Ryan Sheridan, NP
ADHD In Women: Holistic Considerations for Women with ADHD
Updated: Mar 15
ADHD in women requires special considerations based on individual presentation of symptoms, goals, and needs. Symptoms can be a little different than men and treatment can vary slightly.
Medications may impact menstrual cycle and pregnancy, so it is important to use medication for ADHD in women prudently.
Integrative psychiatry provides a holistic approach to managing ADHD in women.
Attention Deficit Hyperactivity Disorder (ADHD) affects women in several ways - often differently than men. All the more reason to use a holistic approach for ADHD fosters meaningful, lasting improvement. The underlying diagnostic tools for ADHD are the same, regardless of sex. However, understanding how the nuances of ADHD and ADHD may present is imperative.
In this article we will discuss some of the symptoms of ADHD women commonly experience, treatment options for women with ADHD, and exploring prescribing medications for women with ADHD including menstruation and pregnancy.
As a reminder, I am an integrative provider and I conceptualize ADHD differently than other prescribers and providers. To me, ADHD is just another shade of normal and certainly is not inherently bad. I talk about this more in other posts about ADHD, but back to women with ADHD...
What do ADHD symptoms look like in women?
Interestingly enough, diagnosis and treatment of ADHD in women is often underdiagnosed and undertreated compared to men. This is because women may exhibit more internal symptoms and may not present with the classic symptoms of hyperactivity that are often associated with ADHD. Also, women may be misdiagnosed with anxiety or depression, which can delay proper treatment. This is why it is really important to work with a provider that has a firm grasp on mental health as a whole – even for something like ADHD that may appear to be straightforward.
In general, diagnosis of ADHD is not any different than in men. The same ADHD diagnostic tools are used including DSM-5 symptomatology, health history, screening tools, and other evaluations.
Below are some common ways that ADHD can affect women. While men may experience these same symptoms of ADHD, certain symptoms are more likely to present in women.
Women with ADHD may struggle with inattentiveness, which can manifest as forgetfulness, distractibility, and difficulty concentrating on tasks. As with anyone can lead to difficulty in school, work, and personal relationships.
Women with ADHD may experience more intense emotions, mood swings, and difficulty regulating their emotions. This can result in impulsiveness, overreaction, and difficulty managing stress.
Women with ADHD may struggle with executive functioning, which involves planning, organizing, and completing tasks. This can lead to difficulty with time management, procrastination, and completing projects.
Women with ADHD may have difficulty in social situations, which can lead to social isolation, anxiety, and depression. They may struggle with maintaining friendships, understanding social cues, and making and keeping plans.
What are the treatments for ADHD in women?
The treatment of ADHD in women does not significantly differ from that of men. And as an integrative provider, I always suggest a combination of medication (if appropriate), therapy, and lifestyle optimizations. The following are some common treatment options for ADHD in women:
Stimulant medication, such as methylphenidate (Ritalin) and amphetamines (Adderall), is often used to treat ADHD. Non-stimulant medication, such as atomoxetine (Strattera), may also be prescribed. The medication can help improve concentration, reduce hyperactivity, and manage impulsive behaviors. Remember, I do not endorse a medication-only approach, especially in women who are planning to become pregnant (more on this later).
Therapy can help women with ADHD learn coping strategies and develop skills to manage their symptoms. Women are also more likely to have accompanying diagnoses of anxiety or depression, making therapy an irreplaceable part of treatment.
Women with ADHD may benefit from lifestyle changes such as exercise, healthy eating, mindfulness, and good sleep hygiene. These changes are proven to help improve focus, reduce stress, and improve overall cognitive functioning.
Support groups can provide women with ADHD a supportive environment where they can share their experiences and receive support from others who understand their challenges.
Just to be clear, the treatment plan for each woman with ADHD will vary depending on their specific symptoms, goal, and needs. No two treatment plans will be alike because what worked for one woman, may not work for another.
What are the best ADHD medications for women?
There is no single "best" ADHD medication for women, as the choice of medication depends on the individual's specific symptoms, goals, and needs. I go a explore medications for ADHD a little deeper in another post, but here are some common ADHD medications that may be prescribed for women:
Stimulant medications, such as methylphenidate (Ritalin), dextroamphetamine (Dexedrine), and mixed amphetamine salts (Adderall), are often used to treat ADHD. These medications are thought to work by increasing the levels of dopamine and norepinephrine in the brain, which can help improve concentration and reduce hyperactivity. While stimulants can be highly effective for managing ADHD symptoms, they may also have side effects, such as insomnia and decreased appetite. So we want to find the right dose that helps reduce symptoms but doesn’t potentiate side effects.
Non-stimulant medications, such as atomoxetine (Strattera), guanfacine (Intuniv), and clonidine (Kapvay), are also used to treat ADHD. These medications work a little differently in the brain than stimulants, but the goal in symptom reduction is the same. Non-stimulant medications may be a good option for women who cannot tolerate stimulant medications or who have co-occurring conditions, such as anxiety or hypertension.
Combination of medications:
Some women may benefit from combination therapy, which involves taking both a stimulant medication and a non-stimulant medication. We want to make sure we aren’t stacking medications and chasing after side effects with other medicaitons, though.
You know what I am going to say, right? Medication should only be used as part of a comprehensive treatment plan that includes therapy and lifestyle optimization. Women with ADHD should work closely with a provider to determine the most appropriate treatment for their individual needs. Also, women are also more likely to experience gastrointestinal symptoms related to ADHD treatment with stimulants, so diligent use of medication is always best.
Can ADHD medications affect a woman’s period?
There is some evidence to suggest that ADHD medication might have an impact on menstrual cycles in some women. However, we really need more research to understand the extent and relationship between ADHD medications may impact a woman’s menstrual cycle.
Stimulant medications, such as methylphenidate and amphetamines, can cause changes in blood
pressure and heart rate, which some think could potentially affect menstrual cycles. Some women may experience changes in the length, duration, or timing of their periods while taking these medications. However, the overall impact on menstrual cycles appears to be relatively small and varies from woman to woman, with most women not noticing any changes.
Non-stimulant medications, such as atomoxetine, are less likely to affect menstrual cycles, but they may cause other side effects such as nausea and decreased appetite, which could lead to changes in a menstrual cycle for secondary reasons.
If you are a woman taking ADHD medication and you are experiencing changes in your menstrual cycle or other symptoms related to your reproductive health, make sure you talk with your provider and share your concerns. They can help you determine whether the medication is the cause of your symptoms and help you manage any side effects that you may be experiencing. Remember, before starting any medication, it is a good idea to talk about any potential concerns with your prescribing team.
What ADHD medication is safe during pregnancy?
There is not an easy answer to this question, unfortunately. The use of ADHD medication during pregnancy is complex and should be carefully considered and discussed with the entire healthcare team. While some medications may be safe to use during pregnancy, others may pose a risk to the developing fetus.
Stimulant medications, such as methylphenidate and amphetamines, have been studied in pregnancy and have generally not been shown to cause birth defects or other serious problems in the developing fetus. However, they may increase the risk of premature delivery and low birth weight, and their long-term effects on the child are not yet fully understood. Also, stimulants can increase the risk of high blood pressure as well as anxiety.
Non-stimulant medications, such as atomoxetine, have also been studied in pregnancy and have not been shown to cause birth defects or other serious problems in the developing fetus. However, they may increase the risk of high blood pressure in the mother, which can lead to problems during pregnancy.
I cannot stress enough that every woman's situation is unique, and the decision to use ADHD medication during pregnancy should be made in consultation with the woman’s entire healthcare team. The risks and benefits of medication use should be carefully considered, and alternative treatments should be explored if possible. That being said, it is really important we reserve judgment for the choices anyone, including expecting mothers, make with respect to their health and healthcare.
Women who become pregnant while taking ADHD medication should not stop taking the medication without first having a conversation with the prescriber. Suddenly stopping medication can cause withdrawal symptoms, which could be harmful to the mother and fetus.
Integrative psychiatry provides the most comprehensive approach to care, and is especially important for women who are pregnant or may become pregnant because treating each person wholly improves outcomes and reduces risks.
Summary: ADHD in women
In this article we discussed some of the symptoms of ADHD women commonly experience, treatment options for women with ADHD, and explored prescribing medications for women with ADHD. We also talked about how ADHD medications may impact menstruation and pregnancy.
I sound like a broken record, but I truly believe utilizing an integrative treatment approach for ADHD that includes therapy, lifestyle optimization, and medication (where appropriate) provides the best chance of success long-term.
If you have any additional questions about ADHD medications or integrative psychiatry in general, shoot me an email or reach out through my website. If you're looking for a provider and you're in the Washington, DC area, I'd love to help you on your treatment journey!