Menstrual Cycle Phases and ADHD: Why Cycle Syncing Is Essential

There’s the menstrual cycle, and then there’s the menstrual cycle when you have attention deficit hyperactivity disorder (ADHD).

ADDitude readers have already told us what researchers have yet to adequately explore: That the menstrual cycle directly impacts ADHD symptoms. Budding research suggests that premenstrual syndrome (PMS) and its more severe form, premenstrual dysphoric disorder (PMDD), may disproportionately impact individuals with ADHD — a finding that surprises very few ADDitude readers.

That’s why so many menstruating individuals with ADHD track their menstrual cycles and use the information to make informed decisions and navigate life — or at least to maintain perspective on how hormonal fluctuations affect their ADHD symptoms, energy levels, and functioning.

“I 100% schedule my life around my cycle,” said Misha, an ADDitude reader. “I try to do as much as I can while my energy and mood are at their best so it’s easier to have quieter, less productive days later in my cycle.”

Here, we’ll break down the phases of the menstrual cycle, what you can expect to experience at each stage, and ideas for cycle syncing according to your changing ADHD symptoms and energy levels (with tips from ADDitude readers*).

[Get This Free Download: Hormones & ADHD in Women]

Menstrual Cycle Phases and ADHD

The menstrual cycle — the time from the first day of your period to the day before your next one — lasts an average of 28 days. We can split the cycle into two phases: the follicular phase and the luteal phase. Fluctuating estrogen and progesterone levels through these phases explain ever-changing energy, mood, and productivity levels. A good rule of thumb: High-estrogen states equate to better mood and greater executive functioning (EF) — you’re generally at your best here. In low-estrogen states, mood and EF worsen — as do ADHD symptoms.¹

Follicular Phase

The follicular phase lasts approximately two weeks, starting on the first day of your period and ending with ovulation.

What to Do on Your Period

Estrogen levels remain low during menstruation, which can last anywhere from two to eight days, though the average is four to six days.² You can expect to experience typical symptoms — cramps, headaches, bloating, fatigue, moodiness — during your flow, and aggravated ADHD symptoms like forgetfulness, trouble focusing, and emotional dysregulation.

• Try to slow down and decrease your to-dos.
  • “The week of menses, I limit my client load and sometimes even take a few days off. This practice has decreased my need to cancel a client session and reschedule.” — Liz, Minnesota
  • “I slot into ‘only do what I can manage’ mode during my period. I get migraines and cramps, so I rest in bed on a heating pad, answer work emails on my phone, and order out or do easy meals for the kids and myself.” — An ADDitude Reader
  • “My daughter tries to keep workload to a minimum by planning errands, appointments, and even meals in advance. She often asks for assistance from me and her husband.” — Barbara, Georgia
  • “I’ve let go of trying to function the same way I do the rest of the month. I sleep more, eat what I want to, take time off, etc. It hasn’t been easy, but it feels healthier.” — Lynette, Illinois

[Read: Women, Hormones, and ADHD]

• Avoid foods that worsen menstrual cramps. According to one study, a diet high in inflammatory foods like meats, oil, caffeine, sugars, and salts may worsen cramps, while foods high in omega-3 fatty acids reduce cramping.^{3 4}
  • “On my period I usually try not to drink caffeine because it makes my cramps and nausea worse,” — Michelle, Oregon
  • “I absolutely do not eat dairy, sugary and/or fried foods, or anything cold at this phase, otherwise my cramps get much worse!” — Stephanie

• Get your body moving. Regular exercise can reduce menstrual pain, and light activity during your period may also help.^{5 6}
  • “I make sure I exercise because it helps with physical discomfort and brain fog.” — Michelle, Oregon
  • “During my period I cannot do much exercise, but I try to do some gentle walking and stretching.” — An ADDitude Reader

• Use pain relievers.
  • “I use Cycle patches from The Good Patch, as they are the only thing I have found that help with the pain and don’t upset my stomach.” — Elizabeth, New Hampshire

• Rest and get enough sleep. Sleep problems are common in ADHD, and they’re also common during and leading up to menstruation, contributing to overall feelings of exhaustion.^{7 8} As one reader said, “I’ve always been an awful sleeper, but my periods made me feel more weary than usual.”
  • Practice good sleep hygiene. Avoid screens in the hour before bedtime; try progressive muscle relaxation or another relaxing activity; keep your bedroom cool and dark; avoid eating close to bedtime.

During the Rest of the Follicular Phase

Estrogen levels start to rise about a week after the start of your period, and continue to climb for about seven days, shooting up and peaking just before ovulation (i.e., when an egg is released from one of the ovaries).⁹ Many ADDitude readers recognize that the week after their period is when they feel most productive, focused, and energetic. ADHD symptoms are also more manageable.

“After my period I usually have a day where I wake up and it suddenly feels easier to breathe. I feel lighter.” — An ADDitude Reader

“At peak ovulation. I think I am a superhero and push and over-estimate everything that I want to do and can do.” Michelle, New York.

“I find that as my first week (flow) subsides, my ADHD symptoms are so much better. I feel like I get so much more done on those days. I’m much more stable, motivated, focused, and mentally competent.” —An ADDitude Reader

What to Do After Your Period

• Work on your big projects and cross off to-dos.
  • “I plan my more ‘focus-needed’ tasks for the weeks after my period. I try to be as productive as possible during the two weeks after my period because I know I’m going to struggle with the basics afterward.” —An ADDitude Reader
  • “The first half of the cycle is when I get the most done. I’ve started to schedule regular tasks I find boring during this time, like doing several loads of laundry before I get nothing done later.” — Edith

• Schedule your appointments and social events during this time.
  • “Days 2 to 10/12 are the best. I try to plan social events and travel for this time, when possible, as well as haircuts and other personal appointments.” — Misha
  • “In general, when I’m ovulating I try to do the more social things of life, say networking or dating, as I have the most energy and am at my “brightest.” —  Stephanie

• Take your workouts up a notch.
  • “I know that the week after my period I am a rockstar, I feel as though I can conquer the world, and my workouts are so strong that week.” — Addison, Wisconsin
  • “I tend to structure my exercise around my cycles. I do light exercise and yoga during my period. After my period, I transition to more weightlifting and strength exercises.” — An ADDitude Reader

• Do your future self a favor. Think of what you can do during this phase to prepare to ride out the more difficult parts of your cycle.
  • “Being perimenopausal, I don’t always know when my menses will come or for how long. I have frozen food and pre-made grab-and-go food for myself. I keep post-it notes with me for when something comes to mind that I should do/refill to try not to forget anything.” — Tammy, Colorado
  • “I have to use all the cope-ahead strategies I can. I do a full restock haul of all the of-course-I’m-out-of-that things to create a little buffer of tolerance. I’ve learned to think of the version of me on my cycle as a guest I want to host well.” —Lindsay, Pennsylvania
  • “Laundry, dishes, the icky floor, the bathroom… I (try) to stay on top of it for as long as I can before my period starts.” — Ine

Luteal Phase

The luteal phase — also lasting about two weeks — starts after ovulation and ends the day before your period. Estrogen levels plummet after ovulation (assuming fertilization has not occurred), and rise slightly during the mid-luteal phase before dropping off again in the days leading up to menses.⁹ Progesterone levels, meanwhile, rise in the days after ovulation before falling in the lead up to menstruation.

Changing hormone levels in this phase are thought to explain the range of symptoms that appear for many in the weeks before menstruation, collectively known as PMS. Symptoms of PMS include (but are not limited to) mood swings, anxiety, irritability, sadness, changes in appetite, trouble sleeping and/or insomnia, headaches, and poor concentration.¹⁰ The luteal phase, according to ADDitude readers, wreaks havoc on ADHD symptoms.

“The entire week leading up to my period is where my ADHD symptoms get even more intrusive than usual. My executive functioning dips even lower, distractibility and difficulty focusing is increased, and my mood/energy level is much lower, causing me to feel badly about all the things I’m not being successful at that week.” —  Chloe

“About six days prior to my menstruation my rejection sensitive dysphoria (RSD) is at its worst. I cry a lot, I binge eat, and I see mainly/only the dark side of things.” — Chiara, Italy

“From day 14 to 25, my symptoms of inattentive ADHD are worse. It certainly feels like my working memory is the most severely affected three days before my period. I just can’t remember what I’m doing, I’ll walk into the kitchen 100 times, and forget each time that I’m trying to get something to eat.” — Kay, Scotland

Even ADHD medications seem to lose their effectiveness during the luteal phase.

“My ADHD meds are significantly less efficacious for about 10 days per month; two days before the bleed I am a barely functional zombie.” — An ADDitude Reader

“The week leading up to my cycle, I might as well not even take my ADHD meds. It’s like my body overrides them.” — Norma, Wisconsin

For readers with PMDD — a condition that, according to one study, may be more prevalent in people with ADHD than in the general population¹¹ — this phase of the menstrual cycle is when severe symptoms appear, affecting all aspects of life.

“It’s debilitating. I’m unable to concentrate on work, my marriage, or just my overall mindfulness because I’m plagued with thoughts of anxiety and overwhelm. For me, it feels like I take one step forward during the one or two weeks before/after PMDD and five steps back during the week of PMDD.” — Angelina, California

What to Do Leading Up to Your Period

• Consider rescheduling big events and/or holding off on making important decisions.
  • “The week before my period is worse now that I’m premenopausal. I purposely don’t schedule big, important meetings during this week. If I can possibly avoid anything extra on my schedule, I will.” — An ADDitude Reader
  • “I have gotten good at noticing my inability to cope, lack of focus, and emotional dysregulation the week or so before my period, and I’m able to scale back on big projects and demanding social engagements. I’m better at not scheduling large groups of kids to come hang out at our house those weeks.” — An ADDitude Reader
  • “I enjoy multi-day backpacking trips, but I absolutely know I must avoid that time frame around my period so that I don’t make stupid decisions that may spell disaster.” — Laura, Oregon

• Tell your loved ones about your symptoms.
  • “I advise people in my life that I will likely be more emotional/irrational/impulsive during this time.” —An ADDitude Reader
  • “A few days before, I notice a shift within myself and I speak to my husband about it so he knows what’s coming.” — Jodi
  • “I mark the expected first day of my period in my calendar each month so that I know not to plan major social functions, challenging conversations, or anything important that would potentially be ruined by increased anxiety, emotional lability or decreased focus and memory in the week leading up to it (especially in the two to three days prior). It’s in our shared calendar, so my husband also has a heads up and can plan accordingly.” — Sarah
  • “My nurse midwife gave me cute red dangly earrings to wear when I’m feeling symptoms as a way to let my family know to be a bit more gentle with me, knowing that I’m not totally feeling like myself.” — An ADDitude Reader

• Avoid triggering situations.
  • “Life is much harder two weeks prior to menstrual period. ADHD symptoms are worse and it seems like meds don’t really do anything. I try to avoid talking about or dealing with things that trigger big emotions.” —An ADDitude Reader

• Say no more often — and ask for help.
  • “I don’t commit to anything extra the week leading up to my period because I am very forgetful and easily overwhelmed.” — An ADDitude Reader
  • “Everyone gets a, ‘No, I do not have the mental capability today, but would love to meet up next week instead.’” —Tanya, Vermont
  • “Around a week before my period starts, I try not to force myself to stay on top of things because it’s too exhausting. My boyfriend (he’s ADHD also) tries to pick up the slack where he can.” — Ine

• Adjust medications as needed.
  • “I take extra ADHD meds in order to not drop the ball completely, and I allow myself a lot of ‘free passes’ (like take-away if cooking/grocery shopping is too much).” — An ADDitude Reader
  • “I take my afternoon medication earlier, though my boss is very understanding when I have to take the day off.” — An ADDitude Reader
  • “With PMDD, I make sure to double up on my depression medication for that week, take PTO if needed, and practice self-care daily.” —Noelle, New York

• Talk to your doctor if your symptoms are significant… especially if you suspect that you might have PMDD. Treatments are available to ease your symptoms during this time.
  • “I’m now taking Vyvanse, Sertraline (an SSRI), and hormonal birth control, which have greatly helped with my symptoms.” —Liz, Canada
  • “Since choosing an IUD as my main form of contraception, the impact of my menstrual cycle on daily life has reduced dramatically.” — An ADDitude Reader
  • “A combination of the mini pill and Zoloft helps a ton.” — An ADDitude Reader
  • “I don’t menstruate. I use hormonal birth control specifically because I couldn’t handle trying to plan my life around my cycle.” — An ADDitude Reader

• Practice self-care and be extra kind to yourself.
  • “I make sure all my comfortable clothing is clean and ready, and I keep my hot water bottle on display. I have comedy films ready and treats in the cupboard.” — An ADDitude Reader
  • “I try to extend grace and kindness to myself when I recognize I’m being impacted by my cycle. I’m perimenopausal so this is a wild and unpredictable ride. I’m a mom and shift worker, so there isn’t much I can do to accommodate my symptoms besides be kind to myself, medicate for the cramps, and hope I’m not rostered on bad days.” — An ADDitude Reader
  • “I don’t have the luxury of scheduling around my cycle, but now that I’m being treated for ADHD, I am more aware of how my cycle affects things — especially my ADHD symptoms. It’s made me have a bit more compassion for myself.” — An ADDitude Reader

*Reader quotes edited for brevity and clarity.

Menstrual Cycle Phases and ADHD: Next Steps

• Read: PMS and ADHD — How the Menstrual Cycle Intensifies Symptoms
• Read: ADHD Impairment Peaks in Menopause, According to ADDitude Reader Survey
• Read: PMDD, Autism, and ADHD — the Hushed Comorbidity

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