What Is PMS? Understanding Symptoms, ADHD Connections, and Managing Relief

What does PMS mean?

PMS, or premenstrual syndrome, refers to a collection of physical and emotional symptoms that occur during the luteal phase of the menstrual cycle, typically in the one to two weeks before menstruation starts. The term "premenstrual" simply means "before menstruation," while "syndrome" indicates a group of symptoms that consistently appear together.

The prevalence and impact

Research shows that approximately 47.8% of reproductive-age women worldwide experience PMS. For about 20% of women, symptoms become severe enough to disrupt daily activities, while others experience mild to moderate effects. Women in their 30s are most likely to experience PMS, though symptoms can begin at any point during reproductive years.

What causes PMS

Symptoms arise from hormonal fluctuations during the menstrual cycle, particularly changes in estrogen and progesterone levels. Research also suggests that fluctuations in serotonin, a brain chemical that regulates mood, play a significant role in triggering premenstrual symptoms. If your brain chemistry is already affected by ADHD, these hormonal shifts can have compounded effects.

Importantly, symptoms typically disappear within a few days of menstruation starting, which distinguishes PMS from other conditions.

Common PMS symptoms

Premenstrual symptoms vary widely from person to person, but they generally fall into two categories: physical and emotional.

Physical symptoms:

• Bloating and water retention
• Breast tenderness and swelling
• Headaches or migraines
• Abdominal cramping and back pain
• Changes in appetite and food cravings
• Digestive issues like nausea or constipation
• Skin changes or acne breakouts
• Fatigue and low energy
• Sleep disturbances

Emotional and psychological symptoms:

• Mood swings and irritability
• Anxiety or feelings of tension
• Low mood or sadness
• Difficulty concentrating
• Changes in sleep patterns
• Increased emotional sensitivity
• Changes in interest in intimacy
• Feeling overwhelmed or on edge

For many women, emotional symptoms become the most disruptive aspect of PMS, affecting relationships, work performance, and overall quality of life. This is especially true for women with ADHD.

ADHD and periods: The hidden connection most people don't know about

Why ADHD period symptoms intensify: Many women with ADHD notice their symptoms worsen dramatically during certain phases of their menstrual cycle, a connection often overlooked in clinical settings. Recent research provides compelling evidence for why this happens.

Your brain relies on dopamine for attention, executive function, and emotional regulation in the very areas where ADHD creates challenges. During the luteal phase, fluctuating estrogen levels affect dopamine production and receptor sensitivity.

Common ADHD period symptoms include:

• Severe difficulty concentrating and maintaining focus
• Increased impulsivity and poor impulse control
• Difficulty organizing thoughts and managing tasks
• Time blindness becoming more pronounced
• Emotional dysregulation and mood instability
• Rejection sensitive dysphoria intensifying
• Sleep problems worsening
• Executive dysfunction (starting tasks, completing them, planning)
• Increased forgetfulness and memory lapses

The cycle connection: Research demonstrates that ADHD symptom fluctuations follow predictable patterns across the menstrual cycle. According to Eng et al. (2023), declines in estrogen particularly affect two points in the cycle:

1. Mid-cycle (periovulatory period): Rapid estrogen declines interact with increased reward-seeking behaviors and approach motivation, leading to heightened hyperactivity and impulsivity
2. Perimenstrual phase (end of cycle): Estrogen withdrawal coincides with increased negative affect and social withdrawal, intensifying inattention symptoms

Many women don't realize their ADHD symptoms fluctuate with their menstrual cycle. You might think your medication stopped working when actually you've entered your luteal phase. Or you might blame yourself for lack of willpower when hormonal changes have genuinely affected your brain chemistry.

ADHD menstrual cycle patterns: Why tracking reveals the truth

One of the most powerful tools for managing both ADHD and PMS is cycle tracking. When you track symptoms alongside your menstrual cycle, patterns emerge that might explain struggles you previously attributed to personal failure.

What to track:

• ADHD symptoms (focus, impulse control, emotional regulation, executive function)
• PMS physical symptoms (bloating, fatigue, pain)
• Mood changes and emotional intensity
• Sleep quality
• Energy levels
• Medication effectiveness (if applicable)
• Stress and anxiety levels

The Samphire App offers personalized tracking with cycle-phase awareness, allowing you to log ADHD symptoms, PMS symptoms, and general wellbeing together. When you see patterns emerge such as consistently worse focus during your luteal phase you can plan accordingly rather than fighting against your biology.

How hormones and dopamine interact: The neurobiological explanation

Recent research illuminates the biological mechanism connecting ADHD and cycle-related symptom changes. According to research cited by Eng et al. (2023), estradiol (the primary form of estrogen during reproductive years) has facilitative effects on dopamine functioning throughout the brain.

When estrogen declines, dopamine availability decreases in two critical areas:

1. Prefrontal cortex: This region controls executive function focus, planning, impulse control. Reduced dopamine here creates temporary impairments in attention and emotional regulation
2. Mesolimbic regions: These reward-processing areas show altered responsivity, contributing to increased anhedonia (loss of pleasure in activities) and reduced motivation

This explains why women with ADHD often notice their executive function challenges intensify before their period, even if their ADHD medication dose remains constant.

ADHD and irregular periods: Understanding the connection

Some women with ADHD also experience irregular periods or disrupted menstrual cycles. This can stem from several factors:

• Executive dysfunction affecting self-care: Missed medications, inconsistent sleep, poor nutrition, and stress can disrupt hormonal regulation
• Emotional dysregulation affecting the hypothalamic-pituitary-ovarian axis: The brain system controlling your cycle is sensitive to stress and emotional intensity
• Comorbid conditions: ADHD often co-occurs with conditions like PCOS or thyroid disorders that affect cycle regularity
• Medication effects: Some ADHD medications can influence cycle timing

If you notice your periods becoming irregular, speak with a healthcare provider to rule out underlying conditions. Consistent tracking helps you recognize whether irregular periods are a pattern or temporary fluctuation.

Managing both ADHD and PMS: An integrated approach

Effective management requires addressing both conditions simultaneously rather than treating them separately.

Lifestyle approaches:

• Regular physical activity (particularly helpful for both ADHD and PMS)
• Consistent sleep schedule (challenging but critical for ADHD symptom management)
• Stress reduction through breathwork, meditation, or mindfulness
• Balanced nutrition with attention to blood sugar stability
• Limiting caffeine during luteal phase (can worsen ADHD restlessness and anxiety)
• Heat therapy for physical pain
• Structured routines, especially during high-symptom phases

Tracking and planning

Use your cycle awareness to plan demanding tasks during the follicular phase (post-menstruation), when many women with ADHD experience improved focus and executive function. Reserve the luteal phase for flexible, low-pressure activities when possible.

Medical interventions:

For women seeking non-hormonal, non-stimulant support, brain stimulation technology offers evidence-based relief. Nettle™ is a CE-marked medical device (UK/EU) clinically proven to reduce menstrual pain and support emotional regulation and focus. Lutea™ (US/Canada) offers wellness support designed to enhance calm, balance, and focus during hormonally sensitive times particularly valuable during the luteal phase when ADHD symptoms intensify.

Some women also benefit from:

• SSRI medications for severe emotional symptoms (can be taken continuously or during luteal phase)
• Hormonal birth control to stabilize hormone levels (though effectiveness varies individually)
• Supplements like magnesium or vitamin B6 (consult healthcare provider first)
• Cognitive Behavioral Therapy (CBT) to improve emotional regulation and coping strategies