Practical advice: When ADHD and PMS collide

IMPORTANT: This blog is not a substitute for therapy, but provides evidenced-based education for the purposes of self-help, or to compliment the therapeutic process. ​ ​This blog is non-monetized.

By: Sarah Palozzi, Registered Psychotherapist (Qualifying)

This article aims to talk about menstruation in a gender inclusive manner since we know not all women menstruate and not all people who menstruate are women. In this article, the word ‘woman’ is used to describe people assigned female at birth (AFAB), in the context of socialization, so we use the terms “woman/women” or “man/men” as social constructs.


Premenstrual symptoms (PMS) tend to be included in the category of mysterious things that remain taboo in ‘polite’ conversation, sometimes especially so with our significant others.  Further, the influence of socialization on gender norms in our day to day lives, also impacts the health information available to us because the medical research conducted and health care provided for girls and women can also be quite imbalanced. In fact, a recent Canadian publication shed a dismal light on the imbalance of research on ADHD on girls and women versus boys and men. Translated into real life, PMS + ADHD sometimes cancels the possibility of communicating anything at all right from the start, especially feelings and thoughts about how hard the experience of PMS can be [1]. 

The following ‘PMS protocol’ is intended to help close the gap for the every day person with ADHD trying to make sense of it all, providing context and support, inviting curiosity about your own experiences, and serving as a practical tool for people with ADHD to communicate with their partners about their menstrual cycles.

What’s Included:

  • Research and resources on the link between menstrual cycles and ADHD,
  • A breakdown of the nuanced difficulties people may experience during their menstrual cycles,
  • How to identify and prioritize needs during menstrual cycles,
  • Free Downloads: Communication guidelines and suggestions for bringing partners in,
  • General tips and tools for how to communicate with partners and other suggestions to mitigate negative impacts.

Part 1: “Why Am I Like This?!

Context And the Research

The Link Between Menstrual Cycles and ADHD

The relationship between menstrual cycles and ADHD is shaped by the connection between chemical messengers in our bodies, estrogen and dopamine.  As estrogen levels decrease during the luteal phase of a menstrual cycle (the beginning), the levels of available dopamine also decrease.

We know dopamine plays an important role in supporting executive function, which includes the ability to pay attention, problem solve and regulate emotions. Because an ADHD brain is not able to use available dopamine effectively as is, the continual decrease of dopamine that lines up with the menstrual cycle is the reason why people tend to experience ADHD and symptoms more intensely during their cycles.[2],[3],[4]. There is also lots of research that documents ADHD brain activity during this period of time.[5]

Understanding Shame

Socialization plays a huge part in how we all understand, consider and discuss both ADHD and PMS. We learn early about gender expectations; women (and people AFAB) are generally socialized and rewarded for being attentive and thoughtful, polite and accessible to others, dutiful and responsible. If we feel like we are failing in these areas, shame can overshadow our natural primary need to connect with others.  In fact, research shows women are highly motivated to hide ADHD symptoms, and personal strengths are often used to mask any “deficits”.[6]

In a therapeutic context, shame can be understood as a learned protective response. Specifically, experiencing shame is really a form of self-preservation and self-protection in a world or context where it isn’t safe to be ourselves. For example, as a protection from confrontation, or standing up for ourselves, it may be easier to default to the position that we are to blame. Thinking this way keeps us from ‘rocking the boat’, another trait that gendered socialization (the “nice girl” narrative) impacts. While it may be easier to feel shame than anger or sadness, it robs us of the opportunity to make authentic connections with our partners and loved ones. [7]

Not addressing the underlying causes of shame however can make things worse in the long run. If it starts to affect our daily functioning – such as the ability to calmly problem-solve, it can start to impact more areas of our lives. 

Part 2: “What Is Even Happening?!” 

Identifying Needs

Tracking Symptoms

Tracking symptoms and emotions throughout your cycle can help identify predictable patterns. It’s a lot easier to deal with being turned upside down if you know what’s coming.

Executive function can already be an area of challenge for people with ADHD, which makes it difficult to notice how ADHD symptoms change in relation to menstrual cycles. How to stop and notice, identify needs and emotions, or just simply decide on what to communicate, let alone how to communicate it seems daunting. During our cycles, we may feel like nothing is working, and we are losing control, but find it difficult to make that connection and anticipate our needs prior to the start of our cycle. This is a blind spot that is completely understandable, but also very frustrating.

There are many free period tracker apps that can use your cycle information to make accurate predictions and help give you a notification a few days prior. You can also use this as a way to note the symptoms that become most challenging. As with all health-related decision-making, your privacy and personal comfort level matters. Cautiously evaluate your own risk related to inputting your personal health information into these applications.
 
Having something tangible to reflect on may serve as a helpful way to facilitate discussion with our partner and have a discussion about needs. You may also consider normalizing the discussion by inviting your partner to help track symptoms as a way of supporting you, and placing the information in a localized spot in the home where both people have access to it.

Conducting Your Own Needs Assessment

Changes in hormone levels result in heightened symptoms of ADHD. It may be supportive to break down needs in common categories. By identifying specific needs, you may be able to alleviate burdens that are heightened during this time and bring your partner in as a support with a specific ask.

Some common needs and categories that are often compromised during this time, including a self-assessment that can be shared with your partner, are noted below.
 
When making a decision about what may be most pressing, consider how much the symptoms interfere with your life or relationship by rating them below. You may also wish to allow your partner to complete the exercise to allow them the opportunity to reflect on their own impact, and how they can make changes to support you.


Part 3 – “What can I do, really?”

Mitigating

Negative Impacts

While we often consider the personal symptoms of ADHD and PMS as individual burdens, rather than those that can be shared with a partner, inviting our partners in can be helpful.

  • Tips for consideration:
  • Let your partner know the dates of your menstrual cycle can help so they can play a more supportive role. It can be as simple as “I’m about to get my period…”.
  • Consider timing discussions with your partner about important things for when you are not experiencing PMS symptoms.
  • Consider that not all problems have to be solved; sometimes just a note of appreciation, or acknowledgement can make a big  difference.
  • It might be helpful to reflect on a time that you did feel supported by your partner, or imagine how your life would be improved if you invited your partner in.
  • It’s not always about WHAT is being communicated, but HOW it is being communicated. Being mindful of effective communication strategies, as well as any potential natural tendencies within the relationship can be helpful as well. Some communication styles can unintentionally shut others down. If you feel you need more support in this area, check out this  Intense Emotions and Mindful Communication Resource to help learn the skills of mindful communication (especially around tough topics). [8]

Self-Compassion

When considering how to bring our partners into the discussion, lots of FEELINGS likely come up.  Sometimes we can feel pre-defined, or boxed in, and feel we are not supposed to have new desires or expectations. PMS symptoms are similarly categorized into the digestible narrative filled with, often unfunny, “time of the month” jokes.  But what if the things that come up during PMS are totally valid things – now we just have a little ‘hormonal courage’ to bring them up?
 
Communicating needs can be extremely difficult for anyone, but especially so for people with ADHD, in particular, late diagnosed ADHD. Many late diagnosed adults share a story of feeling left to fend for themselves emotionally, to figure out how to be in relationships that was never quite the norm or expectation. So masking enters the chat! This coping mechanism can be extremely isolating. Once diagnosed, despite having permission to reframe perspectives, and look at things from an ADHD lens, it’s normal to continue to struggle in an attempt to gradually shift away from the tendency toward perfectionism or over-functioning as learning to understand your new brain identity takes hold.
 
Being willing to ask for help within a relationship is incredibly healthy. It’s one step that can be taken on this journey, and suggests you are motivated to be in a health relationship. That means something. Suppressing your own emotional responses in favor of preserving the status quo, or whatever opinion you feel your partner may have about you or your symptoms, is usually counter-productive. There should be room for both people to have their needs met in their relationships.
 
Regular communication can lead to many opportunities:

  • It supports reconciliation after intense interactions,
  • provides a way to express and get needs met, and
  • also invites empathy and appreciation.

The following tools (attached below) may help spark curiosity of how you may wish to invite your partner into your experience.

If you have a particularly bad day, no need to pull your hair out. Hormonal changes make the already challenging task of regulating emotions enough to invite your partner in. Forgive yourself for not being able to handle all situations in whatever idealized way you feel you should be able to handle them.

You deserve to be supported.


Free Downloads:The ADHD + PMS Needs Assessment

uploads/3/4/3/8/
The ADHD + PMS Needs Assessment
adhd___pms_needs_assessment.pdf
File Size: 156 kb
File Type: pdf
Download File


The ADHD + PMS Communication Tips Tool
adhd___pms_commincation_tips.pdf
File Size: 151 kb
File Type: pdf
Download File


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Picture of Sarah Palozzi, H. BA., B.Ed, MACP, Registered Psychotherapist (Qualifying)

Sarah Palozzi, H. BA., B.Ed, MACP, Registered Psychotherapist (Qualifying)

Sarah works with individuals, ages 10+, couples and families specializing in with trauma processing and recovery, stress related to depression, ADHD, anxiety and life transitions, as well as recovery from addiction. Sarah offers services both virtually across Ontario, as well as in-person in Bolton or Alliston, ON.

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