Premenstrual Dysphoric Disorder and ADHD

A woman’s mental health can be dramatically affected by alterations in the natural fluctuation of hormones that occur during the menstrual cycle. The dips in estrogen after ovulation and right before your period can lead to worsened ADHD and PMDD symptoms. As can the drastic changes in your progesterone levels across your luteal phase. Further, the peaks of estrogen prior to ovulation and mid-luteal phase can lead to increased histamine and worsened PMDD symptoms. Read more to learn why:

Why do these hormone changes affect some women more than others?

Premenstrual dysphoric disorder (PMDD) is a more serious and debilitating form of premenstrual syndrome (PMS) that is more likely to affect neurodivergent women. PMDD is defined by debilitating affective and physical symptoms that affect women during the luteal phase of their menstrual cycle including:

·        Depressed mood, sadness, hopelessness, worthlessness, decreased interest in normal activities

·        Increased anxiety, tension, or the feeling of being on edge

·        Mood swings, Increased irritability, anger, or both

·        Self-critical thoughts, increased sensitivity to rejection

·        Frequent or sudden tearfulness

·        Conflict with family, coworkers, or friends

·        Concentration problems

·        Fatigue, lethargy, or lack of energy

·        Changes in appetite, such as binge eating, overeating, or craving certain foods

·        Changes in sleep pattern, such as excessive sleeping or difficulty sleeping

·        Feelings of being overwhelmed or out of control

·        Physical symptoms: breast tenderness, headaches, joint/muscle aches, weight gain, bloating

If you have these symptoms, consider using this screening tool to learn more.

Causes of PMDD Symptoms

Premenstrual dysphoric disorder (PMDD) is under-researched and not fully understood, but it is thought to be caused by numerous factors that affect your brain’s neurochemistry and communication circuits (e.g., hormones, inflammation, stress, genetics, sensitivity to hormones and hormonal changes). Sufferers typically notice severe mood changes one to two weeks before the start of their period, that resolve within a few days after their period arrives.

PMDD is linked to unstable progesterone concentrations and may also reflect a hypersensitive or abnormal reaction to changes in progesterone and estrogen. Further, the changes in hormone levels across your cycle can lead to debilitating PMDD symptoms by affecting important neurotransmitters such as serotonin and dopamine.

Changes in progesterone levels can alter one’s mood and sense of well-being. Further, progesterone can decrease dopamine in the prefrontal cortex, which can modulate emotional responses. Decreased dopamine in the prefrontal cortex is already a problem among those with ADHD, making emotion regulation (e.g., irritability, anger, mood swings) and executive dysfunction symptoms worse for those with PMDD.

 Serotonin is an important contributor to well-being, playing a role in sleep, sexual behavior, mood, and cognitive functions. Estrogen promotes synthesis, prevents degradation, inhibits the reuptake of serotonin, and promotes the expression of serotonin receptors. Thus, estrogen plays a large role in the overall mood of women. Drops in estrogen mid-cycle and right before your period can lead to a serotonin deficiency.

Furthermore, estrogen increases dopamine synthesis and decreases its degradation and reuptake. It improves working memory, decision-making, and pleasure. Thus, the dips in progesterone and estrogen during your cycle affect dopamine availability in the prefrontal cortex and both dopamine and serotonin throughout the brain. Accordingly, some people may feel worse after ovulation when estrogen and progesterone are low, then feel a bit better during their mid-luteal phase, and worse again when both drop near the start of their period. Still others may be sensitive to progesterone changes and may feel the effects of PMDD across their full luteal cycle (~15 days).

 Other Complicating Factors: Mast Cells and Histamine

Mast cells are a type of white blood cell, one of our immune cells, with different receptors that can bind different things and trigger the release of its contents, histamine being one of them. Histamine is an immune signaling amine and a neurotransmitter. Histamine, in its role as a neurotransmitter, works to control the sleep-wake cycle. It is excitatory and can increase norepinephrine and epinephrine levels, leading to anxiety and insomnia. As an immune signaling amine, histamine is released by mast cells. Histamine may then be received by four different receptors (H1 through 4), playing many roles in the body and brain.

Histamine has a strong connection to our hormones through mast cells. Mast cells have a receptor for estrogen which stimulates the release of histamine and down-regulates the DAO enzyme that clears histamine. Histamine release can then stimulate the ovaries to make more estrogen, resulting in what can be a vicious cycle of estrogen → histamine → estrogen → histamine.

Individuals can have varying levels of tolerance to histamine. Those with lower tolerance or mast cell activation (more common in neurodivergence) may have elevations in measurable histamine that can cause the following symptoms: allergies/congestion, heart palpitations, cold/ heat intolerance, skin changes including itchy skin, flushing or hives, heavy/painful cycles, headaches, and breast tenderness.

If your histamine bucket is full or you are sensitive to changes in histamine, you may not tolerate estrogen fluctuations seamlessly. Accordingly, histamine symptoms are more common in women and often track with the menstrual cycle, occurring when estrogen is high at ovulation and then again in the mid-luteal phase a few days before your period. That’s why mid-cycle and premenstrual mood symptoms can be aided by antihistamines (e.g., H1 and H2 blockers). If taking antihistamines helps some of your symptoms, then histamine may be contributing to your PMDD symptoms.

It is important to track your symptoms daily for a few cycles to understand the unique response you have to these fluctuations in your hormones across your cycle. See more about PMDD, treatment resources, and tracking options here.