Practical tools for female-specific ADHD: The impact of hormonal fluctuations in clinical practice and from the literature.

Hormonal fluctuations significantly impact women with attention deficit/hyperactivity disorder (ADHD), affecting symptom severity, mood, sleep, and treatment efficacy. Many women report cyclical variations in symptom intensity and reduced psychostimulant efficacy during the late luteal phase of their menstrual cycle. Also, during the postpartum period and in the (peri)menopause, ADHD symptoms may worsen, accompanied by increased mood and sleep disturbances. Neglecting these features specific to women with ADHD has resulted in underdiagnosis and misdiagnosis of ADHD, as well as suboptimal treatment. In addition, the accuracy of ADHD diagnosis in women is complicated by symptom masking, comorbid anxiety/depression, and referral biases. To help improve care for women with ADHD, we provide practical recommendations for assessing the impact of hormonal fluctuations in ADHD research and practice (e.g., a protocol for assessment, including menstrual cycle tracking and validated questionnaires for mood and sleep disturbances). Our recommendations are informed by extensive clinical experience and research initiatives focused on women with ADHD. We briefly describe the specifics of clinical presentation, premenstrual exacerbations of these women, and their optimal treatment. We also suggest tailored assessment, such as considering hormonal status in ADHD diagnosis and symptom tracking across menstrual, postpartum, and (peri)menopausal phases. While more research is sorely needed, recognising and identifying these hormone-related fluctuations is crucial for improving research practices and clinical management of women with ADHD.