The Link Between Estradiol Deficiency and Attention Deficit Disorder (ADD)

ADD impacts millions of women and girls, yet many go undiagnosed or misdiagnosed for most of their lives.¹ It’s a disorder that manifests in childhood, but has never been easily recognized in girls. For a lot of years, ADD was thought to be a boys’ phenomenon. Now we know better.

ADD simply displays differently in girls. They don’t fit the stereotype of this disorder and their symptoms are more subtle. Where boys seem to be “bouncing off walls” or acting out in other ways, girls tend to turn inward and suffer from self-esteem issues, self-blame, major depressions, anxiety and eating disorders.

Girls and women are commonly misdiagnosed as bipolar or having a primary depressive disorder rather than ADD. If they do get the appropriate diagnosis, they are generally treated with the same drugs given to young boys, which don’t address the complexities seen in females with the condition.

The Hormone Connection with ADD
Steroid hormones are not just sex hormones. They play an important role throughout the body and especially in the brain. Estradiol in particular exerts a significant and complex impact on brain chemistry. This hormone has been shown to be neuroprotective² and has a substantial influence on memory, cognition and brain plasticity, thus helping the brain perform better and faster. Estradiol does this by increasing vital concentrations of serotonin, dopamine, and other neurotransmitters significant to healthy brain performance.

Conversely, when hormones are fluctuating or deficient, neurotransmitters cannot be manufactured in the quantities needed for normal brain function. Evidence shows that the brains of those with ADD are deficient in these neurotransmitters. Treatment usually involves medications that target these deficiencies by stimulating the production of serotonin and dopamine. What is often left out of that equation for girls and women is the impact fluctuating hormones have on ADD.³

Insufficient Estradiol Levels Worsen ADD in Women
Scientific research continues to explore the vital role estradiol plays in the brain.^4,5 Several decades ago, it was noted that there was a possible link between hormones and ADD in women (Hussey 1990). Low estradiol states—such as those occurring during a woman’s monthly cycle, post pregnancy, or during perimenopause and menopause—seem to exacerbate ADD symptoms.⁶ It consistently appears that girls with ADD experience increasingly severe problems at the onset of puberty, a time when hormone levels fluctuate between highs and lows. Women have likewise reported that the arrival of perimenopause caused their ADD symptoms to worsen while at the same time lessening the effectiveness of their ADD medications. Physicians frequently respond to these women by upping their stimulant medication, which does little to help.

Support for Women with ADD
What does seem to help women with ADD is a holistic treatment approach that combines various strategies. These can include ADD medications; behavioral techniques—such as cognitive behavioral therapy and coaching; diet; exercise; and last, but not least, hormone replacement therapy.

HRT, especially properly administered bioidentical HRT, has been shown to ease some symptoms of ADD for perimenopausal and menopausal women with this disorder. Restoring physiologic levels of testosterone and estradiol enables these hormones to combine efforts in the brain and increase vital serotonin and dopamine levels. This beneficial replenishing of key hormones can provide relief from depression, anxiety and other disabling symptoms related to the neurotransmitter deficiencies of ADD.

Common Signs of Adult ADD
Women are often not diagnosed with ADD until their mid-30s or even into their 40s or 50s when hormone insufficiencies cause symptoms to worsen. If your patients have had at least 5 of the symptoms listed below during puberty or sometime prior to the onset of perimenopause, you may want to test them for ADD and measure their hormone levels as well.

1. Disorganization and forgetfulness
2. Lack of motivation
3. Problems starting tasks
4. Tardiness
5. Anxiety
6. Depression
7. Relationship troubles
8. Extreme distractibility and/or hyper-focus
9. Poor listening skills
10. Restlessness, difficulty relaxing
11. Sleep problems
12. Angry outbursts
13. Difficulty prioritizing
14. Impulsiveness

Article References:

¹ Quinn PO, Madhoo M. A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls: Uncovering This Hidden Diagnosis. Prim Care Companion CNS Disord. 2014; 16(3): PCC.13r01596. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195638/
² Marin, R., Diaz, M., Alonso, R., Sanz, A., Arevalo, M. A., and Garcia-Segura, L. M. (2009). Role of estrogen receptor α in membrane-initiated signaling in neural cells: interaction with IGF-1 receptor. J. Steroid Biochem. Mol. Biol. 114, 2–7. http://www.ncbi.nlm.nih.gov/pubmed/19167493
³ Martel MM, Klump K, Nigg JT, Breedlove SM, Sisk CL. Potential Hormonal Mechanisms of Attention-Deficit/Hyperactivity Disorder and Major Depressive Disorder: A New Perspective. Horm Behav. 2009 Apr; 55(4): 465–479. http://www.ncbi.nlm.nih.gov/pubmed/19265696
⁴ Cook Ian A, Morgan Melinda L, Dunkin Jennifer J, David Steven, Witte Elise, Lufkin Robert, Abrams Michelle, Rosenberg Susan, Leuchter Andrew F. Estrogen replacement therapy is associated with less progression of subclinical structural brain disease in normal elderly women: a pilot study International journal of geriatric psychiatry, 2002; 17(7): 610-8.
⁵ Wise PM, Dubal DB, Wilson ME, Rau SW. Estradiol is a neuroprotective factor in in vivo and in vitro models of brain injury. J Neurocytol. 2000 May-Jun;29(5-6):401-10.
⁶ Quinn, PO. AD/HD in Women: Do We Have the Complete Picture? http://www.chadd.org/LinkClick.aspx?fileticket=-tHjnQjXheY%3D