ADHD, then you know that your monthly cycle only makes that all the more intense. It might even feel like you have bipolar disorder–during ovulation, you feel like you’re on top of the world, but as soon as PMS hits, it’s like your emotions take on a life of their own. You’re not imagining it – PMS really does make ADHD symptoms worse, and vice versa. Read on to discover some of the reasons what happens when PMS strikes with ADHD and what you can do to feel like you’re in better control of both your mind and your emotions.

The Dopamine-Estrogen-Progesterone Connection

One of the primary differences between a neurotypical brain and an ADHD one has to do with dopamine levels. More specifically, the dopamine levels in those with attention-deficit disorders are lower than in “normal” brains. Psychology Today provides a succinct explanation of how dopamine works in the brain:

“Dopamine is a neurotransmitter that helps control the brain’s reward and pleasure centers. Dopamine also helps regulate movement and emotional responses, and it enables us not only to see rewards but to take action to move toward them. […]The presence of a certain kind of dopamine receptor is also associated with sensation-seeking people, more commonly known as “risk takers.”

In short, dopamine controls how we view reward and pleasure, making you more likely to be impulsive or to crave chocolate. Low dopamine also affects concentration, motivation, and mood – in short, the same symptoms as ADHD.

In men, that’s pretty much the end of the story. However, in women, it’s different. Two primary female hormones, estrogen and progesterone, control how dopamine is processed in the brain. During the first half of your cycle, estrogen is high and progesterone is low. As a result, you feel great. However, during the last half of your cycle – around the same time as PMS and your period hit – estrogen levels drop and progesterone levels increase, making you more likely to have difficulty concentrating, controlling emotions, and controlling impulses. And because women with ADHD are more sensitive to low estrogen than neurotypical women, it’s all the more intense and harder to deal with.

Hormones and Medications

Part of how most ADHD medications work, and amphetamines, in particular, is through increasing dopamine levels or through making the brain process the neurotransmitter more slowly. It makes sense then that estrogen and progesterone would affect how the brain processes medications. For instance, taking estrogen generally makes ADHD medications more effective, and taking progesterone makes them less effective. While the synthetic progestins in birth control pills are not progesterone, there is some evidence that they can cause side effects similar to ADHD. Although research has not yet been done, it seems reasonable to conclude that birth control pills might also have a negative effect on ADHD symptoms.

What Can You Do?

Because so much of this has to do with how the brain processes dopamine, activities that increase dopamine should be your first step.

• Exercise is a great way to boost dopamine levels – there’s a reason why runners talk about having a “runner’s high”. Exercise can also be a good way to burn off some energy and vent some of that natural irritability that comes with PMS. The best way to do this is to find an exercise you really enjoy, whether it be running, cycling, or something more off-the-wall like Japanese sword-fighting, and do it every day.
• Omega-3 fatty acids increase dopamine levels. These are common in meats and fish, so try to eat more of those around the time that PMS starts. You should also take a daily supplement – this is one of those things where too much can’t hurt, and too little can be a problem.
• Get enough sleep. Your brain doesn’t use much dopamine levels when you’re asleep and when you sleep, it helps you to recharge your brain.
• It may feel impossible, but try not to stress. Anxiety depletes dopamine stores, which will make both PMS and ADHD symptoms all the worse. If you’re having trouble reducing stress, perhaps speak to your doctor about anti-anxiety medications.
• Vitamin C helps to reduce the speed of dopamine processing in your brain. Meditation also increases dopamine levels.

It isn’t in your head: your ADHD symptoms really do get worse when you are nearing the end of your cycle. Luckily, there are things that you can do about it. If the above tips aren’t enough to help you get through each month, talk to your doctor. Because of the differences in how women’s brains process amphetamines, adjustments may be needed for your medications.