This review gathered 11 studies of females, from girls aged 6 to 12 to adults up to 48. Only 6 of the 11 included people with a formal ADHD diagnosis. The studies were too different to combine.
The evidence mostly hinted at a link between ADHD symptoms and sex hormones. Low estrogen phases seemed most often tied to worse symptoms. In four menstrual cycle studies, symptoms tended to rise after ovulation or before a period. Some females felt their medication worked less well then. In one small study of nine, all reported improvement after a premenstrual dose increase.
Puberty findings were mixed. Hyperactivity eased as girls went through puberty in one group. In a college sample, inattention and early puberty were linked, but the review reports the direction both ways.
Among 25 pregnant females, total ADHD symptoms did not differ by medication choice. Still, hyperactivity and depression scores fell more in those who kept taking medication. Hormone levels were similar in girls with and without ADHD. Females with polycystic ovary syndrome (PCOS) reported more hyperactive and impulsive symptoms. No menopause studies were found. Many studies were small, and 4 of the 11 had an unsatisfactory risk of bias.
The authors suggest clinicians ask whether symptoms shift with hormonal changes, which they say could inform options such as premenstrual stimulant dose adjustment, based on very limited evidence. Any change to ADHD medication, including around periods or in pregnancy, is a decision to make with a prescriber.
The numbers Stats and what the terms mean
The statistics behind the plain-language claims above.
- Eng, 2023: change in hyperactivity as girls developed through puberty, estimate = −0.19, SE = 0.08, p ≤ .05.
- Ostojic, 2016: link between inattention and early puberty in 253 female college students, odds ratio = 1.270, 95% CI [1.040, 1.552].
- Baker, 2022: drop in hyperactivity during pregnancy by medication group, discontinuers = −0.39 versus maintainers = −2.78, p = .0128.
- Baker, 2022: change in depression scores during pregnancy by medication group, discontinued = 4.32 versus medication maintained = −0.65, p = .0009.
- Hergüner, 2015: hyperactivity and impulsivity scores in PCOS compared with controls, p = .009.
What the terms mean:
- estimate The size and direction of the change the study measured; a minus sign means the score went down.
- SE The standard error, a measure of how much the estimate could wobble by chance.
- p How likely a result this strong would be if there were no real effect; smaller means less likely to be chance.
- odds ratio How much more likely one thing is when another is present; 1 means no difference.
- 95% CI The range the true value most likely falls in.
Source: Osianlis E, Thomas E, Jenkins L, et al.. ADHD and Sex Hormones in Females: A Systematic Review. Journal of Attention Disorders (2025). doi:10.1177/10870547251332319