Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence

Ashley G. Eng, Urveesha Nirjar, Anjeli R. Elkins, Yancey J. Sizemore, Krystina N. Monticello, Madeline K. Petersen, Sarah A. Miller, Jordan Barone, Tory A. Eisenlohr-Moul, Michelle M. Martel

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations


Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that exhibits striking sex differences in symptoms, prevalence, and associated problems across development. Etiological factors and mechanisms underlying these sex differences remain one of the most understudied aspects of this disorder. The current paper seeks to provide a novel theoretical framework for understanding this phenomenon by reviewing evidence that females with ADHD may experience a “double whammy” of organizational and activational pubertal hormonal effects. We propose a novel theory of activational effects of cyclical circulating ovarian hormones on ADHD with increasing risk at times of rapid declines in estrogen. These declines may decrease executive function and trait control at two points of the cycle characterized by biphasic affective risk: (1) increases in approach/risk-taking behaviors at mid-cycle (periovulatory) and (2) increases in avoidance/negative affect perimenstrually. Low estrogen and control may then interact with increases in positive and negative affect, respectively, to increase hyperactivity-impulsivity symptoms post-ovulation and inattention symptoms perimenstrually. These interactions may be exacerbated by organizational pubertal effects on relatively overdeveloped limbic circuitry and adolescent-specific social pressures magnified in females with ADHD.

Original languageEnglish
Article number105466
JournalHormones and Behavior
StatePublished - Feb 2024

Bibliographical note

Publisher Copyright:
© 2023 Elsevier Inc.


  • Activational effects
  • ADHD
  • Affective risk
  • Menstrual cycle
  • Ovarian hormones

ASJC Scopus subject areas

  • Endocrinology
  • Endocrine and Autonomic Systems
  • Behavioral Neuroscience


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