# paper.pdf ## Metadata - PDFFormatVersion=1.4 - Language=en-US - IsLinearized=false - IsAcroFormPresent=false - IsXFAPresent=false - IsCollectionPresent=false - IsSignaturesPresent=false - CreationDate=D:20260527092253+02'00' - Creator=Adobe InDesign 18.0 (Windows) - Custom.CrossMarkDomains[1]=springer.com - Custom.CrossMarkDomains[2]=springerlink.com - Custom.CrossmarkDomainExclusive=true - Custom.CrossmarkMajorVersionDate=2010-04-23 - Custom.doi=10.1007/s00737-026-01718-x - ModDate=D:20260528073409+02'00' - Producer=Adobe PDF Library 17.0; modified using iText® 5.5.13.4 ©2000-2024 iText Group NV (SPRINGER SBM; licensed version) - Trapped=False - crossmark:crossmarkdomains=springer.comspringerlink.com - pdfx:crossmarkdomains=springer.comspringerlink.com ## Contents ### Page 1 Introduction Attention Deficit/Hyperactivity Disorder (ADHD) is aneurodevelopmental condition characterised by inatten-tion, hyperactivity and impulsivity (American PsychiatricAssociation, a). It negatively affects executive func-tioning, including organisation, focus, emotional regula-tion, and memory (Brown). Adult ADHD prevalencerates range between 2.58% and 6.76% (Song et al.),and recent research suggests nearly equal prevalence in Received: 2 January 2025 / Accepted: 29 April 2026 © The Author(s) 2026 Jessica Bramham 1 School of Psychology, University College Dublin, Dublin,Ireland 2 Health Service Executive, Dublin, Ireland 3 ADHD Ireland, Dublin, Ireland 4 School of Medicine, University College Dublin, Dublin,Ireland # Abstract # Purpose Gender differences in the presentation of Attention-Deficit/Hyperactivity Disorder (ADHD) are well-documented,yet the interaction between ADHD and female reproductive stages remains underexplored. This study investigates howADHD impacts menstruation, perinatal experiences, and menopausal symptoms in females. # Methods A cross-sectional study was conducted with 602 females (mean age = 39.52; SD = 10.21), including 377 with self-reported ADHD and 225 without, recruited through ADHD support groups, social media, Volunteer Ireland, and Prolific.Participants reported their menstrual regularity and completed the Premenstrual Symptoms Screening Tool (PSST). Retro-spective postpartum depression levels were measured using the Edinburgh Postnatal Depression Scale (EPDS), and peri- andpost-menopausal symptoms were evaluated using the Greene Climacteric Scale (GCS). # Results Females with ADHD exhibited significantly higher rates of menstrual irregularity (χ2 = 14.2, p < .001), more severepremenstrual symptoms (χ2 = 204.7, p < .001), elevated postpartum depression levels (t = 7.89, p < .001) with increased riskof unplanned pregnancies and pregnancy-related complications, and greater menopausal symptom severity (t = 9.61, p <.001) compared to their non-ADHD counterparts. # Conclusions These findings highlight a higher prevalence of reproductive-related challenges in females with ADHD, under-scoring the need for further research in this area and more in-depth analysis. They emphasise the importance of integratingADHD considerations into female health research and clinical practice. Highlights - ● Females with ADHD experience more severe premenstrual symptoms, including higher rates of PMS and PMDD. - ● ADHD is linked to higher postpartum depression rates and perinatal complications, underscoring the need for targetedsupport. - ● Females with ADHD report more severe climacteric symptoms during menopause. - ● Further studies addressing reproductive health challenges in females with ADHD is required. Keywords ADHD · Female health · Women’s health · PMDD · Perinatal · Menopause ADHD and the female reproductive stages: menstruation, perinataland menopause Christine Boyd1[ ![http://orcid.org/0009-0002-8131-4994]() ](http://orcid.org/0009-0002-8131-4994) · Margo Wrigley2 · Ken Kilbride3 · Aisling Mulligan4[ ![http://orcid.org/0000-0001-7708-1177]() ](http://orcid.org/0000-0001-7708-1177) · Jessica Bramham1[ ![http://orcid.org/0000-0002-6696-7500]() ](http://orcid.org/0000-0002-6696-7500) Archives of Women's Mental Health (2026) 29:89 [ ![http://crossmark.crossref.org/dialog/?doi=10.1007/s00737-026-01718-x&domain=pdf&date_stamp=2026-5-27]() ](http://crossmark.crossref.org/dialog/?doi=10.1007/s00737-026-01718-x&domain=pdf&date_stamp=2026-5-27) ![Springer Logo]() ### Page 2 males and females1 Numerous research papers have used the terms “female” and“women” interchangeably and have not asked participants to specifytheir sex. We recognise that there are a range of gender identities whowere assigned female at birth (AFAB). To enhance clarity, this studyconsiders menstruation, pregnancy and menopause which are stagesrelevant to the female reproductive lifecycles, so we refer to sex(female) rather than gender identity (woman). In reporting previousresearch, sex and gender usage will be reported transparently (Heidariet al.). in adulthood, despite underdiagnosis infemales (Hinshaw et al.). ADHD frequently co-occurs with physical and mentaldisorders (Kanarik et al.), and there are notable genderdifferences in these co-occurrences. Females with ADHDare more likely to present with internalised symptoms suchas anxiety and depression than males and are more likely tobe referred for emotional issues (Vildalen et al.; Wil-liamson and Johnston; Klefsjö et al.). Depres-sion tends to manifest earlier and recur more frequently infemales with ADHD compared to those without (Powellet al.). Female sex hormones may influence ADHDpresentation, yet research in this area remains sparse, witha recent review identifying only four relevant studies,of which conflicting evidence is presented (Camara et al.). However, growing evidence indicates that ADHD isaffected by female reproductive stages, including menstrua-tion, pregnancy, and menopause. Premenstrual symptoms Hormonal fluctuations across the menstrual cycle cancause physical and mental shifts in females (Rehbein etal.). Oestrogen levels drop after ovulation, rise inthe mid-luteal phase, and decrease again during men-struation. Declining oestradiol levels (the primary formof oestrogen), may impair executive functioning, includ-ing emotion regulation and attention (Eng et al.).Studies have suggested a link between ADHD symptomfluctuation and hormonal changes (Roberts et al.;Haimov-Kochman and Berger). Preliminary find-ings indicate that adjusting stimulant doses during thepremenstrual week may alleviate inattention and mooddifficulties (De Jong et al.). Premenstrual Syndrome (PMS) is recognised asa common condition that is characterised by a rangeof emotional and physical symptoms including moodswings, anxiety and bloating (Dilbaz and Aksan).Premenstrual Dysphoric Disorder (PMDD) is includedin the DSM-5 and involves mood lability, irritability,depression, anxiety, difficulty in maintaining concentra-tion and fatigue, typically emerging for one to two weekspreceding menstruation (American Psychiatric Associa-tion,). Females with ADHD are disproportionatelyaffected by PMDD, with prevalence rates as high as45.5% (Dorani et al.), compared to 1.6% in thegeneral population (Reilly et al.). These findingsunderscore the need for further investigation into theinteraction between ADHD and premenstrual symptoms. Perinatal symptoms A small number of studies suggest that females withADHD have additional risk factors around pregnancy.They have higher rates of unplanned pregnancies andteenage pregnancies (Meinzer et al.; Owens andHinshaw) and over half report perinatal complica-tions (Dorani et al.). Females who have had an abor-tion were three times more likely to report a diagnosis ofADHD (Van Ditzhuijzen et al.). While pregnancy-associated hormonal increases may temporarily mitigateADHD symptoms (Nadeau and Quinn), postpartumdeclines in oestrogen and progesterone have been linkedto mental health challenges (Trifu,). Postpartumdepression (PPD) is elevated in females with ADHD,with reported rates of 57.6%, compared to between 14.5and 19.6% in females without ADHD (Dorani et al.;Andersson et al.). Andersson et al. () foundthat 16.8% of females with ADHD were diagnosed withPPD compared to 3.29% in those without ADHD. Giventhe discrepancy between these prevalence rates, the pres-ence of postpartum depression in the context of ADHDneeds further exploration. Climacteric symptoms (peri and post-menopausal) The climacteric period encompasses the perimenopausal,menopausal, and postmenopausal phases, marked bydeclines in oestrogen and progesterone levels (Greene). Oestrogen and progesterone levels decline dur-ing perimenopause and menopause, which affects therelease of serotonin and dopamine (Antoniou et al.).As dopamine is a key neurotransmitter associated withADHD, this additional reduction in dopamine can resultin further difficulties with focusing and concentration(Epperson et al.). Evidence suggests that climac-teric symptoms, including concentration and mood dif-ficulties, are more severe in females with ADHD (Doraniet al.). However, this life stage remains under-researched in the context of ADHD. In summary, ADHD in females has been underex-plored in clinical and research settings (Young et al.). This study is the first to compare a large sample offemales with and without ADHD to investigate the inter-play between ADHD and female reproductive stages. ### Page 3 Research questions This study aimed to expand upon Dorani et al.’s ()work by exploring the following four questions. In com-parison with non-ADHD females: (1) Menstruation: Dofemales with ADHD experience higher rates of PMS andPMDD? (2) Do females with ADHD have higher numbersof unplanned pregnancies, abortions, loss of pregnancy,pregnancy-related complications and higher rates of post-partum depression? (3) Do females with ADHD have moresevere menopausal symptoms? (4) Is there a relationshipbetween ADHD symptom severity and severity of PMS,PMDD, PPD and climacteric symptoms? Methods Participants A total of 801 females in Ireland with ADHD participatedin this cross-sectional study. Inclusion criteria were femalesaged 18–69 living in Ireland who had experienced menstru-ation, pregnancy, or perimenopause/menopause. As shownin Fig., participants were included in the ADHD groupif they indicated a diagnosis of ADHD, whether throughformal diagnosis or self-identification and met the AdultSelf Report Scale’s (ASRS) criteria for ADHD (Kessler etal.). Non-ADHD participants did not meet the ASRScriteria. The final sample included 602 females (meanage = 39.52; SD = 10.21), comprising 377 with ADHD and225 without. ADHD participants were recruited via ADHDIreland, while non-ADHD participants were recruitedthrough social media, Volunteer Ireland, and Prolific. Measures Demographics Participants provided information on age, education, medi-cations, and medical conditions. Premenstrual symptoms Menstrual regularity and Premenstrual Symptoms Screen-ing Tool (PSST) responses were collected to assess forPMS and PMDD. The PSST is a 19-item retrospectivequestionnaire rated on a 4-point Likert scale (0 = not at all,3 = severe), designed to identify Premenstrual DysphoricDisorder and Premenstrual Syndrome in line with DSM-IVcriteria (Steiner et al.). It shows high sensitivity (79%)in previous studies (Henz et al.) and strong internalreliability in this study (α = 0.95). The scoring for the criteriathresholds are provided in Steiner et al.’s paper. Perinatal symptoms Pregnancy history, including number of lifetime pregnan-cies, number of unplanned pregnancies, miscarriage, still-birth or abortions, pregnancy-related complications, firstpregnancy age and current pregnancy status were collected.PPD was assessed using the Edinburgh Postnatal Depres-sion Scale (EPDS) (Cox et al.), a 10-item scale ratedon a four-point Likert scale (0 to 3). The cut-off for PPD is10 points. The EPDS for this study has high internal reli-ability (α = 0.93). ### Page 4 Climacteric (peri and post-menopausal) symptoms Participants were asked to report whether they were inthe perimenopause stage or post-menopause stage. Cli-macteric symptoms were assessed using the the GreeneClimacteric Scale (GCS) (Greene), a 21-item scalemeasuring psychological, somatic, vasomotor and sexualdysfunction symptoms, rated on a four-point Likert scaleranging from 0 to 3. The scale has been validated in anumber of studies (Greene) internal reliability washigh in this study (α = 0.91). ADHD symptoms ADHD symptoms were assessed using the 18-item AdultSelf Report Scale (ASRS v1.1.) (Kessler et al.), awidely used tool for ADHD screening. Items are scoredon a five-item Likert scale (1 = never, 5 = very often) andconsist of two domains: Part A screens for ADHD, whilePart B investigates symptoms. If a minimum of four ofthe six questions in Part A meet the rating criteria, thesymptoms are consistent with an ADHD diagnosis. TheASRS has good concurrent validity (Adler et al.)and high internal reliability in this study (α = 0.96). Procedure Participants completed the measures online via Qualtrics.All participants answered demographic questions and theASRS. The PSST, EPDS, or GCS were displayed basedon their reported health status (menstrual cycle, preg-nancy, or menopause). Analyses Data were downloaded to SPSS 29.0 (IBM, Chicago,IL). Percentages, frequencies, ranges, means and stan-dard deviations were used to describe the data. Between-group comparisons were made using the chi-squared testfor categorical variables and t-tests were used to comparecontinuous variables. Mann-Whitney tests were usedfor data that did not follow a normal distribution. Pear-son’s correlations were used to examine the relationshipbetween ADHD severity and severity of PMS, PMDD,PPD and climacteric symptoms. The level of statisticalsignificance was set at p < .05. Data from 96 participantswere removed as they had not completed the ASRS scaleand data from 103 were removed as they met the incor-rect ASRS criteria levels for their group as per Fig.. Results Demographic Table shows the age, education status, current medicationtypes and co-occurring conditions for the ADHD group andnon-ADHD group. An independent samples t-test showed no significantdifference in age between the ADHD and non-ADHDgroups t(600) = 0.1, p = .952. Mood disorders includingdepression (35.2%) and anxiety (32.9%) were reportedmore frequently in the ADHD group than the non-ADHDgroup (10.2% and 9.8%). This was also reflected in medi-cation rates, with 31.8% of the ADHD group taking anti-depressants compared to 11.6% of the non-ADHD groupand more of the ADHD group (17.2%) taking anti-anxietymedication compared to 5.3% of the non-ADHD group. | Table 1 General characteristics of the ADHD group and the non-ADHD group | | - | | Demographic variable | ADHDn = 377 | Non-ADHDn = 225 | | Age in years, M (SD) | 39.50(9.76) | 39.56(10.95) | | Education Level, n (%) | | Secondary school up to age 16 | 6 (1.6) | 2 (0.9) | | Secondary school beyond age 16 | 16 (4.2) | 6 (2.7) | | Post secondary school qualificationa | 80 (21.2) | 42 (18.7) | | Undergraduate degree | 123 (32.6) | 61 (27.1) | | Postgraduate degree | 150 (39.8) | 114 (50.7) | | Current medication type, n (%) | | None | 86 (22.8) | 136 (60.4) | | ADHD medication | 152 (40.3) | 0 (0) | | Antidepressants | 120 (31.8) | 26 (11.6) | | Anti-anxiety medication | 65 (17.2) | 12 (5.3) | | Melatonin | 44 (11.7) | 4 (1.8) | | Hormonal contraceptives | 65 (17.2) | 42 (18.7) | | Other | 76 (20.2) | 21 (9.3) | | Reported medical conditions, n (%) | | None | 98 (26.0) | 154 (68.4) | | Mood disorder including depression | 133 (35.2) | 24 (10.6) | | Anxiety disorder | 124 (32.9) | 23 (10.2) | | Personality disorder | 7 (1.9) | 0 (0.0) | | Seasonal Affective Disorder | 31 (8.2) | 3 (1.3) | | Current substance use disorder(alcohol/drugs) | 11 (2.9) | 1 (0.4) | | Substance use disorder in remission | 18 (4.8) | 3 (1.3) | | Delayed Sleep Phase Syndrome | 19 (5.0) | 0 (0.0) | | Hypertension | 27 (7.2) | 10 (4.4) | | Hypothyroidism | 34 (9.0) | 15 (6.7) | | Other | 62 (16.4) | 11 (4.9) | | a Defined as a level 5 or 6 post-Leaving Certificate qualification onthe Irish National Framework of Qualifications | | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | ### Page 5 Menstrual symptoms All participants (N = 602) completed the menstruation ques-tions and the PSST questionnaire. The results are shown inTable. The ADHD group had significantly higher frequency ofirregular menstrual cycles than the non-ADHD group. Pre-menstrual symptoms and impact on functionality were sig-nificantly higher for females with ADHD across all domains.Rates of PMS and PMDD were significantly higher in theADHD group than the non-ADHD group. Perinatal symptoms An independent samples t-test showed no significant differ-ence in age between the ADHD group (n = 216, M = 44.37,SD = 7.3) and the non-ADHD group (n = 119, M = 44.43,SD = 9.84) who completed the perinatal questionst(333) = 0.1, p = .951. Table shows the ADHD group had a significantlyhigher number of unplanned pregnancies, ante, peri andpostpartum complications. They had a significantly higherEPDS scores, and a significantly higher number reached thePPD threshold. Although the median number of unplannedpregnancies was 0 for both groups, the ranges were 0–3 and0–5 for the non-ADHD and ADHD groups respectively,and a Mann-Whitney U Test found significant differencesbetween the two groups. The mean number of unplannedpregnancies were 0.77 for the ADHD group and 0.56 forthe non-ADHD group. There were no significant differencesbetween the two groups on childbearing, birth of a child,age at first pregnancy, number of babies, stillbirths, miscar-riages, or abortions. Climacteric (peri and post-menopausal) symptoms From the total sample, 218 (36.2%) reported that they werein the peri or postmenopausal stage. A statistically signifi-cant difference in age was observed between the ADHDgroup (n = 148; M = 48.26, SD = 6.01) and the non-ADHDgroup (n = 70; M = 51.41, SD = 9.06), t(216) = 3.0, p = .003,indicating that the groups were not fully age-matched. The peri-menopausal and post-menopausal groups werecombined and the results are displayed in Table. The totalscore, psychological score and its two subscales anxietyand depression, somatic and sexual dysfunction scores,were significantly higher in the ADHD group than the non-ADHD group. There were no significant differences invasomotor scores between the groups. The ADHD groupreported higher rates (48.6%) of Hormone ReplacementTherapy (HRT) than the non-ADHD group (17.1%). HRTdid not result in significant differences across the domains | Variable | ADHDn = 377 | Non-ADHDn = 225 | Statistic | p | | - | - | - | - | - | | Menstrual Regular-ity, n (%) | χ2 = 14.2 | < 0.001*** | | Regular menstrualcycle | 235(62.3) | 177(78.7) | | Irregular men-strual cycle | 126(33.4) | 45(20.0) | | Unknown | 16(4.2) | 3 (1.3) | | PSST symptoms, M(SD) | | Anger/irritability | 2.00(0.80) | 1.33(0.79) | t = 9.9 | < 0.001*** | | Anxiety/tension | 2.15(0.80) | 1.12(0.87) | t = 14.9 | < 0.001*** | | Tearful | 2.27(0.79) | 1.34(0.96) | t = 12.9 | < 0.001*** | | Depressed mood | 1.97(0.93) | 1.05(0.92) | t = 11.7 | < 0.001*** | | Decreased interestin home | 1.94(0.89) | 0.96(0.83) | t = 13.4 | < 0.001*** | | Decreased interestin work | 2.00(0.89) | 0.92(0.85) | t = 14.5 | < 0.001*** | | Decreased interestin social | 1.95(0.92) | 1.05(0.87) | t = 11.9 | < 0.001*** | | Difficultyconcentrating | 2.21(0.82) | 0.80(0.79) | t = 20.7 | < 0.001*** | | Fatigue/lack ofenergy | 2.41(0.75) | 1.55(0.87) | t = 12.7 | < 0.001*** | | Overeating | 2.25(0.86) | 1.58(0.93) | t = 8.9 | < 0.001*** | | Insomnia | 1.36(1.06) | 0.53(0.81) | t = 10.0 | < 0.001*** | | Hypersomnia | 1.61(0.97) | 0.83(0.88) | t = 9.9 | < 0.001*** | | Feelingoverwhelmed | 2.14(0.85) | 0.97(0.91) | t = 15.9 | < 0.001*** | | Physicalsymptoms | 2.09(0.84) | 1.67(0.77) | t = 6.0 | < 0.001*** | | PSST functionality,M (SD) | | Work efficiency | 1.92(0.80) | 0.98(0.82) | t = 13.9 | < 0.001*** | | Coworkerrelationships | 1.17(0.93) | 0.46(0.68) | t = 10.1 | < 0.001*** | | Familyrelationships | 1.76(0.87) | 0.91(0.79) | t = 12.0 | < 0.001*** | | Social lifeactivities | 1.80(0.87) | 0.95(0.78) | t = 11.9 | < 0.001*** | | Homeresponsibilities | 1.90(0.86) | 0.81(0.76) | t = 15.7 | < 0.001*** | | PMS/PMDD, n (%) | χ2(2) = 203.98 | < 0.001*** | | No/Mild PMS | 50(13.3) | 155(68.9) | | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | ### Page 6 in the ADHD group, but it yielded significantly lower ratesof anxiety and depression domains in the non-ADHD group. Relationship between ADHD symptom severity andmenstruation, perinatal and menopausal symptoms Table shows the relationships for the whole sample andthe ADHD and non-ADHD groups separately. Pearson’scorrelations were conducted to examine the relationshipsbetween ADHD severity, as measured by the total score onthe ASRS symptoms, and the total symptom scores for thePSST, EPDS, and GCS. ADHD symptom severity was correlated significantlywith premenstrual total symptoms, postpartum depres-sion total and menopause symptoms for the total sampleand for the ADHD and non-ADHD groups when analysedseparately. Discussion This study aimed to determine whether females with ADHDexperience greater challenges than females without ADHDregarding menstruation, the perinatal period, and meno-pause. It further explored whether there is a relationshipbetween ADHD symptom severity and severity of PMS,PMDD, PPD and climacteric symptoms. Given the cross-sectional design of the study, causality cannot be inferred. Menstrual symptoms The results highlight significant differences between theADHD and non-ADHD groups concerning menstrual reg-ularity, premenstrual symptoms, PMS, and PMDD rates,as well as the impact of these symptoms on functionality.Significantly elevated rates of PMS and PMDD were foundamong females with ADHD compared to those withoutADHD. Specifically, the prevalence of moderate to severePMS and PMDD was substantially higher in the ADHDgroup, indicating a heightened susceptibility to severe pre-menstrual symptomatology and its associated challengesamong females with ADHD. Moreover, findings show a substantial disparity inpremenstrual symptomatology between the two groups.Females with ADHD reported significantly higher symp-toms across all domains when symptoms compared to theirnon-ADHD counterparts. These results suggest that ADHDexacerbates premenstrual symptoms, contributing to greateremotional and physical distress during the menstrual cyclefor females with ADHD. Additionally, the impact of pre-menstrual symptoms on functionality was markedly higheramong females with ADHD across all domains assessed,underscoring the substantial burden that premenstrualsymptoms impose on the daily functioning and interper-sonal relationships of females with ADHD, highlightingthe need for targeted supports to address these challengescomprehensively. The ADHD group exhibited a notably higher frequencyof irregular menstrual cycles compared to the non-ADHDgroup, suggesting an association between ADHD and men-strual irregularity. This finding closely corresponds to previ-ously documented rates (Dorani et al.), emphasisingthe importance of considering menstrual health as a compo-nent of comprehensive care for females with ADHD. This is the first study to compare premenstrual symptomsin females with ADHD and without, emphasising the impor-tance of recognising and addressing menstrual health issuesamong females with ADHD. Further research is needed toexplore the underlying reasons for these findings and toassess the availability, utilisation, and adequacy of supportsfor females with ADHD with premenstrual issues in Ireland. Perinatal The perinatal results provide insights into the associationbetween ADHD and perinatal challenges, as well as theirimpact on PPD scores. The ADHD group had significantlyhigher postpartum depression scores and rates compared tothe non-ADHD group. These findings highlight the elevatedrisk of PPD among females with ADHD in Ireland, empha-sising the importance of early identification and interventionto mitigate adverse effects on maternal and child well-being.This study is the first to explore this topic within an Irishcontext, potentially informing perinatal care and support-ing the education of females about PPD risk factors priorto pregnancy. While the median number of unplanned pregnancieswas the same for both groups, the ADHD group reporteda significantly higher range, suggesting a greater inci-dence of unplanned pregnancies. Menstrual irregularitiesand challenges with consistent contraception use, due toADHD-related difficulties with executive functioning, maycontribute to this heightened rate (Lundin et al.; Sho-ham et al.). | Variable | ADHDn = 377 | Non-ADHDn = 225 | Statistic | p | | - | - | - | - | - | | Moderate to SeverePMS | 174(46.3) | 56(24.9) | | PMDD | 152(40.3) | 14(6.2) | | *p < .05, **p < .01, ***p < .001 | | - | - | - | - | - | - | - | - | - | - | - | - | - | Table 2 (continued) ### Page 7 No significant differences were found between thegroups regarding age at first pregnancy, the number ofabortions, or negative reproductive outcomes such asstillbirths or miscarriages. However, females in theADHD group reported a significantly higher frequencyof antenatal, perinatal, and postpartum complicationscompared to those in the non-ADHD group, aligningwith previous research (Dorani et al.; Walsh et al.). The study also identified significantly higher ratesof unplanned pregnancies among females with ADHD.Collectively, these findings emphasise the importanceof integrated, ADHD-informed perinatal care pathways.Clinicians should consider ADHD as a potential risk fac-tor during reproductive planning and pregnancy. Perimenopause/post menopause The ADHD group reported greater climacteric symptomsoverall, including higher psychological, anxiety anddepression scores. This aligns with the established linkbetween ADHD, anxiety, and depression (Vildalen et al.; Williamson and Johnston). While vasomotorscores were slightly higher in the ADHD group, no sig-nificant differences were identified, contrary to previousresearch. Other factors such as BMI and levels of exer-cise may influence these results (Gold et al.; Liu etal.). | Table 3 Perinatal factors and postnatal depression scores in theADHD-group and non-ADHD group | | - | | Variable | ADHD | Non-ADHD | Statistic | p | | Reproduc-tive status,n (%) | | Currentlypregnant | 4 (1.1) | 4 (1.8) | – | – | | Ever beenpregnant | 236(62.6) | 134 (59.6) | χ2 = 0.6 | 0.489 | | Ever hada baby | 216(57.3) | 119 (52.9) | χ2 = 1.1 | 0.310 | | Age atfirst preg-nancy, M(SD) | 28.4(6.21) | 28.61 (5.78) | t = 0.3 | 0.795 | | Numberof babies,Mdn (range) | 2 (1–6) | 2 (1–6) | U = 12297.5 | 0.493 | | Num-ber ofunplannedpregnancies,Mdn (range) | 0 (0–5) | 0 (0–3) | U = 13252.5 | 0.012* | | Had astillbirtha, n(%) | 4 (1.1) | 1 (0.44) | – | – | | Had amiscarriage,n (%) | 112(29.7) | 52 (23.1) | χ2 = 4.5 | 0.108 | | Numberof miscar-riages, Mdn(range) | 1 (1–9) | 1 (1–3) | U = 2436.5 | 0.183 | | Terminatedpregnancy,n (%) | 46(12.2) | 22 (9.8) | χ2 = 2.0 | 0.366 | | Number ofabortions,Mdn (range) | 1 (1–3) | 1 (1–2) | U = 480.5 | 0.991 | | Pregnancy complica-tions (n = 236, 225) | | Antenatalcomplica-tions, n (%) | 122(51.7) | 43 (19.1) | χ2 = 13.3 | < 0.001*** | | Deliverycomplica-tions, n (%) | 123(52.1) | 45 (20.0) | χ2 = 11.8 | < 0.001*** | | Postpartumcomplica-tions, n (%) | 112(47.5) | 28 (12.44) | χ2 = 25.6 | < 0.001*** | | EPDSb totalscore, M(SD) | 17.90(6.76) | 11.71 (7.04) | t = 7.9 | < 0.001*** | | PPD pre-sentc, n (%) | 190(88.0) | 68 (57.1) | χ2 = 41.2 | < 0.001*** | | *p < .05, **p < .01, ***p < .001a Chi-square testing was not conducted as the sample size was toosmallb Edinburgh Postnatal Depression Scalec Scored > 10 on the EPDS, meeting criteria for PPD | | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | | Table 4 Comparison of mean GCS score of peri-menopausal and post-menopausal females (n = 218) | | - | | GCS domains, M(SD) | ADHDn = 148 | Non-ADHDn = 70 | t | p | | Total score | 32.1 (9.99) | 18.5 (9.13) | 9.614 | < 0.001*** | | Psychological | 20.0 (5.66) | 10.4 (5.70) | 11.662 | < 0.001*** | | Anxiety | 10.7 (3.17) | 5.4 (3.32) | 11.388 | < 0.001*** | | Depression | 9.3 (3.13) | 5.0 (3.03) | 9.531 | < 0.001*** | | Somatic | 7.4 (4.36) | 4.2 (3.23) | 5.499 | < 0.001*** | | Vasomotor | 2.7 (1.93) | 2.4 (1.94) | 1.012 | 0.313 | | Sexual Dysfunction | 2.0 (1.02) | 1.5 (1.07) | 3.042 | 0.003*** | | *p < .05, **p < .01, ***p < .001 | | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | | Table 5 Correlation between ADHD Severity and Reproductive StageVariables | | - | | Reproductive vari-able with ASRS total | ASRS total symptom score | | Total | ADHD | Non-ADHD | | Premenstrual | n = 600r = .69** | n = 376r = .40** | n = 224r = .40** | | Postpartum | n = 335r = .51** | n = 216r = .35** | n = 119r = .42** | | Menopause | n = 218r = .64** | n = 148r = .47** | n = 70r = .26* | | *p < .05**p < .001 | | - | - | - | - | - | - | - | - | - | - | - | - | - | ### Page 8 Notably, the ADHD group reported 2.8 times higherrates of HRT usage than their non-ADHD counterparts.This may reflect more severe climacteric symptoms inthe ADHD group or misinterpretation by clinicians ofpre-existing ADHD difficulties as menopause-related.Further research would clarify whether HRT interven-tions are effective for females with ADHD and how bestto address overlapping symptoms. No difference was observed between the two groupsregarding sexual dysfunction, suggesting that hormonalchanges impact females with and without ADHD simi-larly. However, the correlation between severe ADHDsymptoms and climacteric symptoms should be consid-ered when supporting females with ADHD during thislife stage. This study is the first to explore ADHD symp-toms during the climacteric stage in females in Ireland,providing valuable insights into the challenges faced bythis population. Limitations Several limitations should be acknowledged. Firstly,older participants were asked to retrospectively reporttheir menstrual experiences, which introduces the pos-sibility of recall bias. However, menstrual symptomsrepresent recurrent and often clinically significant experi-ences across many years of the reproductive lifespan, andtheir inclusion allows for representation of cumulativereproductive experiences. Future research could adoptlongitudinal designs to more precisely capture symptomtrajectories. Secondly, while participants met ASRS cri-teria for ADHD, self-selection may have introduced bias,as individuals could meet the criteria due to other mentalhealth conditions. As such, findings should be interpretedwith precaution. Future research could refine this researchby recruiting participants with a formal ADHD diagno-sis. Thirdly, PPD was assessed only after the birth ofthe first baby, potentially overlooking cases arising withsubsequent births. Next, the peri/post menopause groupwas not fully age-matched, with the non-ADHD groupbeing significantly older. As menopausal symptom sever-ity may vary with age and stage progression, age mayrepresent a potential confounding factor in the observedgroup differences. The ADHD group reported higher useof medications which may have influenced mood, sleep,and cognitive symptoms, potentially confounding symp-tom reports. Sensitivity analysis adjusting for medicationuse and age would be informative in future work. Finally,this study did not collect data on race, ethnicity, or socio-economic variables which may limit external validity. Conclusion This study provides important insights into the challengesfaced by females with ADHD across key reproductivestages, including menstruation, the perinatal period, andmenopause, within the Irish healthcare context. Theseresults support the need for routine enquiry regarding men-strual health, pregnancy planning, postpartum mood, andmenopausal symptoms in females with ADHD. Similarly,health providers should consider ADHD symptomatologywhen assessing cyclical mood changes, perinatal distress,and climacteric difficulties in females. An integrated, ADHD-informed approach to femalehealthcare may facilitate earlier identification of vulner-ability, improve reproductive planning support, and enabletimely psychological or pharmacological intervention dur-ing high-risk periods such as the postpartum phase andperimenopause. The findings highlight the importance oflifespan-oriented, gender-sensitive ADHD care. Futureresearch should further refine screening pathways and treat-ment protocols to better support females with ADHD acrossreproductive transitions, ultimately improving maternalhealth outcomes and overall quality of life. Author contributions All authors contributed to the study conceptionand design. Material preparation, data collection and analysis wereperformed by Christine Boyd and Jessica Bramham. The first draft ofthe manuscript was written by Christine Boyd and all authors com-mented on previous versions of the manuscript. All authors read andapproved the final manuscript. Funding Open Access funding provided by the IReL Consortium.This research was funded by Ireland’s Department of Health in con-junction with the Women’s Health Taskforce. Declarations Conflict of interest The authors declare that the research was con-ducted in the absence of any commercial or financial relationships thatcould be construed as a potential conflict of interest. Open Access This article is licensed under a Creative CommonsAttribution 4.0 International License, which permits use, sharing,adaptation, distribution and reproduction in any medium or format,as long as you give appropriate credit to the original author(s) and thesource, provide a link to the Creative Commons licence, and indicateif changes were made. The images or other third party material in thisarticle are included in the article’s Creative Commons licence, unlessindicated otherwise in a credit line to the material. If material is notincluded in the article’s Creative Commons licence and your intendeduse is not permitted by statutory regulation or exceeds the permitteduse, you will need to obtain permission directly from the copyrightholder. To view a copy of this licence, visit. ### Page 9 References Adler LA, Spencer T, Faraone SV, Kessler RC, Howes MJ, BiedermanJ, Secnik K (2006) Validity of pilot Adult ADHD Self-ReportScale (ASRS) to rate adult ADHD symptoms. Ann Clin Psychia-try 18(3):145–148. American Psychiatric Association (2022) Diagnostic and statisticalmanual of mental disorders (5th ed., text rev.). Andersson A, Garcia-Argibay M, Viktorin A, Ghirardi L, Butwicka A,Skoglund C, Larsson H (2023) Depression and anxiety disordersduring the postpartum period in women diagnosed with atten-tion deficit hyperactivity disorder. J Affect Disord 325:817–823. Antoniou E, Rigas N, Orovou E, Papatrechas A, Sarella A (2021)ADHD symptoms in females of childhood, adolescent, reproduc-tive and menopause period. Materia Socio-Medica 33(2):114. Brown TE (2009) ADD/ADHD and impaired executive function inclinical practice. Curr Atten Disorders Rep 1(1):37–41. Camara B, Padoin C, Bolea B (2021) Relationship between sex hor-mones, reproductive stages and ADHD: a systematic review.Arch Women Ment Health 1–8. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depres-sion: development of the 10-item Edinburgh Postnatal Depres-sion Scale. Br J psychiatry 150(6):782–786. De Jong M, Wynchank DS, van Andel E, Beekman AT, Kooij JJS(2023) Female-specific pharmacotherapy in ADHD: premen-strual adjustment of psychostimulant dosage. Front Psychiatry14:1306194. Dilbaz B, Aksan A (2021) Premenstrual syndrome, a common butunderrated entity: review of the clinical literature. J Turkish Ger-man Gynaecol Association 22(2):139. Dorani F, Bijlenga D, Beekman AT, van Someren EJ, Kooij JS (2021)Prevalence of hormone-related mood disorder symptoms inwomen with ADHD. J Psychiatr Res 133:10–15. Eng AG, Phan JM, Shirtcliff EA, Eisenlohr-Moul TA, Goh PK, MartelMM (2023) Aging and pubertal development differentially predictsymptoms of ADHD, depression, and impairment in children andadolescents: An eight-year longitudinal study. Res child AdolescPsychopathol 1–14. Epperson CN, Shanmugan S, Kim DR, Mathews S, Czarkowski KA,Bradley J, Brown TE (2015) New onset executive function dif-ficulties at menopause: a possible role for lisdexamfetamine. Psy-chopharmacology 232:3091–3100. Gold EB, Crawford SL, Shelton JF, Tepper PG, Crandall CJ, Green-dale GA, Avis NE (2017) Longitudinal analysis of changes inweight and waist circumference in relation to incident vasomo-tor symptoms: the Study of Women’s Health Across the Nation(SWAN). Menopause (New York, NY), 24(1), 9. Greene JG (2008) Constructing a standard climacteric scale. Maturitas61(1–2):78–84. Haimov-Kochman R, Berger I (2014) Cognitive functions of regularlycycling women may differ throughout the month, depending onsex hormone status; a possible explanation to conflicting resultsof studies of ADHD in females. Front Hum Neurosci 8:191. Heidari S, Babor TF, De Castro P, Tort S, Curno M (2016) Sex andgender equity in research: rationale for the SAGER guidelinesand recommended use. Res Integr peer Rev 1(1):1–9. Henz A, Ferreira CF, Oderich CL, Gallon CW, Castro JRSD, ConzattiM, Wender MCO (2018) Premenstrual syndrome diagnosis: Acomparative study between the daily record of severity of prob-lems (DRSP) and the premenstrual symptoms screening tool(PSST). Revista Brasileira de Ginecol e obstetrícia 40:20–25. Hinshaw SP, Nguyen PT, O’Grady SM, Rosenthal EA (2022) AnnualResearch Review: Attention-deficit/hyperactivity disorder in girlsand women: underrepresentation, longitudinal processes, and keydirections. J Child Psychol Psychiatry 63(4):484–496. Kanarik M, Grimm O, Mota NR, Reif A, Harro J (2022) ADHD co-morbidities: A review of implication of gene× environmenteffects with dopamine-related genes. Neurosci Biobehav Rev104757. Kessler RC, Adler LA, Ames M, Demler O, Faraone S, Hiripi E, Wal-ters EE (2005) The World Health Organization Adult ADHDSelf-Report Scale (ASRS): A short screening scale for use in thegeneral population. Psychol Med 35:245–256. Klefsjö U, Kantzer AK, Gillberg C, Billstedt E (2021) The road todiagnosis and treatment in girls and boys with ADHD–gender dif-ferences in the diagnostic process. Nord J Psychiatry 75(4):301–305. Liu T, Chen S, Mielke GI, McCarthy AL, Bailey TG (2022) Effects ofexercise on vasomotor symptoms in menopausal women: a sys-tematic review and meta-analysis. Climacteric 25(6):552–561. Lundin C, Wikman A, Wikman P, Kallner HK, Sundström-PoromaaI, Skoglund C (2023) Hormonal Contraceptive use and risk ofdepression among young women with attention-deficit/hyperac-tivity disorder. J Am Acad Child Adolesc Psychiatry 62(6):665–674. Meinzer MC, LeMoine KA, Howard AL, Stehli A, Arnold LE, Hecht-man L, Chronis-Tuscano A (2020) Childhood ADHD and involve-ment in early pregnancy: mechanisms of risk. J Atten Disord24(14):1955–1965. Nadeau KG, Quinn PO (2002) Gender and history of ADHD: an unex-amined gender bias. Gender Issues and ADHD: Research, Diag-nosis, and Treatment. Silver Spring, MD: Advantage Books, 2–19 Owens EB, Hinshaw SP (2019) Adolescent mediators of unplannedpregnancy among women with and without childhood ADHD. JClin Child Adolesc Psychol. Powell V, Agha SS, Jones RB, Eyre O, Stephens A, Weavers B, Len-non J, Allardyce J, Potter R, Smith D, Thapar A, Rice F (2021)ADHD in adults with recurrent depression. J Affect Disord295:1153–1160. Rehbein E, Hornung J, Sundström Poromaa I, Derntl B (2021) Shapingof the female human brain by sex hormones: a review. Neuroen-docrinology 111(3):183–206. Reilly TJ, Patel S, Unachukwu I, Knox CL, Wilson CA, Craig MC,Cullen AE (2024) The prevalence of premenstrual dysphoric dis-order: Systematic review and meta-analysis. J Affect Disord Roberts B, Eisenlohr-Moul T, Martel MM (2018) Reproductive ste-roids and ADHD symptoms across the menstrual cycle. Psycho-neuroendocrinology 88:105–114. Shoham R, Sonuga-Barke E, Yaniv I, Pollak Y (2021) ADHD is asso-ciated with a widespread pattern of risky behavior across activitydomains. J Atten Disord 25(7):989–1000. ### Page 10 Song P, Zha M, Yang Q, Zhang Y, Li X, Rudan I (2021) The prevalenceof ADHD: A global systematic review and meta-analysis. J globalhealth. 11 Steiner M, Macdougall M, Brown E (2003) The premenstrual symp-toms screening tool (PSST) for clinicians. Archives Wom-en’s Mental Health 6:203–209. Trifu S, Vladuti A, Popescu A (2019) The neuroendocrinologicalaspects of pregnancy and postpartum depression. Acta Endocri-nol (Bucharest) 15(3):410. Van Ditzhuijzen J, Ten Have M, De Graaf R, Van Nijnatten CH, Vol-lebergh WA (2013) Psychiatric history of women who have hadan abortion. J Psychiatr Res 47(11):1737–1743. Vildalen VU, Brevik EJ, Haavik J, Lundervold AJ (2019) Femaleswith ADHD report more severe symptoms than males on the adultADHD self-report scale. J Atten Disord 23(9):959–967. Walsh CJ, Rosenberg SL, Hale EW (2022) Obstetric complicationsin mothers with ADHD. Front Reproductive Health 4:1040824. Williamson D, Johnston C (2015) Gender differences in adults withattention-deficit/hyperactivity disorder: A narrative review. ClinPsychol Rev 40:15–27. Young S, Adamo N, Ásgeirsdóttir BB, Branney P, Beckett M, Colley W,Cubbin S, Deeley Q, Farrag E, Gudjonsson G, Hill P, HollingdaleJ, Kilic O, Lloyd T, Mason P, Paliokosta E, Perecherla S, Sedg-wick J, Skirrow C, Woodhouse E (2020) Females with ADHD:An expert consensus statement taking a lifespan approach provid-ing guidance for the identification and treatment of attention-def-icit/ hyperactivity disorder in girls and women. BMC Psychiatry20(1):404. Publisher’s note Springer Nature remains neutral with regard to juris-dictional claims in published maps and institutional affiliations.