ADHD in Women: Understanding Differences

Attention Deficit Hyperactivity Disorder (ADHD) in women is complex and currently under-diagnosed and under-represented with doctors still following gender-specific, biased diagnostic criteria but, despite common misconceptions, ADHD affects women just as much as men.

A big problem with female ADHD diagnoses right now is societal and cultural biases which lead to underdiagnosis or even misdiagnosis.

“Women will typically (but not always) internalise more, social norms and what’s expected of women, the additional work they are required to take on (childcare, caring, running the show in many cases) has a role to play in how they experience ADHD due to the levels of demands and responsibility they have.”Liz Mulhall-Brewer

According to a study published in The Journal of Clinical Psychiatry, the rate of ADHD diagnosis among women has increased by 55% in recent years, compared to just 40% in men which clearly indicates that awareness around the differences Males and Females with ADHD face on a day to day basis is becoming more apparent.

But, is it enough?

Symptoms of ADHD in females

You likely stumbled upon this guide by searching something like, what are the symptoms of ADHD in women? right? Well, while there is a lot of overlap in symptoms between males and females, we need to also remember that ADHD, much like Autism, is a spectrum of challenges. Spectrum implies that not everyone is the same and everyone is unique which can make diagnosis trickier for some rather than others.

Research shows that women with ADHD primarily leaning towards the inattentive ADHD subtype but that is by no means an absolute, again, ADHD/ADD is a spectrum of challenges and can manifest itself differently regardless of gender or age.

ADHD is like an artists easel; Full of colour, mixing and blending in a unique way – no artists easel is the same, right?

Welcome to the world of ADHD.

Common: Inattentive ADHD in Women

• Trouble staying focused
• Appearing not to listen when spoken to
• Being easily distracted
• Disorganization or messiness
• Difficulty paying close attention to details
• Making careless mistakes in tasks
• Forgetting routine tasks
• Avoiding tasks that require sustained concentration
• Frequently losing things like books, keys, or papers
• Not following through on instructions
• Difficulty organizing and completing tasks
• Failing to meet deadlines

Uncommon: Hyperactive ADHD in Women

• Difficulty playing quietly
• Acting or speaking without thinking
• Difficulty waiting their turn, such as in line
• Interrupting or blurting out responses
• Fidgeting constantly
• Difficulty staying seated
• Talking excessively
• Trouble keeping on one topic
• Making and losing friends quickly

Combined ADHD in Women

Combined ADHD in women represents a subtype of Attention Deficit Hyperactivity Disorder where both inattentive and hyperactive-impulsive symptoms are present. This form of ADHD is particularly complex as it encompasses a wide range of symptoms that can significantly impact various aspects of life.

Females were more impaired as compared to men in most of the effects of ADHD like social functioning, time perception, stress tackling and mood disorders. Males were more impaired in working memory and educational functioning as compared to femalessource

Diagnosing combined ADHD in women can be challenging due to overlapping symptoms with other conditions and the stereotypical perception of ADHD as a male-dominated disorder. Furthermore, societal expectations often pressure women to mask their symptoms, making it difficult for healthcare providers to recognize and diagnose the condition accurately.

Learn more: The Different Types of ADHD: Unravelling the Intricacies

Hormone & Menstrual Cycle Impact

Unlike men, women have to deal with a myriad of hormones and emotions which can make it extremely hard to regulate and function even for some who doesn’t live with ADHD. The core hormone responsible for the ups and downs and periods where managing things might seem easier than normal is estrogen.

The Hormonal Cycle

The menstrual cycle can be divided into several phases but two distinct hormonal cycles with higher levels of estrogen and lower levels. There is a secondary hormone at play called progesterone which supports pregnancy functions and the later stages of the cycle.

First-half: High estrogen

• Follicular Phase: Following menstruation, estrogen levels rise, often leading to improved mood and cognitive functions. Women with ADHD may experience a temporary alleviation of symptoms during this phase.
• Ovulatory Phase: This phase may present a peak in ADHD symptom management, correlating with the highest levels of estrogen.

Second-half: Low estrogen

• Luteal Phase: The decline in estrogen and higher progesterone levels during this phase can lead to increased ADHD symptoms, often worsening premenstrual symptoms (PMS) and can contribute to greater emotional dysregulation and inattentiveness.
• Menstrual Phase: While some women report a continuation of heightened symptoms, others experience relief as the cycle restarts and estrogen levels begin to rise again.

Estrogen’s Impact on ADHD

Estrogen is known to interact with neurotransmitters that are pivotal in cognitive functions and mood regulation, such as dopamine, serotonin, and norepinephrine amongst others. These specific neurotransmitters are also crucial in managing attention, impulsivity, and emotional responses, which are core challenges encountered by both men and women with ADHD.

A study in 2017 found a correlation between higher estrogen levels and better cognitive function, attention and executive decision making.

Women experience natural fluctuations in estrogen and progesterone levels throughout their menstrual cycle, during pregnancy, and in menopause, and these fluctuations can lead to corresponding changes in ADHD symptoms.

Hormonal Implications for Treatment

Higher levels of estrogen, particularly in the first half of the menstrual cycle, can enhance the effectiveness of medications used to treat ADHD by increasing the availability of neurotransmitters.

However, during the latter half of the cycle, as estrogen levels decline, women may experience a worsening of ADHD symptoms. This can manifest as increased difficulty with focus, heightened emotional sensitivity, and greater challenges with impulse control. The drop in estrogen levels post-ovulation can particularly exacerbate these symptoms, leading to more pronounced ADHD manifestations during the premenstrual and menstrual phases. Understanding the relationship between estrogen and ADHD is crucial for tailoring treatment and management strategies for women with the disorder, especially in ensuring that these strategies are responsive to hormonal changes.

Female ADHD Diagnosis

The ADHD diagnosis process for females can often be complicated due to presentation of challenges as well co-occuring conditions and the added pressure of societal and cultural biases as well as the pressure on women as whole.

Co-occurring Conditions

There is a high prevalence between ADHD and a small-group of co-occurring conditions which can also make the diagnostic process more complicated both because of the recurrence but also because of misdiagnosis.

Here is a list of co-occurring conditions;

• Any Anxiety Disorder: 47.1%.
• Any Mood Disorder: 38.3%.
• Social Phobia: 29.3%.
• Obesity (Obese): 29.4%.
• Specific Phobia: 22.7%.
• Bipolar Disorder: 19.4%.
• Intermittent Explosive Disorder: 19.6%.
• Major Depressive Disorder: 18.6%.
• Generalized Anxiety Disorder: 8.0%.
• Panic Disorder: 8.9%.
• PTSD: 11.9%.
• Agoraphobia: 4.0%.
• Obsessive-Compulsive Disorder (OCD): 2.7%.
• Dysthymia (mild, chronic depression): 12.3%.
• Any Substance Abuse Disorder: 15.2%.
• Alcohol Abuse: 5.9%.
• Alcohol Dependence: 5.8%.
• Drug Abuse: 2.4%.
• Drug Dependence: 4.4%.

Do keep in mind that these statistics are normalised across the entire adult ADHD population and is not restricted to just women. This is something I just couldn’t find the answers to in my research. Regardless, it provides great insight into the other challenges you may face when trying to get a diagnosis.