We have investigated the impact of gender on ADHD in a number of earlier posts. We have covered topics such as:
Gender Based Metabolic Differences in ADHD brains
Gender Dependent ADHD Genes, including MAOA, SLC6A2, SLC6A4 and COMT
ADHD subtypes and Comorbid Disorders
Clearly, there are a number of boy/girl differences in the root causes, diagnoses and treatment methods for the disorder.
However, we need to investigate whether intra-individual differences are also an important factor, especially where medication treatment and medication dosing levels are concerned. Based on a number of studies, it appears that women may actually require different medication dosing levels depending on where they are in their menstrual cycle. Additionally, post-menopausal drugs such as estradiol patches may also alter the drug effects of certain ADHD medications such as amphetamines. The main culprits are most likely fluctuating levels of estrogen and progesterone.
Here are brief summaries on some of the relevant studies and their findings. Wherever possible, I will include a link to the original studies:
The link between Estradiol treatment and amphetamine medications: This study focused on whether pretreatment with estradiol played any role in the reaction to amphetamines. The drug used in this study was D-Amphetamine, which would correspond to the medication Dexedrine, however, this is also the predominantly active compound in medications such as Adderall or Vyvanse (once this “pro-drug” is metabolized). It is unclear at the moment whether chemical “cousins” to amphetamines, such as methylphenidate (Ritalin, Concerta, Daytrana, Metadate), also exhibit these fluctuations when combined with estradiol-releasing drugs.The study found that for females who took estradiol-supplementing treatments during the early follicular phase (pre-ovulation) of the menstrual cycle experienced an overall greater “stimulating” effect of the amphetamine medication (taken as 10 mg of amphetamine). This may suggest that a slightly lower dosage during this stage of the menstrual cycle might be warranted, and (as this blogger’s personal hypothesis) may actually affect the addiction potential of ADHD stimulant drugs such as amphetamines.
Another study by the same group found that estrogen may be responsible for some of the heightened euphoric effect felt from amphetamine-based drugs. However, the hormone progesterone may actually counteract some of this euphoria. During the luteal phase of the menstrual cycle (after ovulation), high levels of both estrogen and progesterone are seen (although levels of both of these taper off going into menstruation), so the effects of estrogen may be curbed. During the late follicular phase, where progesterone levels are low and estrogen levels begin to spike, the “high” may be at its peak, especially if stimulants are involved.
A case study found that an increase in inattentive symptoms coincided cyclically with the menstrual cycle for a patient who was undergoing treatment for newly-diagnosed ADHD with a twice-daily dosing regimen of the stimulant medication Concerta.
The findings from these two studies suggest the possibility that a slightly smaller dosing schedule with amphetamine-based ADHD medications (such as Adderall, Vyvanse or Dexedrine) may be warranted during the follicular phase. However, during the luteal phase, when progesterone levels are higher, the amphetamine-based effects are less pronounced. This may correlate to a slightly higher dosing regimen for amphetamine-based treatment for ADHD and related disorders.
While there is a relatively good theoretical basis for this assertion above, practical consideration measures must also be considered. Based on the relative scarcity of studies (besides the 2 mentioned above) on the amphetamine-menstrual cycle interactions, it is unclear as to how pronounced the medication change should be.For instance, should someone taking 10 mg of Adderall during the follicular phase boost up to 15 mg for the luteal phase? 20 mg? 30 mg? Additionally, hormonal fluctuations vary during the phases themselves, such as the estrogen spike during the late follicular phase. Questions abound, especially when dealing with the brief ovulatory phase as well.
This blog post hopefully introduces what may be a new consideration to women who have ADHD and are currently taking stimulant-based medication treatments. Perhaps this posting simply confirms what you have already experienced.
Nevertheless, given the fact that administering variable levels of medication based on cyclical patterns such as time of day (like ramping up methylphenidate concentrations via controlled release formulations to offset “acute tolerance” based effects), and the fact that individuals with ADHD may experience seasonal variations in symptoms, at least suggests, that variable dosing of medications across the near-monthly period of the menstrual cycle may prove to be beneficial treatment strategy for females with ADHD.
Comment from Leslie
This is a landmark article – if ADHD meds need to be regulated for where a woman is in her menstrual cycle – SHOUDN’T ALL MEDS – and how about surgery? There have been studies on the timing of surgery for women and the outcome based on where she is in her cycle. It is the same as stated above. Surgery during the premenstrual phase has a lot more risks than prior to ovulation.
Women need to have a medical model based on their own bodies and not of men’s .
PG
Author: Leslie Carol Botha
Author, publisher, radio talk show host and internationally recognized expert on women's hormone cycles. Social/political activist on Gardasil the HPV vaccine for adolescent girls. Co-author of "Understanding Your Mood, Mind and Hormone Cycle." Honorary advisory board member for the Foundation for the Study of Cycles and member of the Society for Menstrual Cycle Research.
Filed Under: ADHD Deficit Hyperactivity Disorder, Birth Control Pills/BCP's, Hormone Imbalance, Menstruation, Wellness Tagged With: Menstrual Cycle, Natural Progesterone
About Leslie Carol Botha
Author, publisher, radio talk show host and internationally recognized expert on women's hormone cycles. Social/political activist on Gardasil the HPV vaccine for adolescent girls. Co-author of "Understanding Your Mood, Mind and Hormone Cycle." Honorary advisory board member for the Foundation for the Study of Cycles and member of the Society for Menstrual Cycle Research.
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last reply was november 7, 2011
Melissa
July 28, 2009
Just wanted to say thank you for the post.
It helped confirm what I’ve been suspecting…..when I am on my cycle, I notice that my regular dosage of adderall does not effect me at all. I am even able to take a nap!!!
Now I’m going to go talk to my doctor and ask about increasing my dosages during certain times of my cycle.
jess
November 23, 2010
explains a lot… was so depressed and frustrated lately… missed something really important with school…. ugh :(
Kayla
December 7, 2010
Absolutely! I experience a PROFOUND difference in the effects of my stimulant (Adderall) around ovulation and in the days preceding and following the onset of my period. The symptoms are similar to those of stimulant withdrawal, actually, unless I boost my dosage. I get headaches, inattention, irritability, intense appetite, sweats, depression spells. It really is an awful rollercoaster!
Some psychiatrists have suggested ovulation-ceasing birth control medication to alleviate some of the hormonal roller coaster that goes on. This may be a viable option for some women, I think. I just tried my first brand of birth control (Loestrin 24), and it just about caused a nervous breakdown.
I can’t help but wonder, also, the relationship between hormonal imbalance and ADHD symptoms, on the whole. What if chemical estrogens in the environment are a precipitating factor in the ADHD “epidemic?”
Leslie Carol Botha
December 7, 2010
You raise an interesting question about estrogen in the environment and ADHD. I will have to look into that.
mea
November 7, 2011
Me too!!! Conserta does not work when I am pmsing.. and during period… even if I take my birth control late in the day… the next day I can sence the meds not working.. can not do anything….
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Hi Trish. I wonder how things turned out for you last year. I just started Vyvanse about a month ago and I'm pretty sure I'm not going to be getting my period at all this month. I did have an hour or two of cramping and such a light period over the past week I wasn't sure about it. Initially, I thought it was the beginning of my menstruation, but it's actually never started. I also normally get quite significant cramping but not much at all this week. I was also starting to think that I might be experiencing perimenopause, but it seems unlikely when my aunts 10+ yrs older than me are still having periods. This just came on very suddenly and feels unnatural so I am looking at changes that may be causing this disruption. This question has been asked in many other places online. I'd like to know what conclusion you came to. I am 44yrs old for the record. All the best!
Ladies i would let your doctors know about this sence we could not find it!!! also if you go to our drugh look up at the start of the site there is a number for the dea that want to know about side effects not listed... See when they do these studies its a small amout of people but when it its released to the public,Then more side effects show up because of the large amount of people taking it.So it would not hurt if one of you or both let them know they keep up on these meds even after it is released and well make the company put it in if they get enough people telling them that way the next time it comes up it well be in the side effect Have a great day Chuck1957
I came across this forum in search of answers for myself. I have had pretty regular cycles for over 20 years, now 32 years old. I have been taking Vyvanse for almost 3 years. I recently missed my period for 3 months then had it for 15 days before my doctor put me on progesterone to stop the bleeding. I was not pregnant, my internal exam was normal/healthy, I have not been under any additional stress, no recent weight gain/loss, no excessive exercising, and all of my hormone levels are in the normal range. I was told by my doctor that sometimes this is just happenstance and everything may return back to normal which is my hope, but I couldn't help wondering if the only drug I am on (Vyvanse) could somehow have contributed. Please let me know if you guys find out anything more. Thanks!
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You are here: Home / Adolescent Health / ADHD Deficit Hyperactivity Disorder / Why the Menstrual Cycle May Effect ADHD Medication Dosing Levels
Why the Menstrual Cycle May Effect ADHD Medication Dosing Levels
May 22, 2009 by Leslie Carol Botha 5 Comments
ADHD Treatment Blogs
We have investigated the impact of gender on ADHD in a number of earlier posts. We have covered topics such as:
Gender Based Metabolic Differences in ADHD brains
Gender Dependent ADHD Genes, including MAOA, SLC6A2, SLC6A4 and COMT
ADHD subtypes and Comorbid Disorders
Clearly, there are a number of boy/girl differences in the root causes, diagnoses and treatment methods for the disorder.
Expand...
However, we need to investigate whether intra-individual differences are also an important factor, especially where medication treatment and medication dosing levels are concerned. Based on a number of studies, it appears that women may actually require different medication dosing levels depending on where they are in their menstrual cycle. Additionally, post-menopausal drugs such as estradiol patches may also alter the drug effects of certain ADHD medications such as amphetamines. The main culprits are most likely fluctuating levels of estrogen and progesterone.
Here are brief summaries on some of the relevant studies and their findings. Wherever possible, I will include a link to the original studies:
The link between Estradiol treatment and amphetamine medications: This study focused on whether pretreatment with estradiol played any role in the reaction to amphetamines. The drug used in this study was D-Amphetamine, which would correspond to the medication Dexedrine, however, this is also the predominantly active compound in medications such as Adderall or Vyvanse (once this “pro-drug” is metabolized). It is unclear at the moment whether chemical “cousins” to amphetamines, such as methylphenidate (Ritalin, Concerta, Daytrana, Metadate), also exhibit these fluctuations when combined with estradiol-releasing drugs.The study found that for females who took estradiol-supplementing treatments during the early follicular phase (pre-ovulation) of the menstrual cycle experienced an overall greater “stimulating” effect of the amphetamine medication (taken as 10 mg of amphetamine). This may suggest that a slightly lower dosage during this stage of the menstrual cycle might be warranted, and (as this blogger’s personal hypothesis) may actually affect the addiction potential of ADHD stimulant drugs such as amphetamines.
Another study by the same group found that estrogen may be responsible for some of the heightened euphoric effect felt from amphetamine-based drugs. However, the hormone progesterone may actually counteract some of this euphoria. During the luteal phase of the menstrual cycle (after ovulation), high levels of both estrogen and progesterone are seen (although levels of both of these taper off going into menstruation), so the effects of estrogen may be curbed. During the late follicular phase, where progesterone levels are low and estrogen levels begin to spike, the “high” may be at its peak, especially if stimulants are involved.
A case study found that an increase in inattentive symptoms coincided cyclically with the menstrual cycle for a patient who was undergoing treatment for newly-diagnosed ADHD with a twice-daily dosing regimen of the stimulant medication Concerta.
The findings from these two studies suggest the possibility that a slightly smaller dosing schedule with amphetamine-based ADHD medications (such as Adderall, Vyvanse or Dexedrine) may be warranted during the follicular phase. However, during the luteal phase, when progesterone levels are higher, the amphetamine-based effects are less pronounced. This may correlate to a slightly higher dosing regimen for amphetamine-based treatment for ADHD and related disorders.
While there is a relatively good theoretical basis for this assertion above, practical consideration measures must also be considered. Based on the relative scarcity of studies (besides the 2 mentioned above) on the amphetamine-menstrual cycle interactions, it is unclear as to how pronounced the medication change should be.For instance, should someone taking 10 mg of Adderall during the follicular phase boost up to 15 mg for the luteal phase? 20 mg? 30 mg? Additionally, hormonal fluctuations vary during the phases themselves, such as the estrogen spike during the late follicular phase. Questions abound, especially when dealing with the brief ovulatory phase as well.
This blog post hopefully introduces what may be a new consideration to women who have ADHD and are currently taking stimulant-based medication treatments. Perhaps this posting simply confirms what you have already experienced.
Nevertheless, given the fact that administering variable levels of medication based on cyclical patterns such as time of day (like ramping up methylphenidate concentrations via controlled release formulations to offset “acute tolerance” based effects), and the fact that individuals with ADHD may experience seasonal variations in symptoms, at least suggests, that variable dosing of medications across the near-monthly period of the menstrual cycle may prove to be beneficial treatment strategy for females with ADHD.
Comment from Leslie
This is a landmark article – if ADHD meds need to be regulated for where a woman is in her menstrual cycle – SHOUDN’T ALL MEDS – and how about surgery? There have been studies on the timing of surgery for women and the outcome based on where she is in her cycle. It is the same as stated above. Surgery during the premenstrual phase has a lot more risks than prior to ovulation.
Women need to have a medical model based on their own bodies and not of men’s .
PG
Author: Leslie Carol Botha
Author, publisher, radio talk show host and internationally recognized expert on women's hormone cycles. Social/political activist on Gardasil the HPV vaccine for adolescent girls. Co-author of "Understanding Your Mood, Mind and Hormone Cycle." Honorary advisory board member for the Foundation for the Study of Cycles and member of the Society for Menstrual Cycle Research.
Filed Under: ADHD Deficit Hyperactivity Disorder, Birth Control Pills/BCP's, Hormone Imbalance, Menstruation, Wellness Tagged With: Menstrual Cycle, Natural Progesterone
About Leslie Carol Botha
Author, publisher, radio talk show host and internationally recognized expert on women's hormone cycles. Social/political activist on Gardasil the HPV vaccine for adolescent girls. Co-author of "Understanding Your Mood, Mind and Hormone Cycle." Honorary advisory board member for the Foundation for the Study of Cycles and member of the Society for Menstrual Cycle Research.
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last reply was november 7, 2011
Melissa
July 28, 2009
Just wanted to say thank you for the post.
It helped confirm what I’ve been suspecting…..when I am on my cycle, I notice that my regular dosage of adderall does not effect me at all. I am even able to take a nap!!!
Now I’m going to go talk to my doctor and ask about increasing my dosages during certain times of my cycle.
jess
November 23, 2010
explains a lot… was so depressed and frustrated lately… missed something really important with school…. ugh :(
Kayla
December 7, 2010
Absolutely! I experience a PROFOUND difference in the effects of my stimulant (Adderall) around ovulation and in the days preceding and following the onset of my period. The symptoms are similar to those of stimulant withdrawal, actually, unless I boost my dosage. I get headaches, inattention, irritability, intense appetite, sweats, depression spells. It really is an awful rollercoaster!
Some psychiatrists have suggested ovulation-ceasing birth control medication to alleviate some of the hormonal roller coaster that goes on. This may be a viable option for some women, I think. I just tried my first brand of birth control (Loestrin 24), and it just about caused a nervous breakdown.
I can’t help but wonder, also, the relationship between hormonal imbalance and ADHD symptoms, on the whole. What if chemical estrogens in the environment are a precipitating factor in the ADHD “epidemic?”
Leslie Carol Botha
December 7, 2010
You raise an interesting question about estrogen in the environment and ADHD. I will have to look into that.
mea
November 7, 2011
Me too!!! Conserta does not work when I am pmsing.. and during period… even if I take my birth control late in the day… the next day I can sence the meds not working.. can not do anything….
FOLLOW ME ON THE WEB!
SEARCH
Search for: Submit Form
Not finding what you are looking for?
Try our Custom Search
Leslie Carol Botha
Experiencing Hormone Imbalance Related Anxiety?
Consult with
Leslie Carol Botha
Today!
Q96
QSciences
EMPowerplus Q96
Promotes Hormone Balance, Mental Clarity & Mental Wellness
Powerful Vitamins, Amino Acids & Minerals Working Synergistically to Purify, Optimize & Protect Mind & Body
Real Women - Real Data -
Real Solutions
Hormones Matter
Real World Data for Real Life Decisions
Take a Health Survey Today!
Medication adverse reactions, treatment outcomes, drug safety and efficacy data.
Touchstone Essentials