My interpretation of the research on Oestrogen + ADHD
Important research is ongoing into the relationship between ADHD-type symptoms and the inevitable and purposeful fluctuations of oestrogen across the menstrual cycle. Participants in a recent study reported increased impulsivity and inattention at points in their cycles when oestrogen was in decline.
This graphic is shared with the kind permission of Professor Michelle Martel of the University of Kentucky. Professor Martel presented the graphic at the US Psychiatric and Mental Health Congress 2024 as part of her presentation entitled “ADHD in Adult Women: Challenges and New Directions”.
So, why would that be? What role is oestrogen playing here? A significant one, but first, some background on the relationship between dopamine and ADHD.
Where dopamine might fit in
ADHD is traditionally thought of as being driven by a dopamine deficit (see my previous article for a discussion around the impact of the Glutamate/GABA pathway on ADHD). If you are concerned about low dopamine, the first thing to note is that our dopamine must be manufactured from raw ingredients within the food that we eat. I will write about how to set yourself up for successful dopamine manufacture next time. Once the dopamine is made, it must be released and it must activate a receptor to impact our sense of pleasure, reward or motivation, and then it must be broken down and removed. We don’t want to have access to excessive amounts of dopamine, because too much dopamine is as problematic as too little dopamine (1):
Symptoms of low dopamine include apathy, fatigue, addictions, anxiety, inability to focus,
Symptoms of high dopamine include feeling stressed or wired, inability to focus, hyperactivity, insomnia and anxiety.
Therefore, ADHD-type symptoms can be driven by:
poor manufacture of dopamine + fast removal and breakdown of dopamine, or
abundant manufacture of dopamine + slow removal and breakdown of dopamine.
This is why not everyone with ADHD gets on well with the prescription medication which works by prolonging dopamine’s availability - it is a case of too much of a good thing.
From this brief introduction to ADHD, you will understand why I recommend the Lifecode Gx Nervous System genetics report to clients struggling with ADHD-type symptoms: rather than guessing which part of your dopamine pathway needs support, you will discover what your ability to manufacture dopamine is, how sensitive your dopamine receptors are to dopamine, and how quickly you are predisposed to breakdown and remove your dopamine. You are then empowered to take targeted, personalised action.
Where oestrogen might fit in
The research states that oestrogen has many “profound yet complex effects” on dopamine neurotransmissions (2). In simple terms:
oestrogen increases the manufacture of dopamine,
oestrogen induces the release of dopamine,
oestrogen regulates the number of dopamine receptors (dopamine needs to activate a receptor to do its job),
oestrogen reduces the number of dopamine transporters (so more dopamine is available to do its job for longer).
If you are someone who manufactures dopamine unenthusiastically, for these four reasons, you may really feel a boost in the ability to focus, to feel pleasure and to be productive with greater access to oestrogen.
If you are someone who removes and breaks down dopamine quickly, you may also really feel a boost in the ability to focus, to feel pleasure and to be productive with greater access to oestrogen. Why? The enzyme which is responsible for the breakdown and removal of dopamine is also responsible for the breakdown and removal of oestrogen. This increase in the enzyme’s workload can slow it down with the beneficial effect that you end up holding onto your dopamine for longer. This genetic profile is known as “Fast COMT” and is tested for as part of the Lifecode Gx Nervous System genetics report.
Insights from the research
A series of 9 case studies was published in 2023 in which the idea of cyclical adjustments to ADHD medication was explored (3). The case studies were inspired by the experience of several women who described an exacerbation of their ADHD and depressive symptoms and/or insufficient effect of their established dosage of psychostimulant in the premenstrual week. Accordingly, the stimulant dosage was increased during the premenstrual week and response and side effects were monitored. Premenstrual inattention, irritability and energy levels improved and resembled non-menstrual weeks more closely.
The mechanism of action of the psychostimulants was to block the reuptake and removal of dopamine (and its daughter neurotransmitter, noradrenaline), so that the patients had access to the dopamine (and its daughter) for longer.
Where to start
I’m not a doctor and the dose of prescription medication is not a matter for me, my tools are diet and lifestyle interventions and supplements. We can have a huge impact on the availability of dopamine if we deploy these tools carefully. Here is where I would start:
ensure that you have a protein-rich breakfast and lunch to provide tyrosine for dopamine production (more on eating for dopamine production next time),
allocate 20 minutes to mealtimes, chew your food thoroughly and eat away from all provocations in order to optimise your digestion and facilitate the absorption and utilisation of the tyrosine,
test and then optimise your levels of vitamin D, iron, B12 and folate to support dopamine production,
experiment with drinking green tea to slow down your COMT when you sense that your productivity is decreasing, in order to preserve your dopamine,
tune into how your productivity and mood fluctuate throughout the month.
If you would like my support and guidance, please book a free Zoom call using the button below and we can discuss working together.
References:
“Estradiol and the Catechol-o-methyltransferase gene interact to predict working memory performance: a replication and extension”, (2023) Journal of Cognitive Neuroscience, 35(7): 1144-1153.
“The role of estrogen receptors and their signalling across psychiatric disorders”, (2021) International Journal of Molecular Science, 22(1), 373.
“Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage”, (2023) Frontiers in Psychiatry, 14: 1306194.
