PMDD and ADHD: Why So Many Women Have Both, and What It Means for Treatment

This article builds on PMDD Symptoms in Australia, where I covered what PMDD is, how it’s diagnosed, and the full range of treatment options. If you’re new to PMDD, start there. This piece goes somewhere I only touched on briefly last time: the striking overlap between PMDD and ADHD.

The number that should be getting more attention

If you have ADHD, your risk of also having PMDD isn’t marginally higher. Research published in the British Journal of Psychiatry (2025) found provisional PMDD in 31.4% of women with a clinical ADHD diagnosis, and 41.1% of women with high ADHD symptom levels - compared with 9.8% of women without ADHD. That’s roughly a three-fold increase in risk. An earlier 2020 study from the Journal of Psychiatric Research found a similar pattern: 45.5% of women with ADHD met criteria for provisional PMDD, against 28.7% in the general population. Risk climbs further again when anxiety or depression are also present.

In plain terms: if you have ADHD and a menstrual cycle, there is a very real chance PMDD is also part of your picture - whether or not anyone has named it yet.

Why the two conditions tangle together

The overlap isn’t coincidental. Oestrogen has a modulating effect on dopamine, one of the key neurotransmitters implicated in ADHD. As oestrogen drops in the luteal phase, that dopamine support drops with it - which means the attention, working memory, and emotional regulation difficulties that women with ADHD already manage can intensify significantly in the week or two before a period.

This creates two-way confusion:

PMDD can look like an ADHD flare. Poor concentration, overwhelm, forgetfulness, and disorganisation are core PMDD symptoms too, not just ADHD ones.

ADHD can mask PMDD, or vice versa. If a woman already attributes her bad weeks to “ADHD being ADHD,” the cyclical pattern underneath - the thing that would point to PMDD - can go completely unnoticed for years.

This is exactly the kind of pattern I described in my first PMDD article: symptoms that look psychiatric on the surface, with a hormonal driver underneath that never gets asked about.

The question that untangles it

The single most useful question I ask a patient with known or suspected ADHD is the same one I ask everyone: “Is there a time in your cycle when this isn’t there?”

If ADHD symptoms are roughly stable across the month, that’s ADHD alone. If there’s a clear worsening that arrives predictably in the luteal phase and lifts within days of your period starting - on top of a baseline that was already there - that’s very likely PMDD (or premenstrual exacerbation, PME) layered on top of ADHD. The distinction matters, because it changes where treatment focuses.

Two full cycles of tracking, exactly as I described in the first article, is what makes this visible. For women with ADHD, I’d add one thing: track it in whatever format you’ll actually stick to. Simple beats thorough. A three word note each evening is more useful than an abandoned spreadsheet.

What treatment looks like when both are present

The lifestyle bedrock, and the “treat the brain, treat the hormones, or both” framework from my last article, still apply here - they don’t change. What does change is the layer of coordination between ADHD management and PMDD treatment:

Timing matters more. If cyclical SSRI dosing is being considered for PMDD, we look at how that interacts with existing ADHD medication and its own dosing pattern across the month.

Stimulant response can shift with the cycle. Some women notice their usual ADHD medication feels less effective in the luteal phase - this is worth flagging specifically, because it’s often the hormonal dip, not a medication failure.

Hormonal stabilisation can help both conditions at once. For some women, stabilising the cycle (whether through a combined pill or body-identical hormone therapy, as covered in the first article) reduces not just PMDD symptoms but the premenstrual worsening of ADHD symptoms too.

Psychological support benefits from a clinician who understands both. The shame and self-blame that build up over years of unexplained “bad weeks” is significant, and it’s compounded when a woman has already been told her whole life that her struggles are “just her ADHD.”

Beyond the clinic: workplace advocacy

Perimenopause and menopause are, rightly, getting more airtime in workplace conversations. PMDD deserves the same - and the case is even stronger for women managing both PMDD and ADHD, where a predictable, cyclical dip in functioning is often happening on top of a baseline that already requires accommodation. Flexibility in hours, workload, and the kind of practical supports increasingly being discussed for perimenopause could make a real difference here too.

Frequently Asked Questions

Can PMDD be mistaken for an ADHD medication not working? Yes. If concentration, emotional regulation, or motivation seem to fall apart at a specific, repeating point each month rather than gradually, it’s worth tracking against your cycle before assuming a medication or dose change is needed.

Does treating ADHD also treat PMDD? No - they’re separate conditions requiring separate consideration, even though good ADHD management can make the overall picture easier to manage. Hormonal or SSRI-based PMDD treatment is usually still needed if PMDD is confirmed.

Should I get assessed for PMDD if I already have an ADHD diagnosis? If you notice a cyclical pattern to your worst weeks - and up to 45% of women with ADHD do have PMDD - it’s absolutely worth raising with your GP, using the tracking approach outlined in my first PMDD article.

Is this overlap officially recognised? Research into the ADHD-PMDD link is relatively recent and still growing, but the pattern is well-documented across multiple studies now. Clinical awareness is catching up more slowly than the evidence.

Getting Support

If you live with ADHD and suspect there’s a cyclical layer on top of it that’s never been properly named, I’d encourage you to start tracking and bring that data to an appointment. Dr Kafa Lee at Arami Women’s Health has a specific clinical focus on the overlap between PMDD, perimenopause, and adult ADHD in women.

Appointments are available in-person and via telehealth. Book online at aramiwomenshealth.com.au — Arami does not take phone or email bookings.

This article is general information and does not replace individualised medical advice. If you are experiencing thoughts of self-harm, please contact Lifeline (13 11 14) or the Suicide Call Back Service (1300 659 467), or call 000 in immediate danger.

Arami Women's Health | aramiwomenshealth.com.au | (03) 7048 4845 | Appointments via website only