Vyvanse and PMS: The Basics

Written by sarah in Hormones

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While medications such as Vyvanse are highly effective at treating the symptoms of ADHD, they’re not devoid of side effects. Some of the most common include difficulty sleeping, decreased appetite, heart problems, Serotonin syndrome, and more. One of the least commonly understood side effects is Vyvanse’s effect on PMS.

Vyvanse is reported to result in irregular reproductive cycles. Irregularity is reported relatively early, including in people who’ve been taking the drug for less than a month. Other reported interactions between Vyvanse and PMS include the medication not working during the luteal phase of the menstrual cycle.

The rest of the article will look at the effect of the menstrual cycle on the effect of stimulants, including Vyvanse, the effect of ADHD on PMS, and whether ADHD medications can result in a more severe menstrual cycle.

Vyvanse and Menstrual Cycle

As mentioned above, Vyvanse has been reported to interact with the menstrual cycle in two ways, these are:

  • Vyvanse doesn’t work during the luteal phase of the menstrual cycle.
  • People self-report irregular cycles when taking Vyvanse.

There’s no completed clinical study, as of yet, that explains the relationship between irregular cycles and Vyvanse, nor does it corroborate this. However, an independent Phase IV clinical study conducted on eHealthMe reports that this condition is most common in respondents aged 20 to 29.

Additionally, self-reported data on websites such as Reddit and Drugs.com show that many people taking Vyvanse experience cycles that are different, irregular, or have stopped completely. 

The issue is found to resolve itself when respondents are no longer taking Vyvanse, for whatever reason, suggesting there may be a causal relationship between the two.

The reason for this relationship isn’t immediately apparent. While Vyvanse does affect the sympathetic nervous system and hormones associated with it, such as norepinephrine and dopamine, it hasn’t been reported to impact the female reproductive system. 

At the same time, it’s essential to remember that the hormonal system plays a significant part in the menstrual cycle. Even the slightest changes can affect its regularity, which may explain why Vyvanse impacts PMS the way reports suggest it does.

Stimulants and Menstrual Cycle

Aside from irregular menstruation, another way the menstrual cycle and Vyvanse interact is that the drug is reported to stop working right before menstruation, during the luteal phase. To understand why this is the case, it’s essential to first understand Vyvanse better. Like Adderall, another ADHD medication, Vyvanse is a stimulant.

Stimulants are a category of drugs that make users feel alert, energetic, and confident. They speed up the movement of messages between your brain and your body and can also cause reduced appetite. This is why Vyvanse is also used as a treatment for binge-eating disorders. Stimulants are also available naturally and include caffeine and betel nuts.

The relationship between stimulants and the menstrual cycle isn’t well studied. However, some evidence suggests menstruating people tended to take a larger dose of CNS medications (like Vyvanse) during the luteal phase, in the lead-up to their periods.

Researchers suggest that a possible explanation for this change in dosage levels is due to the hormonal changes seen in the luteal phase and higher levels of stress and anxiety during this period and their respective effects on the hormonal system. It should be noted that the study referenced above excluded respondents with psychiatric conditions such as ADHD, which means their use of medication was not prescribed. 

However, anecdotal evidence also suggests that women who take the same prescribed dosage of Vyvanse in the lead-up to their periods as during the rest of the month may not see any positive effects from the drug. 

Another study conducted on women taking dextroamphetamine (also known as d-amphetamine or AMPH, another commonly prescribed stimulant for ADHD) found that the effects of the AMPH were greater in the follicular phase. Furthermore, the participants reported greater results during this phase as compared to the luteal stage. 

As with the first study, this study suggests the effect of stimulants is lower during the luteal phase of the menstrual cycle.

If you notice that your prescribed dosage of Vyvanse (or other stimulant medication) isn’t as effective in the days before your periods, it’s essential to get in touch with your doctor immediately. They’ll be able to guide you on the appropriate next steps, including revising your dosage if necessary.

Can ADHD Meds Make PMS Worse?

While Vyvanse can have an adverse effect on PMS and the menstrual cycle and vice versa, this doesn’t necessarily involve more severe PMS symptoms. However, many women are still concerned that they may experience more painful episodes of PMS if they start taking ADHD medications.

There’s no scientific evidence that ADHD medications can result in more severe PMS symptoms. While a diagnosis of PMS is more common for women with ADHD, this is thought to be due to the condition itself rather than the medications used to treat it. 

This, then, raises the question of the effect of ADHD in general on PMS.

Is PMS Worse With ADHD?

Premenstrual syndrome, or PMS, is a group of symptoms experienced by people before their periods. Symptoms include bloating and pain in the abdomen, sore breasts, headaches, irritability, and more. While PMS is relatively common, some women experience greater symptoms than others, including people with ADHD.

ADHD can make the experience of PMS worse. The reason for this is the effect that the menstrual cycle has on the hormonal system. Estrogen drops in the days leading up to a woman’s period. This, in turn, causes a reduction in dopamine and serotonin levels. 

These play a significant role in ADHD, and people with ADHD are more sensitive to fluctuations in estrogen levels. Let’s look at the relationship between PMS and ADHD in greater detail:

Estrogen and Other Hormones

Research shows that estrogen affects brain function and the way hormones affect the brain. Specifically, it has been shown to stimulate dopamine and serotonin receptors in the brain. This means that when estrogen levels in your body are low, these receptors aren’t as effective.

Serotonin and dopamine control various cognitive functions, including mood, focus, memory, and concentration. Researchers believe that these hormones also play a part in explaining ADHD. We know, for example, that people with ADHD have lower dopamine levels in their brains than those without the disorder.

Estrogen, PMS, and ADHD

As mentioned above, estrogen levels drop in the lead-up to a woman’s periods. Due to the effect this drop has on mood hormones, women with severe PMS or PMDD (premenstrual dysphoric disorder) can find themselves experiencing a variety of mood problems, including mood swings, irritability, and depression.

At the same time, ADHD has been found to make women far more sensitive to the effect of low estrogen levels. This, combined with already low dopamine levels in patients with ADHD, can result in stronger PMS symptoms to a point where daily activities become difficult. Additionally, women may also see a strengthening of their ADHD symptoms, including impulsivity.

It should be noted that PMS isn’t the only time when estrogen levels interact with ADHD. Hormonal changes of any kind affect symptoms. For example, one study noted that women with ADHD were at greater risk of severe symptoms associated with mood disorders, including PMDD, postpartum depression, and menopause. This result held in women across age groups and irrespective of whether they had given birth.

The opposite also holds that when estrogen levels rise, there’s a chance that a woman will experience fewer symptoms of ADHD, which can be seen in pregnant women. Pregnancy causes estrogen levels to rise and remain high, so ADHD symptoms do not significantly increase during pregnancy.

The greatest challenge women with ADHD face is perimenopause. During this period, which begins about 8-10 years before menopause, hormone levels fluctuate, making it extremely difficult to manage ADHD. Due to this, women often report finding it easier to manage their ADHD once menopause sets in.

ADHD in Women

As can be seen above, Vyvanse and other ADHD medications can have a different effect on women than on men, including affecting their menstrual cycles. This difference is true of the disorder as a whole – ADHD tends to affect women differently as compared to men.

This difference is especially seen in the way ADHD manifests in people of each gender. Research indicates that the disorder primarily presents through external symptoms in boys, with some common indications including impulsivity, physical aggression, and substance abuse.

Women, on the other hand, are more likely to show internal symptoms. These symptoms include low self-esteem, eating disorders, depression, and anxiety. They’re also more likely to present with inattentive ADHD in comparison to boys.

Girls and adult women are less likely to display hyperactivity than men, leading many clinicians to misdiagnose them. In fact, many clinicians are moving towards using the term ADD instead of ADHD. 

While ADHD – attention-deficit hyperactivity disorder – centers the hyperactivity part of the disorder, this isn’t necessary to be diagnosed with the condition. Adults of all genders are far less likely to display hyperactivity than children. Thus, the movement towards ADD – attention deficit disorder – which many believe better represents the reality of the condition.

As discussed above, another fact differentiating how ADHD can be seen in girls and women is the hormonal changes a woman undergoes at the onset of menstruation. Girls are more likely to notice symptoms becoming more severe when they first start their periods. These symptoms are likely to become even more evident during perimenopause.

This difference in presentation means that diagnosis rates for ADHD differ significantly in girls and boys. According to the Centers for Disease Control and Prevention, boys are nearly three times more likely to receive a diagnosis for the disorder than girls – 12.9% in boys, compared to 5.6% in girls.

However, this doesn’t mean that there’s an actual difference in prevalence between the two genders. Clinicians are more likely to overlook symptoms of ADHD in women, as they tend to be on the lookout for “masculine” symptoms to help with diagnosis, including hyperactivity and behavioral issues.

Instead of a narrow focus, clinicians need to take the time to identify potential symptoms in girls. At the moment, aside from lower diagnosis rates, women are more likely to be diagnosed later in life, often as late as when they enter college. 

Some common symptoms seen in girls with ADHD include:

  • Withdrawal and introversion
  • Depression and anxiety
  • Low self-esteem
  • Teasing and name-calling in school. Where boys are more likely to show their aggression physically, girls are more likely to let it out verbally.
  • Inattentiveness and trouble focusing and listening in school.
  • Forgetfulness
  • Difficulty with keeping organized
  • Finding it challenging to complete simple, routine tasks like choosing what to wear in the morning and grocery shopping.
  • Perfectionism

Identifying ADHD in women is complicated because, if not caught in childhood, ADHD can often lead to comorbidities in adulthood, including anxiety and mood disorders. These comorbidities are usually quicker to be identified than the underlying issue – ADHD. Thus, women tend to be provided with a different primary diagnosis.

Additionally, certain comorbidities can make diagnosing ADHD difficult. As they mask the symptoms of ADHD, clinicians may not immediately recognize any of the symptoms mentioned above or may attribute them to other concerns, including PTSD and Borderline Personality Disorder. 

All of this makes getting a diagnosis in adulthood challenging, which is why it’s essential to ensure that girls get the correct diagnosis as soon as possible.

Conclusion

Menstruation plays a significant role in the way in which ADHD presents in women. This means that common treatments, including stimulant drugs such as Vyvanse, often don’t work during the luteal phase of the menstrual cycle. 

Vyvanse users also often report that they experience infrequent and disrupted cycles due to their medication use. Additionally, Vyvanse (along with other ADHD medications) can result in more severe PMS symptoms, requiring careful management and monitoring.

Sources

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