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Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease

Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease
Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease
Introduction: Attention-Deficit/Hyperactivity Disorder (ADHD) in girls and women is under-recognised and under-researched, despite increasing awareness of clinical challenges and unmet needs. This review by the Eunethydis Special Interest Group on Female ADHD, addresses current knowledge and identifies research gaps for future work. Issues in women with ADHD across the lifespan such as late diagnosis, pubertal development, sexual health, hormonal birth control, executive function difficulties, and gynaecological disorders associated with ADHD are highlighted.

Methods: the review synthesises existing literature and self-reported experiences of women with ADHD to explore the impact of hormonal fluctuations (puberty, menstrual cycle, pregnancy, (peri)menopause) on ADHD symptoms and mood disturbances. It examines the interplay of oestrogen and progesterone with dopaminergic pathways, when periods of lower oestrogen may affect cognition, as well as the manifestation of executive function deficits, and the intersection of ADHD with reproductive health.

Results: hormonal transitions exacerbate ADHD symptoms and mood disturbances, yet pharmacological research and tailored treatments are lacking. Executive function deficits manifest differently in girls and women with ADHD and are influenced by neuropsychological and neurobiological profiles. Diagnostic practices and sociocultural factors contribute to delayed diagnoses, increasing the risk of comorbidities, impaired functioning, and diminished quality of life. Undiagnosed women have increased vulnerability to premenstrual dysphoric disorder, postpartum depression, and cardiovascular disease during perimenopause.

Discussion: longitudinal, sex-specific studies incorporating hormonal status and lived experience are needed. Individualised interventions should be developed to address the unique needs of girls and women with ADHD. Addressing these gaps will advance more equitable diagnosis, management, and support for girls and women with ADHD, improving outcomes across the female lifespan.
Female – ADHD – Consensus – Sex hormones – Lifespan – Sex specific – Menstrual cycle – Self-reported needs, consensus, ADHD, sex hormones, lifespan, menstrual cycle, female, sex specific, self-reported needs
Kooij, J.J. Sandra
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de Jong, Maxime
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Agnew-Blais, Jessica
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Amoretti, Silvia
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Bang Madsen, Kathrine
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Barclay, Isabella
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Bölte, Sven
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Borg Skoglund, Charlotte
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Broughton, Thomas
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Carucci, Sara
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van Dijken, Dorenda K.E.
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Ernst, Julia
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French, Blandine
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Frick, Matilda A.
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Galera, Cédric
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Groenman, Annabeth P.
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Kopp Kallner, Helena
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Kerner auch Koerner, Julia
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Kittel-Schneider, Sarah
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Manor, Iris
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Martin, Joanna
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Matera, Emilia
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Parlatini, Valeria
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Philipsen, Alexandra
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Ramos-Quiroga, Josep Anthoni
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Rapoport, Iris L.
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Lundin Remnélius, Karl
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Sénéquier, Amandine
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Thorell, Lisa
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Wittekoek, Janneke M.E.
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Wynchank, Dora
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et al.
Kooij, J.J. Sandra
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de Jong, Maxime
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Agnew-Blais, Jessica
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Amoretti, Silvia
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Bang Madsen, Kathrine
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Barclay, Isabella
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Bölte, Sven
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Borg Skoglund, Charlotte
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Broughton, Thomas
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Carucci, Sara
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van Dijken, Dorenda K.E.
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Ernst, Julia
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French, Blandine
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Frick, Matilda A.
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Galera, Cédric
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Groenman, Annabeth P.
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Kopp Kallner, Helena
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Kerner auch Koerner, Julia
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Kittel-Schneider, Sarah
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Manor, Iris
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Martin, Joanna
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Matera, Emilia
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Parlatini, Valeria
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Philipsen, Alexandra
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Ramos-Quiroga, Josep Anthoni
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Rapoport, Iris L.
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Lundin Remnélius, Karl
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Sénéquier, Amandine
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Thorell, Lisa
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Wittekoek, Janneke M.E.
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Wynchank, Dora
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Kooij, J.J. Sandra, de Jong, Maxime and Agnew-Blais, Jessica , et al. (2025) Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women's Health, 6, [1613628]. (doi:10.3389/fgwh.2025.1613628).

Record type: Review

Abstract

Introduction: Attention-Deficit/Hyperactivity Disorder (ADHD) in girls and women is under-recognised and under-researched, despite increasing awareness of clinical challenges and unmet needs. This review by the Eunethydis Special Interest Group on Female ADHD, addresses current knowledge and identifies research gaps for future work. Issues in women with ADHD across the lifespan such as late diagnosis, pubertal development, sexual health, hormonal birth control, executive function difficulties, and gynaecological disorders associated with ADHD are highlighted.

Methods: the review synthesises existing literature and self-reported experiences of women with ADHD to explore the impact of hormonal fluctuations (puberty, menstrual cycle, pregnancy, (peri)menopause) on ADHD symptoms and mood disturbances. It examines the interplay of oestrogen and progesterone with dopaminergic pathways, when periods of lower oestrogen may affect cognition, as well as the manifestation of executive function deficits, and the intersection of ADHD with reproductive health.

Results: hormonal transitions exacerbate ADHD symptoms and mood disturbances, yet pharmacological research and tailored treatments are lacking. Executive function deficits manifest differently in girls and women with ADHD and are influenced by neuropsychological and neurobiological profiles. Diagnostic practices and sociocultural factors contribute to delayed diagnoses, increasing the risk of comorbidities, impaired functioning, and diminished quality of life. Undiagnosed women have increased vulnerability to premenstrual dysphoric disorder, postpartum depression, and cardiovascular disease during perimenopause.

Discussion: longitudinal, sex-specific studies incorporating hormonal status and lived experience are needed. Individualised interventions should be developed to address the unique needs of girls and women with ADHD. Addressing these gaps will advance more equitable diagnosis, management, and support for girls and women with ADHD, improving outcomes across the female lifespan.

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Accepted/In Press date: 19 May 2025
Published date: 7 July 2025
Keywords: Female – ADHD – Consensus – Sex hormones – Lifespan – Sex specific – Menstrual cycle – Self-reported needs, consensus, ADHD, sex hormones, lifespan, menstrual cycle, female, sex specific, self-reported needs

Identifiers

Local EPrints ID: 503778
URI: http://eprints.soton.ac.uk/id/eprint/503778
PURE UUID: c19051af-1280-47ef-9e51-07cc11a7baf8
ORCID for Valeria Parlatini: ORCID iD orcid.org/0000-0002-4754-2494

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Date deposited: 12 Aug 2025 17:14
Last modified: 01 Oct 2025 02:15

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Contributors

Author: J.J. Sandra Kooij
Author: Maxime de Jong
Author: Jessica Agnew-Blais
Author: Silvia Amoretti
Author: Kathrine Bang Madsen
Author: Isabella Barclay
Author: Sven Bölte
Author: Charlotte Borg Skoglund
Author: Thomas Broughton
Author: Sara Carucci
Author: Dorenda K.E. van Dijken
Author: Julia Ernst
Author: Blandine French
Author: Matilda A. Frick
Author: Cédric Galera
Author: Annabeth P. Groenman
Author: Helena Kopp Kallner
Author: Julia Kerner auch Koerner
Author: Sarah Kittel-Schneider
Author: Iris Manor
Author: Joanna Martin
Author: Emilia Matera
Author: Valeria Parlatini ORCID iD
Author: Alexandra Philipsen
Author: Josep Anthoni Ramos-Quiroga
Author: Iris L. Rapoport
Author: Karl Lundin Remnélius
Author: Amandine Sénéquier
Author: Lisa Thorell
Author: Janneke M.E. Wittekoek
Author: Dora Wynchank
Corporate Author: et al.

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