The overlooked link between ADHD and premenstrual dysphoric disorder

When Priscilla Mutai first began experiencing extreme fatigue, migraines, and mood swings in her late teens, she chalked it up to stress or ordinary premenstrual symptoms. It wasn’t until years later—after academic setbacks, emotional breakdowns, and multiple misdiagnoses—that she discovered what was truly happening inside her body and mind: she was living with both Premenstrual Dysphoric Disorder (PMDD) and Attention-Deficit/Hyperactivity Disorder (ADHD).

“Having ADHD, I already have major issues concentrating, but when PMDD is added onto that, my brain just melts away,” says Priscilla, now 21. “The lack of concentration comes with brain fog where I cannot even construct a sentence.”

Priscilla’s journey mirrors that of countless women navigating a stormy cycle, where hormones ignite mental chaos and ADHD becomes nearly unmanageable.

Yet, despite mounting evidence, this dual diagnosis remains widely misunderstood or ignored—even in medical circles.

Premenstrual Dysphoric Disorder (PMDD) is a severe, hormone-related mood disorder that affects women during the luteal phase of their menstrual cycle, typically causing intense emotional and physical symptoms such as irritability, depression, anxiety, fatigue and mood swings.

Attention-Deficit/Hyperactivity Disorder (ADHD), on the other hand, is a neurodevelopmental condition characterised by difficulties in sustaining attention, impulsivity, restlessness, and executive dysfunction. When PMDD and ADHD co-occur, the hormonal fluctuations that trigger PMDD can worsen the core symptoms of ADHD, leading to a heightened sense of overwhelm, emotional dysregulation, forgetfulness, and reduced coping ability.

A study published in the British Journal of Psychiatry revealed a striking link between ADHD and PMDD: 31.4 per cent of women formally diagnosed with ADHD were found to meet the criteria for PMDD. Among those exhibiting high levels of ADHD symptoms—regardless of whether they had a clinical diagnosis—the rate was even higher at 41.1 per cent. This stands in stark contrast to just 9.8 per cent among women without ADHD.

The findings suggest that hormonal fluctuations across the menstrual cycle, particularly during the luteal phase when estrogen declines and progesterone surges, may intensify ADHD-related traits like emotional reactivity and impulsivity. The study also emphasised that women with ADHD who experience co-occurring depression or anxiety face an even steeper risk, with their likelihood of developing PMDD estimated to be over four times greater than those without ADHD.

Hormonal fluctuations across the menstrual cycle have long been associated with changes in mood, energy, and cognition. However, for women with neurodevelopmental conditions such as Attention-Deficit/Hyperactivity Disorder (ADHD), these shifts can trigger far more profound effects.

According to Dr. Ong’ech John Odero, Chief Medical Specialist, Obstetrics and Gynecology at Nairobi Reproductive Health Services, Premenstrual Dysphoric Disorder (PMDD) is “triggered by an abnormal sensitivity to the normal hormonal fluctuations of the menstrual cycle—particularly to estrogen and progesterone levels that rise and fall during the luteal phase.”

These hormonal shifts are not limited to reproductive changes; they also have a significant impact on brain chemistry. “These hormonal changes impact neurotransmitter systems, especially serotonin, dopamine, and GABA, which are involved in mood regulation, attention, and executive functioning,” Dr. Odero explains.

Compounding effect

These neurotransmitters play a central role in emotional stability and cognitive control—systems that are already compromised in individuals with ADHD, who typically exhibit imbalances in dopamine and norepinephrine pathways.

The hormonal changes experienced during the luteal phase can exacerbate ADHD symptoms, amplifying issues such as inattention, impulsivity, mood swings, irritability, and emotional dysregulation. “Women with ADHD may experience worsening of their baseline symptoms during the luteal phase, and some may even have PMDD-like symptoms due to heightened neurohormonal sensitivity,” notes Dr. Odero.

This neurohormonal interaction creates a compounding effect—not just two overlapping conditions, but a biochemical synergy that heightens the severity of both. Rather than experiencing ADHD and PMDD as isolated diagnoses, many women face a cyclical storm where hormonal sensitivity acts as a catalyst for deeper cognitive and emotional distress.

Dr. Catherine Syengo Mutisya, a consultant psychiatrist, affirms the biological and emotional link between the two conditions.

“Those with ADHD and those with PMDD will have almost similar emotional and cognitive symptoms,” she explains. “Women might experience fatigue, sleep problems, irritability. The hormonal changes in the menstrual cycle worsen ADHD symptoms.”

For Priscilla, these overlaps were devastating. “My PMDD symptoms start two weeks before my periods,” she says. “A general indicator is chronic fatigue, migraines, and muscle and joint pain. On some days, I could sleep for 12 hours and still wake up tired.”

These physical symptoms quickly escalate into emotional paralysis.

“I deal with a loss of interest in everything and everyone. Mood swings and irritability take over. Due to chronic fatigue, it becomes nearly impossible to accomplish simple tasks like bathing, cooking, eating, and going to class. A week passes and you haven’t gotten anything done. Your whole life comes to a standstill.”

Accurate diagnosis

Alongside comorbidities, she also battles depression and anxiety with the darkest part of her cycle being suicidal ideation.

“PMDD will convince you that your life isn’t worth keeping,” she says. “Every day for almost two weeks you’ll be wanting to end your life.”

By the time Priscilla got an accurate diagnosis, she had lived through seven years of undiagnosed PMDD and ADHD. She had taken semester breaks, missed exams, and lost confidence in her ability to function.

“After I deferred for a semester, I insisted on going for therapy,” she says. “My therapist diagnosed me with ADHD, which was confirmed by two psychiatrists. I was put on three medications, but I was still struggling. Eventually, a doctor diagnosed me with PMDD.”

What followed was a revolving door of specialists and incorrect diagnoses—including bipolar and mood disorders.

“My concerns were always dismissed,” she says. “I felt so helpless and isolated. You could just lose your mind.”

Beyond her personal health, Priscilla has had to contend with the toll it has had on her social life.

“PMDD affects me for two weeks every month—that’s six months in a year. Maintaining relationships for only half the month doesn’t work for most people,” she says.

“I’ve lost a lot of friends and had to let go of really lovely people. Saying that PMDD and ADHD affect relationships is an understatement. It’s a miracle that I’m able to maintain the friends I have left.”

Priscilla continues to explore treatment options and finds therapy—especially cognitive behavioral therapy—useful. But she still hasn’t found what works best for her.

“Living with PMDD and ADHD is like having a body that wants to survive and a mind that wants to die,” she says. “The hardest part is the isolation and loneliness—that is enough to kill you.”

Nancy Atieno shares a similar struggle. “I always experience mood swings which normally affect my relationship with everyone. I get emotionally overwhelmed that even if I’m at work, I barely feel myself, making me sleep a lot. I do get fatigued as well throughout that period. Everything seems abnormal and at some point, I get to ask myself why this just has to happen to me as a woman.”

Mercy Chepkemoi, another young woman, shares a quieter yet equally familiar experience.

“I never thought about it. I took it like normal mood swings, anxiety, depression, and bloating,” she says. “But sometimes it got extremely worse.”

Like many women, Chepkemoi didn’t know to question the severity or pattern of her symptoms. She assumed it was something to live with—until it wasn’t.

Dr. Odero is hopeful that growing awareness will drive change, especially in urban healthcare settings and academic hospitals where interdisciplinary approaches are being adopted.

“I wish more people—especially our health care specialists—knew about PMDD and its devastating effect on women with ADHD. The more people know about it, the easier it would be to get support and ask for help,” Priscilla says.