“It is hard enough for girls and women to cope with ADHD symptoms, but when you add in hormonal ups and downs, it can be much worse,” says Jane Massengill, LCSW, a certified master ADHD coach in Danville, Calif. “These changes affect ADHD not only during monthly periods, but also during puberty, pregnancy, and menopause.” The hormone estrogen affects receptors in the brain that release the naturally occurring chemicals serotonin, dopamine, and norepinephrine. When estrogen levels drop during the weeks before a menstrual period or during the years before menopause, so does the level of these brain chemicals. Because symptoms of ADHD are affected by many of these same brain chemicals, it stands to reason that women with ADHD are more sensitive to estrogen. Symptoms of PMS, Low Estrogen, and ADHD During the first two weeks of a menstrual cycle, estrogen levels are high and women with ADHD may be in better control of their ADHD symptoms. As estrogen levels drop toward the end of the cycle, symptoms of low estrogen may start to make usual ADHD symptoms worse. “I notice that my normal brain fog and forgetfulness seem to get worse during that time, and I become more sensitive to any kind of stress," says Corinne Sheh, a 29-year-old mother in Randolph, Mass., at home with her first baby. Here are some typical symptoms that occur when low estrogen meets ADHD:

DepressionMood swingsSleep problemsIrritabilityAnxietyConfusionFatigue

Some women may notice an increase in these symptoms in the years before menopause, when estrogen levels gradually drop by 60 percent. On the other hand, hormone changes that occur during pregnancy, when estrogen levels are higher, seem to protect against ADHD symptoms and women may feel better. “I did notice less ADHD symptoms during pregnancy, and that seems to be continuing during breastfeeding,” Sheh says. Coping With Symptoms of ADHD and PMS If you have ADHD and severe PMS, there are things you can do to cope better with both conditions. “Check in with your doctor,” Massengill advises. “PMS can make ADHD harder to manage, especially if you are on medications for ADHD. Your doctor will also want to rule out other problems, such as a thyroid imbalance or depression ” Here are strategies you can use to better cope with symptoms of PMS and ADHD:

Keep a log or journal. Writing down when your ADHD and PMS symptoms appear and when they are at their worst can help you and your doctor set up a treatment plan.Be honest with your partner. Explaining your hormonal changes can make it easier for your partner to be supportive.Talk to your therapist. Mental health providers familiar with ADHD can help you set up management strategies.Learn stress reduction techniques. Deep breathing, meditation, and mind-body exercises like tai chi or yoga can be very helpful.Take it easy on yourself. Once you understand that PMS and ADHD are going to gang up on you at certain times, you can factor in some personal timeouts and ask for help when you know you are going to need it.

“It’s also very important to take good care of yourself physically during these times,” Massengill says. “That means eating well, getting enough sleep, and avoiding caffeine and alcohol. Two of the best ways to cope with ADHD and PMS symptoms are exercise and meditation.” ADHD and PMS can be a tough combination to deal with, but knowing why and what to expect is half the battle. Talk to your medical team and loved ones about your symptoms, ask for help and support, and take good care of yourself. You can find ways to cope, and you don’t have to do it alone.