Birth Control and ADHD: The Basics

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With around 10 million adults suffering from ADHD, it’s important to know what can worsen or control its symptoms. As a woman with ADHD, you may have noticed your symptoms are more intense when you get your period. How can you use birth control methods while keeping your ADHD symptoms in check?

Birth control pills can help reduce ADHD symptoms. The estrogen in the pills can help increase dopamine and the brain’s ability to process it, boost mood, and increase focus. However, the progesterone content in the pill, contraceptive implants, and IUD may limit or even negatively interact with the effectiveness of your ADHD medications.

Read on to learn more about the influences of hormones and birth control on ADHD symptoms. We’ll also talk about ADHD symptoms and different hormonal levels during different periods.

What Hormones Affect ADHD?

ADHD (Attention Deficit Hyperactivity Disorder) is a brain-related condition that develops in childhood and continues well into adulthood if left untreated. The most common symptoms are, stress, difficulty concentrating, poor performance at work, and even substance abuse.

Other symptoms include:

Restlessness.
Impulsiveness.
Lack of organization.
Excessive talking accompanied by interrupting others.

Since ADHD is a complex condition, scientists believe that a multitude of factors can cause it. Many researchers have suggested that genetics is the most important cause. But other factors, including low birth weight, premature birth, exposure to lead, and brain injury, can cause ADHD.

Certain hormones also contribute to ADHD. The most important hormones and neurotransmitters that can affect ADHD symptoms are serotonin, dopamine, and norepinephrine. They affect mood, memory, and concentration by regulating our emotional responses and how we view rewards.

But studies suggest that sex hormones can also worsen ADHD symptoms. That’s why women can experience different symptoms during their menstrual cycle. Plus, ADHD symptoms in boys reduce after puberty, but they increase in girls, which could be linked to hormonal changes.

Androgens and estrogens affect neural functions, including cognition, mood, and memory. What’s more, estrogen can affect serotonin activity, which is a critical factor in regulating mood and behavior.

Girls experience severe fluctuations in these hormones after puberty and during menstrual cycles. According to scientists, ADHD symptoms worsen during the final days of the menstrual cycle before menstruation starts. That’s because estrogen levels are at their lowest during these days of the cycle.

Another evidence that shows hormones can affect ADHD is the influence of pregnancy on ADHD symptoms. Pregnancy can create profound hormonal changes, leading to severe mood swings during different trimesters. Women with ADHD report that their symptoms weaken when their estrogen levels increase.

That’s why regulating these sex hormones can help control ADHD and other mood and behavioral problems.

ADHD and the Pill

The oral contraceptive pill contains optimal levels of estrogen and progesterone to regulate these hormone levels in the body.

Although there’s very little research on the relationship between ADHD and sex hormones, some studies have suggested that taking the pill can regulate mood . These pills can also improve brain function and boost cognitive performance in women.

And even if you take medications for your ADHD, you may feel that they don’t have a significant effect on your symptoms at some point in your menstrual cycle. That’s because progesterone can inhibit the chemicals in your meds.

A study investigated the effectiveness of an ADHD medication called AMPH in two menstrual phases: during the follicular phase when estrogen and progesterone levels are low and the mid-luteal phase when these two hormones are high.

The results showed that estrogen can enhance the effects of stimulants, but progesterone masks these effects.

That’s why some doctors recommend increasing the dosage of ADHD medications before menstruation. The amount you take depends on your symptoms and hormonal levels, so you may need extra doses before or during your period or both.

Another study found that women who took contraceptives experienced fewer ADHD and PMDD symptoms. Interestingly, those on antidepressants reported more PMDD symptoms.

ADHD Medication and Birth Control

There are two common types of medication to control ADHD. These stimulant drugs increase dopamine and help patients focus. Concerta and Ritalin contain methylphenidate, and Adderall contains amphetamine, all of which target dopamine transporters and raise dopamine levels.

Although studies suggest that hormone replacement therapy and contraceptive pills can help manage ADHD symptoms, you should take some precautions. Like any other medication, these solutions aren’t risk-free. According to research, birth control can raise the risk of hypertension, which may lead to a stroke or heart attack. They can also contribute to breast cancer and cervical cancer.

Similarly, ADHD drugs also can have long-term side effects that worsen if combined with birth control pills. These stimulants can also lead to hypertension and, consequently, heart disease. Other side effects include mood changes, weight gain, depression, and headaches.

That’s why you should consult with your healthcare provider before taking these medications. Discuss any family history, especially of high blood pressure and heart disease.

IUD and ADHD

IUDs (Intrauterine Devices) are contraceptive devices that come in different types and mechanisms. They either use hormones or copper as a spermicide to prevent pregnancy. They keep sperm cells from fertilizing the egg by changing the way they move.

Hormonal IUDs use the hormone progestin, which thickens the cervical mucus, blocking the sperm cells from reaching the egg.

As mentioned earlier, progestin can exacerbate ADHD symptoms. High levels of progestin, together with low estrogen levels, are responsible for the mood swings women experience during their cycles.

Progestin interferes with the effects of ADHD medications, reducing their effectiveness.

Additionally, progesterone can increase blood pressure. If you use IUD and take medications such as Vyvanse, you should talk to your doctor and keep your blood pressure in check. Vyvanse is also known to contribute to hypertension, worsening the effects of progesterone.

Birth Control Implants and ADHD

Contraceptive implants, placed under the upper arm’s skin, are another type of long-term birth control. They work by releasing a low and constant dose of progesterone to suppress ovulation and thicken the cervical mucus. They contain no estrogen and, as mentioned earlier, can interfere with ADHD medication.

Plus, progesterone can be dangerous if you have a history of high blood pressure and cholesterol. So, you should talk to your physician before using these implants.

ADHD and Different Phases of the Menstrual Cycle

Dealing with ADHD is difficult with all the irritability, inattention, and overactivity. Unfortunately, hormonal fluctuations can intensify these symptoms, making life with ADHD ever more challenging for girls and women of all ages.

Depending on your age, your estrogen levels fluctuate, which have different effects on your ADHD symptoms.

Puberty

Girls who experience early stages of puberty have difficulty managing their ADHD symptoms, experiencing severe mood swings and irritability. That’s because of increased levels of estrogen and progesterone.

Even when teenage girls are on ADHD medication, their brain metabolizes the medicine more quickly. So, they require higher doses of medication. Plus, the higher progesterone levels make the medications less effective.

During the menstrual cycle, estrogen levels fluctuate wildly. The first day of the cycle, which is when menstruation starts, comes with increased estrogen levels. They continue to rise until ovulation when they drop dramatically and progesterone levels increase. The worst is the last days of the cycle, when both estrogen and progesterone dive, making you feel miserable and irritable.

Pregnancy

During pregnancy, estrogen levels increase, reducing the severity of ADHD symptoms. Doctors may even decide to stop ADHD medications during pregnancy, both because of estrogen levels and the side effects of the medications on the baby.

So, you may experience challenges because you’re off your medication, and estrogen levels may not be enough to make the symptoms go away. Plus, the anxiety that comes with the anticipation of a new baby, caring for your other children, and work stress are all strong enough to cancel out any positive effect of higher estrogen levels.

Postpartum

Maybe the hardest time in terms of experiencing ADHD symptoms is after your baby is born. Estrogen levels sink postpartum and can usually be accompanied by postpartum depression, making things even more problematic.

If you have depression and ADHD before pregnancy, the stress and lack of sleep will likely exacerbate the ADHD symptoms. Talk to your doctor about the most useful choice of medication, especially if you’re breastfeeding.

Perimenopause

Perimenopause, which starts in the late 30s and early 40s, is the transition time between reproductive years and menopause. During this time, controlling ADHD symptoms can get more difficult because of the higher fluctuations in estrogen.

Depression and anxiety can also appear, making your ADHD worse. Talk to your doctor about adjusting your medication dosage and other conditions you’re experiencing.

Menopause

During menopause, which is between the 50s and 60s, there’s a significant drop in estrogen levels (about 65 percent). Menopause makes women feel moody, irritable, depressed, tired, and sad, which is even more difficult if a woman has ADHD.

That’s why some doctors consider hormone replacement therapy for their patients. However, you may experience less severe symptoms because estrogen levels tend to stabilize. Plus, ADHD symptoms don’t usually worsen with age, especially if you’ve been diagnosed early and have been taking medications to control it.

How To Manage Hormones and ADHD

Although hormonal changes can make life with ADHD more difficult, you can control it with an ADHD-friendly lifestyle. Talk to both your psychiatrist and gynecologist about your conditions. Facilitate communication between the two doctors to help them develop a better treatment plan.

Track your cycle and take notes of mood swings to get a clearer idea of how your hormones affect your mood. This way, you can help your doctor adjust your stimulant medication doses based on the day in your cycle.

Such adjusted medication can increase the effectiveness of stimulants without affecting them via progesterone levels. Plus, your doctor can give you antidepressants and anti-anxiety drugs for specific days of your cycle to help you through the phase.

While medication can play a vital role in taking ADHD symptoms under control, behavioral solutions can also be equally helpful.

Getting Enough Sleep

While lack of sleep can affect people’s moods regardless of their conditions, women with ADHD often have trouble falling asleep more than others. Sleep deprivation can worsen ADHD symptoms, while proper sleep can alleviate these symptoms.

Maintaining proper sleep hygiene can help you get a good night’s sleep and stay focused during the day.

Don’t drink coffee after 2 p.m.
Don’t exercise before bed.
Reduce screen time as much as possible.
Have a fixed bedtime routine and go to bed at a specific time, even on weekends.

Exercise Regularly

The best way to curb the hyperactivity associated with ADHD is to work out. It’s so beneficial for boosting focus, giving energy, and enhancing brain power that it has been compared to ADHD medication. So, it’s crucial to incorporate workouts in your daily life just like you do with your medication.

Exercises that get your heart rate up, make you breathe faster, and get your muscles worked up are the best for your symptoms. Running, swimming, biking, and dancing are the most effective types. If you’re not sure which exercises are suitable for you, consult your physician.

Make sure to go outdoors, get a lot of sunshine, and spend time in nature to help reduce stress. Plus, you can try more relaxing activities such as yoga and meditation. This way, you can control your inattention and impulses.

Have a Healthy Diet

An unhealthy diet will affect all aspects of your well-being and make management of ADHD symptoms all the more difficult. So, cut down on sugar, junk food, and fried food as much as possible. Eat enough fiber, healthy fats, and vitamins to help reduce hyperactivity and lack of focus.

Final Thoughts

Different hormones, such as dopamine and serotonin, can help reduce ADHD symptoms. However, sex hormones, including estrogen and progesterone, can also affect ADHD.

Since the amount of these hormones varies depending on age and the day in the menstruation cycle, maintaining high estrogen levels can help women with ADHD.

Birth control pills can be helpful, but you need to consult your physician if you have a family history of heart conditions or hypertension.