Riding the ADHD Rollercoaster

Hormones may play a big part in women with the neurodevelopmental condition

Woman standing next to neurodiversity painted sign
Ruth Danoff was diagnosed with ADHD when she was 50. She is now an advocate for those diagnosed with neurodevelopmental conditions.

Ruth Danoff was 50 when she was diagnosed with Attention-Deficit/ Hyperactivity Disorder or ADHD. At 63, she can look back and understand her inability to sit still in school, her poor grades and the emotional rollercoaster she rode as a child and continues to ride today.

“I am still peeling back the layers of the onion to figure out who I am because I'm not who I was before 50,” says Danoff, who serves on a community advisory council at the Duke Center for Girls & Women with ADHD.

Danoff is not alone in being diagnosed with ADHD late in life. The percentage of women between 23 and 49 who were newly diagnosed with ADHD doubled from 2020 to 2022, according to Epic Research, which looked at more than 3 million patient records nationwide.

ADHD is a neurodevelopmental condition that can cause inattention, hyperactivity and impulsivity. It often shows up differently in women than in men. For Danoff, who calls herself “a huge empath,” emotions can run high.

“I have really big feelings when I have a feeling,” Danoff says. “They’re not average size, they are huge, and it’s very it’s off-putting to me sometimes, let alone to people around me, and that’s very difficult to deal with.”

In males, ADHD tends to show up more as hyperactivity and impulsivity. In females, it’s often more about inattentiveness.

“Every single performance review I've had as an adult has said that I need to pay more attention to detail,” says Danoff.

Also, girls and women tend to report masking their symptoms, and often their ADHD is coupled with anxiety and depression.

Hormonal Changes and ADHD

For Danoff and other women, hormones, particularly estrogen, may also play a part in how ADHD symptoms manifest, says Julia Schechter, co-director of the Duke Center for Girls & Women with ADHD and a licensed clinical psychologist.

Julia Schechter, co-director of the Duke Center for Girls & Women with ADHD

Estrogen levels are known to drop before menstruation, after giving birth and around menopause.

Only a handful of studies linking hormones to ADHD have been conducted. University of Kentucky research involved 97 female college students, most of whom had a formal ADHD diagnosis, across their menstrual cycle. Half were being treated with psychostimulants such as Ritalin or Adderall. Participants reported worse ADHD symptoms, such as inattention and impulsivity, just before and at the start of their period and, to a lesser extent, around ovulation.

Schechter stresses that while these findings are exciting, it’s still an emerging area and more study is needed.

“Considering women spend about a third of our lives in perimenopause or post-menopause, we need more research in this phase of life,” Schechter says.

Empowering Women

Schechter and other clinical researchers aren’t the only ones who think hormones are an important research topic. Last year, the Duke center completed a project asking girls and women with ADHD (including Danoff), parents of girls with ADHD, educators, mental health clinicians and medical providers what their top priorities were in terms of research. The connection between hormones and ADHD topped the list.

“The bottom line is, how do we empower women to know that this could be something that applies to them so that they can be aware of how hormones may be impacting their symptoms and then may be impacting their lives,” says Schechter.

Reed Colver, associate director and learning consultant at Duke’s Academic Resource Center (ARC), says many women are initially diagnosed with ADHD when they get to college.

“In my experience, working with women looks a little bit different,” says Colver, whose office offers support services to undergraduate students. “Some of that is because the expectations around being a young woman, societally and culturally, look different. Emotional dysregulation impacts your ability to learn, and that’s one of the places that, when we’re working with students, we help them understand where emotional dysregulation impacts your ability to learn.”

Although she wishes she had been diagnosed earlier in life, Danoff says it’s never too late to get help and to help others.

“I still struggle with the fact that my brain is literally wired differently than a neurotypical brain.” But, she adds, “Now I am learning to embrace every single cell in my body for what it is.”

ADHD Research at Duke