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Review
. 2025 Jul 7:6:1613628.
doi: 10.3389/fgwh.2025.1613628. eCollection 2025.

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

J J Sandra Kooij  1   2 , Maxime de Jong  2 , Jessica Agnew-Blais  3 , Silvia Amoretti  4 , Kathrine Bang Madsen  5   6 , Isabella Barclay  7 , Sven Bölte  8   9   10 , Charlotte Borg Skoglund  11   12 , Thomas Broughton  3 , Sara Carucci  13 , Dorenda K E van Dijken  14 , Julia Ernst  15   16 , Blandine French  17   18 , Matilda A Frick  19   20 , Cédric Galera  21   22 , Annabeth P Groenman  23   24   25 , Helena Kopp Kallner  26   27 , Julia Kerner Auch Koerner  28   29 , Sarah Kittel-Schneider  30   31 , Iris Manor  32 , Joanna Martin  7 , Emilia Matera  33 , Valeria Parlatini  34   35 , Alexandra Philipsen  36 , Josep Anthoni Ramos-Quiroga  4   37   38 , Iris L Rapoport  23 , Karl Lundin Remnélius  8 , Amandine Sénéquier  3 , Lisa Thorell  12 , Janneke M E Wittekoek  39 , Dora Wynchank  2
Affiliations
Review

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

J J Sandra Kooij et al. Front Glob Womens Health. .

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.

Keywords: ADHD; consensus; female; lifespan; menstrual cycle; self-reported needs; sex hormones; sex specific.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

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