Climbing the Walls: Are Hormones the Final Frontier for Women with ADHD? | Episode 6
Released on May 7, 2025
Introduction
In the sixth episode of Climbing the Walls, hosted by Danielle Elliott from Understood.org, the discussion delves into the intricate relationship between hormones and Attention Deficit Hyperactivity Disorder (ADHD) in women. Titled "Are hormones the final frontier for women with ADHD?", this episode investigates why ADHD diagnoses in women surged post-pandemic and explores the evolving understanding of how hormonal fluctuations impact ADHD symptoms.
The Untold Story: ADHD and Women's Hormonal Health
For decades, medical research predominantly focused on men, assuming findings would be universally applicable. This oversight left a significant gap in understanding how hormonal changes affect women with ADHD. Danielle Elliott contextualizes this historical neglect by highlighting the late inclusion of women in clinical research, a shift initiated by the NIH in 1986 and furthered by the 1993 federal law mandating women's participation in studies.
Rising ADHD Diagnoses Among Women
The podcast underscores a dramatic increase in ADHD diagnoses among women since the pandemic. This rise has sparked a multitude of questions regarding the role of hormones in exacerbating ADHD symptoms. Women have taken to platforms like Reddit to share their experiences, revealing patterns of heightened cognitive difficulties, irritability, and sensitivity aligned with menstrual cycles, postpartum periods, perimenopause, and menopause.
Danielle Elliott reads a Reddit post:
"So at least I know why these issues are happening. And that's kind of a relief. I'm not broken. I'm not not trying hard enough. I'm not a mutant. Why doctors didn't tell me this before now? No effing clue."
[00:01]
Breakthrough Research: Ashley Eng’s Pioneering Study
A cornerstone of the episode is the groundbreaking research led by Ashley Eng, featured at [06:12]. Eng, working under Dr. Michelle Martell at the University of Kentucky's Risk Lab, investigated how hormonal fluctuations during puberty affect ADHD symptoms in young women. Her study, published in Hormones and Behavior in February 2024, confirmed that ADHD symptoms vary across menstrual cycles, correlating with levels of estrogen and progesterone.
Key Findings from Ashley Eng:
- Inattention and Progesterone: A positive association was found, indicating increased inattention during phases of elevated progesterone.
- Hyperactivity and Estradiol: A negative association suggested reduced hyperactivity when estradiol levels are higher.
Ashley Eng explains:
"Broadly, we found that ADHD symptoms are changing across the menstrual cycle. We also saw some connections with different hormones."
[07:54]
These findings validate what many women have been experiencing and pave the way for potential personalized treatments, such as adjusting ADHD medication dosages in sync with hormonal cycles or using hormone-based therapies to stabilize ADHD symptoms.
Duke University’s Inclusive Research Approach
The episode highlights Duke University's innovative approach through the Center for Girls and Women with ADHD. Co-directed by Dr. Julia Schechter, the center prioritizes understanding women's perspectives by conducting "listening and learning sessions" with diverse groups, including postmenopausal women, teen girls, parents, and healthcare providers.
Dr. Julia Schechter shares:
"What we want more of is to better understand the role of hormones on ADHD symptoms and how it impacts ADHD across the lifespan."
[16:40]
This grassroots approach resulted in identifying key research priorities directly from the affected population, emphasizing the critical need for studies tailored to women's unique hormonal landscapes.
Personal Narratives: The Quest for Answers
Emily Mitchell's poignant story illustrates the real-world implications of the research gaps. Diagnosed with ADHD in her youth, Emily faced cognitive challenges exacerbated by hormone-blocking treatments for breast cancer. Her experience underscores the urgent need for evidence-based guidelines on managing ADHD alongside hormonal therapies.
Emily Mitchell recounts:
"So if you're losing estrogen, what else have you got? You know, you give up that. So what's going to happen? Will I lose my mind?"
[22:05]
Her subsequent adjustment in ADHD medication following estrogen blocker treatment demonstrates the delicate balance required in managing ADHD amidst hormonal changes.
Expert Opinions and Future Directions
The episode features insights from Dr. Russell Barkley, a prominent ADHD expert, who lauds Ashley Eng's study for addressing the long-overlooked hormonal factors influencing ADHD in women. He notes the shrinking gender gap in ADHD diagnoses as women increasingly come forward with their experiences.
Dr. Russell Barkley states:
"It's what women have been saying all along. Hormones."
[13:46]
Looking forward, the episode discusses the potential of artificial intelligence (AI) in accelerating research and developing personalized ADHD treatments. Innovations like AI-driven diagnostic tools and treatment effectiveness studies offer hope for more nuanced and timely interventions.
Challenges and Societal Implications
Despite promising research, significant challenges remain. The slow pace of scientific discovery, coupled with limited funding, hinders the development of tailored treatments. Additionally, societal expectations and the reliance on technology exacerbate ADHD management difficulties, suggesting that solutions must extend beyond individual treatments to encompass broader societal changes.
Conclusion: A Call to Prioritize Women's Health in ADHD
Danielle Elliott concludes by asserting that the surge in ADHD diagnoses among women is not merely a product of increased awareness but a reflection of longstanding neglect in prioritizing women's health. The episode advocates for continued research focused on hormonal impacts, personalized treatment strategies, and societal reforms to support women with ADHD effectively.
Final Reflection:
"The Pandemic and TikTok. Ned Hallowell told me there's environmentally induced ADHD and that modern life is making ADHD symptoms worse... But the need for societal solutions doesn't replace the need for individual treatment. And it's time for that individual treatment to consider the experiences of women."
[23:46]
Credits
Climbing the Walls is brought to you by Understood.org, a nonprofit organization dedicated to empowering individuals with learning and thinking differences like ADHD and dyslexia. The episode was produced by Danielle Elliott, with contributions from Neil Drumming, Cody Nelson, Brianna Berry, Ash Beecher, Diana White, Mary Mathis, Karen Watanabe, Kwame Brandt Pierce, Blue Dot Sessions, and Justin D. Wright.
This comprehensive exploration in Climbing the Walls Episode 6 underscores the critical intersection of hormones and ADHD in women, advocating for a more inclusive and scientifically grounded approach to understanding and treating ADHD across different life stages.