Research advances and future directions in female ADHD: The lifelong interplay of hormonal fluctuations with mood, cognition, and disease

Sandra Kooij, JJ, de Jong, Maxime, Agnew-Blais, Jessica, Amoretti, Silvia, Bang Madsen, Kathrine, Barclay, Isabella, Bolte, Sven, Borg Skoglund, Charlotte, Broughton, Thomas, Carucci, Sara, van Dijken, Dorenda, Ernst, Julia, French, Blandine, Frick, Matilda, Galera, Cedric, Groenman, Annabeth, Kopp Kallner, Helena, Kerner auch Koerner, Julia, Kittel-Schneider, Sarah, Manor, Iris, Martin, Joanna ORCID: https://orcid.org/0000-0002-8911-3479, Matera, Emilia, Parlatini, Valeria, Philipsen, Alexandra, Anthoni Ramos-Quirogu, Josep, Rapoport, Iris, Lundin Remnelius, Karl, Senequier, Amandine, Thorell, Lisa, Wittekoek, Jenneke and Wynchank, Dora 2025. Research advances and future directions in female ADHD: The lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women's Health 6 Item availability restricted.

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Abstract

Introduction: Attention-Deficit/Hyperactivity Disorder (ADHD) in girls and women is 2 under-recognised and under-researched, despite increasing awareness of clinical 3 challenges and unmet needs. This review by the Eunethydis Special Interest Group 4 on Female ADHD, addresses current knowledge and identifies research gaps for 5 future work. Issues in women with ADHD across the lifespan such as late diagnosis, 6 pubertal development, sexual health, hormonal birth control, executive function 7 difficulties, and gynaecological disorders associated with ADHD are highlighted. 8 Methods: The review synthesises existing literature and self-reported experiences of 9 women with ADHD to explore the impact of hormonal fluctuations (puberty, menstrual 10 cycle, pregnancy, (peri)menopause) on ADHD symptoms and mood disturbances. It 11 examines the interplay of oestrogen and progesterone with dopaminergic pathways, 12 when periods of lower oestrogen may affect cognition, as well as the manifestation of 13 executive function deficits, and the intersection of ADHD with reproductive health. 14 Results: Hormonal transitions exacerbate ADHD symptoms and mood disturbances, 15 yet pharmacological research and tailored treatments are lacking. Executive function 16 deficits manifest differently in girls and women with ADHD and are influenced by 17 neuropsychological and neurobiological profiles. Diagnostic practices and 18 sociocultural factors contribute to delayed diagnoses, increasing the risk of 19 comorbidities, impaired functioning, and diminished quality of life. Undiagnosed 20 women have increased vulnerability to premenstrual dysphoric disorder, postpartum 21 depression, and cardiovascular disease during perimenopause. Discussion: 22 Longitudinal, sex-specific studies incorporating hormonal status and lived experience 23 are needed. Individualised interventions should be developed to address the unique 24 needs of girls and women with ADHD. Addressing these gaps will advance more 25 equitable diagnosis, management, and support for girls and women with ADHD, 26 improving outcomes across the female lifespan.

Item Type:	Article
Status:	In Press
Schools:	Schools > Medicine
Publisher:	Frontiers Media
ISSN:	2673-5059
Date of First Compliant Deposit:	19 June 2025
Date of Acceptance:	19 May 2025
Last Modified:	19 Jun 2025 14:30
URI:	https://orca.cardiff.ac.uk/id/eprint/178925

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