If you have both ADHD and PMDD — or notice your ADHD symptoms and mood getting significantly worse in the week before your period — this small but pioneering study may resonate with you.
Researchers at a specialist adult ADHD clinic in the Netherlands worked with nine women (ages 22-48) who all described a familiar pattern: despite being on stable ADHD stimulant medication, their focus, mood, energy, and emotional control would plummet premenstrually. Six of the nine women also had a PMDD diagnosis. The clinicians tried something simple — increasing each woman's stimulant medication dose by 30-50% during the premenstrual days only, then returning to their regular dose afterward.
All nine women reported meaningful improvements. Their concentration, productivity, and energy levels during the premenstrual phase started to look more like the rest of the month. Eight reported less irritability, seven had better energy, and several described fewer emotional meltdowns and mood swings. Side effects were minimal or absent, and every woman chose to continue with this approach over follow-up periods ranging from 6 months to 2 years.
The idea behind this approach is that falling estrogen levels before your period may reduce how well stimulant medications work and worsen both ADHD and mood symptoms. By temporarily raising the dose, the researchers hoped to bridge that gap — and the early results suggest it helped. It's important to note this was a very small study with no comparison group, so these are preliminary findings. The researchers are calling for larger, more rigorous trials. If this pattern sounds like your experience, it could be worth discussing with your prescriber — but any medication changes should always be made with professional guidance and monitoring.
Key findings
- All 9 women reported improved ADHD and mood symptoms with premenstrual psychostimulant dose elevation (30-50% increase), with minimal adverse events
- 6 out of 9 women had co-occurring PMDD diagnoses alongside ADHD
- Improvements were consistently noted in concentration, focus, productivity, emotional regulation, and energy levels during the premenstrual phase
- 8 out of 9 women reported reduced irritability, 7 reported improved energy levels, and 6 experienced decreased agitation after dose increase
- All 9 women chose to continue with the elevated premenstrual pharmacotherapy after follow-up periods of 6-24 months
- The premenstrual dose increase ranged from 30-50% above the regular dose, applied for 3-10 days around menstruation, with the exact timing individualized per patient
Methods, briefly
Community case study of 9 consecutive women (aged 22-48) treated at a specialist adult ADHD outpatient clinic in The Hague, Netherlands, between September 2021 and March 2023. All had confirmed ADHD diagnoses via DIVA-5 interview and were on stable psychostimulant dosages. Premenstrual dosage was individually increased (30-50%), and effects on ADHD symptoms, mood, and somatic symptoms were monitored over 6-24 months. A 5-point Likert scale was added during the study to assess ADHD and mood changes. No control group was used.
Limitations to keep in mind
- Very small sample size (N=9) with no control group, inherent to case study design
- Assessment methods were refined during the study rather than standardized from the start
- All outcomes were based on subjective self-report rather than objective measures
- Multiple co-occurring conditions in all patients may have influenced response to dose increase
- Menstrual cycle tracking required for the intervention may be difficult for women with ADHD or irregular cycles
- Single-center study from one specialist ADHD clinic
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