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PCOS and ADHD: what’s the link?

Receiving an ADHD diagnosis alongside a hormone disorder like PCOS can overwhelming. You may feel like you struggle to balance all of your different symptoms in a manageable way. But do hormones affect ADHD symptoms, or does PCOS have a role in ADHD? Let’s try to understand and discuss the link between PCOS and ADHD together. 

What is PCOS?

PCOS or Polycystic Ovarian Syndrome is a complex endocrine or hormone condition impacting 1 in 10 people assigned female at birth. Despite its name, it does not solely involve the ovaries.

Common symptoms individuals with PCOS experience include but are not limited to irregular periods, hair loss, acne, excess hair growth and difficulty getting pregnant.

What is ADHD?

ADHD stands for Attention Deficit Hyperactivity Disorder is characterised by a lasting pattern of inattention with or without hyperactivity, that leads to daily disruption in executive functioning. 

Symptoms can include restlessness, talkativeness, excess fidgeting, boredom, indecisiveness and procrastination. These can vary from person to person. The cause of ADHD remains unknown, although there is growing research surrounding genetic factors. 

Neurotransmitters including serotonin, dopamine and norepinephrine are largely involved in influencing ADHD symptoms such as cognition, memory processing, motor control and endocrine regulation. Sex hormones can be known as the key to releasing these happy neurotransmitters. 

These neurotransmitters are produced by the gut microbiota and influence the gut-brain axis (also referred to as the ‘second brain’). It describes the bidirectional relationship between the gut and the brain and is responsible for cognitive functions such as mood. Often individuals with ADHD can also experience gut issues. 

How does ADHD impact PCOS?

A 2008 article explains that 75-90% of ADHD is caused by genetic factors. It is thought that similar underlying genetic factors could be related to PCOS. 

The link between ADHD and hormones, specifically sex hormones like oestrogen and testosterone requires further studies. There is a possible connection between ADHD and changing hormone levels during the menstrual cycle. As a person with PCOS may have an irregular menstrual cycle it can be hard to measure. 

A large 2018 study that assessed the mental health history of nearly 17,000 women diagnosed with PCOS found that those with PCOS were more likely to be diagnosed with mental health disorders, including depression, anxiety, bipolar disorder and eating disorders. This may be due to major changes in oestrogen levels or other sex hormones. 

A 2022 study also found that there is an associated risk of ADHD and autism spectrum disorders in children born to mothers diagnosed with PCOS. There is a theory that exposure to androgens in utero may have a significant impact on brain development. 

This finding has highlighted the focus on including screening for mental health disorders should be included when diagnosing and assessing a person with PCOS. 

PCOS and ADHD medication

Medications for PCOS can include combined oral contraceptive pills, metformin and anti-androgens. Anti-androgens could be primarily considered to treat hirsutism (excess facial hair) in PCOS. 

As per NHS guidelines, there are 5 types of licensed medication for the treatment of ADHD split into stimulants and non-stimulants. Stimulants work by increasing levels of dopamine and norepinephrine in the brain, which can help with focus and concentration. 

These are primary medications to help manage the symptoms associated with ADHD and are not intended to cure ADHD. 

  1. Methylphenidate 
  2. Lisdexamfetamine 
  3. Dexamfetamine 
  4. Atomoxetine
  5. Guanfacine 

Common side effects of all the medications can impact mood negatively and decrease appetite. There are different versions of these medications from short-acting medications or extended-release medications. Usually, you should find it may take time to find your best dose for your symptoms and any side effects experienced. 

ADHD, PCOS and disordered eating

As part of the treatment for PCOS, the guidelines advise weight loss and the same is seen for those with ADHD if the person is considered to have a ‘high BMI’. Often individuals are given this blanket advice without guidance on implementing positive and sustainable lifestyle changes and with the implication that weight loss will “cure” either of these conditions. This can result in pursuing online sources for clearer guidance and finding unreliable sources that advise dietary restrictions that promise symptom improvement, leading to disordered eating and even eating disorders.

A 2017 systematic review has suggested that ADHD is associated with disordered eating behaviours. More often seen with a person diagnosed with ‘Predominantly hyperactive-impulsive ADHD’ as with this type of ADHD people often struggle with impulsivity. 

More specifically binge eating or overeating are common behaviours associated with this type of ADHD. A 2020 study found that this is because these foods are usually high in fat and/or sugar, resulting in a satisfied feeling due to the activation of dopamine neurons in the reward system in the brain. This contributes to the cycle, as this increases insulin levels, stimulating androgen levels and cortisol (stress) hormones. All of which can disrupt normal appetite signalling.

People with PCOS are also at a higher risk of binge eating disorder likely because of unsubstantiated weight loss advice, insulin resistance and the stressors associated with the condition.

What to do if you are diagnosed with PCOS and ADHD

If you have been diagnosed with both PCOS and ADHD it is essential to speak with a qualified professional to understand how to best navigate these conditions. Reaching out to a PCOS professional with experience working with people with ADHD is recommended for specific nutrition, movement, supplement and stress management support.

Your doctor may be able to prescribe you certain medications for PCOS and ADHD to improve your symptoms.

Key takeaways: PCOS and ADHD

PCOS and ADHD are both disorders which are often misunderstood. The symptoms presented can vary greatly from person to person. It is important to take care of your mental health wellbeing whether you are diagnosed with both or either condition and work alongside your doctor if your pharmacological treatment is not supporting your symptoms.

Sophia Boothby RD Author at The PCOS Collective

Lead Author | Head Dietitian | Registered Dietitian

 

Sophia is a Registered Dietitian working as a Specialist Community Dietitian within a London NHS Teaching Hospital specialising in gut health such as irritable bowel syndrome (IBS) and the low FODMAP diet, type 2 diabetes, PCOS, and cardiac rehabilitation. Sophia offers 1:1 PCOS support in our virtual PCOS clinic.

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