ADHD in Women

PMDD, Autism, and ADHD: The Hushed Comorbidity

Premenstrual dysphoric disorder (PMDD) is a hormonal health condition that causes severe mood and functioning issues, and disproportionately affects people with ADHD or autism. Here, learn about PMDD symptoms, causes, and treatments.

By Tori Morales Verified Updated on February 9, 2024
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Shot of a young woman with ADHD and/or autism experiencing stomach pain, cramps, PMS, PMDD while lying on a sofa at home

What Is PMDD?

Premenstrual Dysphoric Disorder (PMDD) is a hormonal health condition that causes clinically significant and impairing depression, anxiety, mood swings, and uncomfortable physical symptoms in the week leading up to menses, the onset of a period. PMDD symptoms improve following menses and are minimal, if not absent, in the weeks following. PMDD disproportionately affects people with autism and ADHD. Various medications can help control PMDD symptoms1.

PMDD Symptoms

A patient meets the diagnostic criteria for PMDD if at least five of the following symptoms are met, including at least one from each category. The symptoms must cause distress or interfere with activities of daily living during most menstrual cycles over the preceding year:

  • Category A:
    • Unstable and easily influenced mood
    • Irritability
    • Depressive or hopeless mood
    • Anxiety or tension
  •  Category B:
    • Decreased interest in usual activities
    • Difficulty concentrating
    • Fatigue
    • Appetite changes
    • Sleep difficulties, either insomnia or hypersomnia
    • Feeling of overwhelm
    • Physical symptoms: breast tenderness, joint or muscle pain, a sensation of bloating, or weight gain2

PMDD vs PMS

While PMDD shares symptoms with premenstrual syndrome (PMS), PMDD is less common and more severe. PMS may occur in up to 48% of people who menstruate, while PMDD only occurs in 3 to 9%34. In addition, PMDD symptoms interfere with daily functioning, and often require medication to resolve. People with PMDD are at risk for suicidality and suicide attempts, so diagnosis and treatment are vital5. Some people who do not meet the criteria for PMDD may have severe PMS and benefit from similar treatment.

[Read: PMS and ADHD: How the Menstrual Cycle Intensifies Symptoms]

Autism, ADHD, and PMDD

PMDD disproportionately affects people with ADHD and autism, with up to 92% of autistic women and 46% of women with ADHD experiencing PMDD, though estimates vary6 7. There is no agreed-upon cause of PMDD, nor is it known why it affects certain populations more than others, though there are various theories. Possible explanations include:

  • Genetics. PMDD is highly heritable, indicating that there is a genetic link.
  • Hormone sensitivity. As people with ADHD have reduced dopamine levels across the brain, hormone fluctuations may be more likely to reduce dopamine to critically low levels, leading to more severe feelings of exhaustion, moodiness, and lack of motivation. In addition, estrogen may affect cellular pathways that have been implicated in ADHD8.
  • Sensory sensitivity. Autistic people generally have greater sensory sensitivity, and therefore may be more likely to be negatively affected by menses-related symptoms.

Treating PMDD

PMDD has various treatments ranging from lifestyle changes to medication.

  • Antidepressants. Some selective serotonin reuptake inhibitors (SSRIs) have been proven effective at reducing psychiatric PMDD symptoms.
  • Contraceptives. Hormonal contraceptives regulate hormones and can alleviate both physical and psychiatric PMDD symptoms9.
  • Lifestyle changes. Though most people with severe PMDD benefit from medication, lifestyle changes such as improved diet and exercise may improve some symptoms.

PMDD, Autism, and ADHD: Next Steps

Sources:

1American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.), 171. https://doi.org/10.1176/appi.books.9780890425596
2American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.), 171, 172. https://doi.org/10.1176/appi.books.9780890425596
3 A, D. M., K, S., A, D., & Sattar, K. (2014). Epidemiology of Premenstrual Syndrome (PMS)-A Systematic Review and Meta-Analysis Study. Journal of clinical and diagnostic research : JCDR, 8(2), 106–109. https://doi.org/10.7860/JCDR/2014/8024.4021
4Thakrar, P.D., Bhukar, K., & Oswal, R.M. (2021). Premenstrual dysphoric disorder: Prevalence, quality of life and disability due to illness among medical and paramedical students.
5Osborn, E., Brooks, J., O’Brien, P.M.S. et al. Suicidality in women with Premenstrual Dysphoric Disorder: a systematic literature review. Arch Womens Ment Health 24, 173–184 (2021). https://doi.org/10.1007/s00737-020-01054-8
6Obaydi, H., & Puri, B. K. (2008). Prevalence of premenstrual syndrome in autism: a prospective observer-rated study. The Journal of international medical research, 36(2), 268–272. https://doi.org/10.1177/147323000803600208
7Dorani F, Bijlenga D, Beekman ATF, van Someren EJW, Kooij JJS. Prevalence of hormone-related mood disorder symptoms in women with ADHD. J Psychiatr Res. 2021 Jan;133:10-15. doi: 10.1016/j.jpsychires.2020.12.005. Epub 2020 Dec 3. PMID: 33302160.
8Dorani F, Bijlenga D, Beekman ATF, van Someren EJW, Kooij JJS. Prevalence of hormone-related mood disorder symptoms in women with ADHD. J Psychiatr Res. 2021 Jan;133:10-15. doi: 10.1016/j.jpsychires.2020.12.005. Epub 2020 Dec 3. PMID: 33302160.
9Hofmeister, S., & Bodden, S. (2016). Premenstrual Syndrome and Premenstrual Dysphoric Disorder. American family physician, 94(3), 236–240.