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PMDD, ADHD, and Endometriosis: Understanding the Hormonal–Brain Connection Impact on Mental Health

Updated: 2 days ago

A woman with ADHD, endometriosis, and PMDD lies in bed embracing a pillow, seeking comfort and relief. She's wearing a pink sweater and gray leggings. Soft light and a peaceful room with a lamp in view.
A woman with ADHD, endometriosis, and PMDD lies in bed embracing a pillow, seeking comfort and relief

🧠 Snapshot: What Research Tells Us About the Connection

  • PMDD is linked to abnormal brain responses to normal hormone changes, not hormone imbalance (Schmidt et al., NIH).

  • PMDD and ADHD contribute to increased emotional dysregulation.

  • Estrogen modulates dopamine, which helps explain why ADHD symptoms worsen during the luteal phase or premenstrual stage of your cycle (Quinn, 2008; Rucklidge, 2010).

  • Women with ADHD report significantly higher rates of PMDD than neurotypical peers.

  • Endometriosis is associated with chronic inflammation and central sensitization, which impacts mood, stress tolerance, and pain perception.

  • Chronic pain conditions are correlated with higher rates of depression, anxiety, trauma symptoms, and emotional dysregulation, especially when diagnosis is delayed.


Why This Matters for Treatment


These conditions share neurobiological and inflammatory pathways, meaning symptoms can intensify each other rather than exist separately. This is why many women feel “fine for two weeks and completely undone for two weeks.” This is why understanding, validation, and integrated care are essential for effective management of symptoms.

PMDD, ADHD, and Endometriosis: Why These Conditions So Often Show Up Together


If you’ve ever wondered why you feel more emotional, unfocused, and in pain during your time of the month, you’re not imagining a connection.


Many women experience premenstrual dysphoric disorder (PMDD) or premenstrual exacerbation (PME), ADHD, and endometriosis together, often without anyone connecting the dots. Instead, the symptoms of each condition are treated and considered in isolation.

This results in poor treatment outcomes and misdiagnosis. This is especially true for BIPOC women who are more likely to be misdiagnosed with other mental health conditions, such as bipolar disorder. This misdiagnosis is often due to the severity and cyclic nature of symptoms that mimic the features of other conditions.


Research shows that these conditions share biological, neurological, and hormonal pathways that help explain why they are so frequently comorbid and why together they can be so debilitating when left untreated.


Let’s talk about what we know and what it means for your care.


What Is PMDD?


PMDD is a severe, hormone-sensitive mood disorder tied to the luteal phase of the menstrual cycle. PMDD can involve:


  • Intense depression or anxiety

  • Irritability or rage

  • Hopelessness or suicidal thoughts

  • Cognitive fog and overwhelm

  • Heightened pain sensitivity


Interestingly enough, PMDD is not caused by abnormal hormone levels, but by an abnormal sensitivity to normal hormonal fluctuations, particularly with changes in estrogen and progesterone levels.


PME (Premenstrual Exacerbation)

PME (premenstrual exacerbation) is a related condition that is diagnosed when you have another mental health condition that worsens at different points in your cycle. For example, let's say you were diagnosed with depression. During your luteal phase, your depressive symptoms worsen (this can look like not being able to get out of bed, uncontrollable crying, and fits of rage) but improve after your period ends. Improvement looks like returning to your baseline symptoms with depression once your period ends (i.e., feeling calmer, feeling less hopeless or sad, and feeling more clearheaded).


PMS (Premenstrual Syndrome)

PMS (premenstrual syndrome) is less severe and shares a similar symptom profile to PMDD.


The PMDD–ADHD Connection


Research increasingly shows that people with ADHD are significantly more likely to experience PMDD. Why?


Several shared mechanisms stand out:


1. Dopamine Dysregulation


ADHD involves lower baseline dopamine activity. Estrogen directly influences dopamine production and transport. When estrogen drops in the luteal phase, dopamine availability drops further and causes worsening symptoms:


  • Emotional regulation challenges

  • Executive functioning deficits increase

  • Motivation decreases

  • Impulsivity increases


For someone with ADHD, this hormonal shift can feel like their coping tools disappear overnight. Medication may need to be prescribed in order to help women from being debilitated. Zoloft and Prozac are both FDA-approved to treat PMDD and can be life-changing for women who are struggling to manage their symptoms. There are two dosing models as well: continuous (taken on an ongoing basis) and intermittent (taken for 2 weeks during the menstrual cycle only).


2. Nervous System Sensitivity


Both ADHD and PMDD involve heightened nervous system reactivity. This can amplify:


  • Emotional intensity

  • Emotional outbursts

  • Sensory overload

  • Rejection sensitivity

  • Stress responses (e.g., vasovagal syncope, which is triggered by the vagus nerve being overstimulated in response to stress)


What may look like “mood swings” is often a nervous system under real biological strain, with the inability to recalibrate.


Endometriosis and Mental Health


Endometriosis adds another layer — and it’s not just about pain.

Endometriosis is increasingly understood as a whole-body inflammatory condition, not simply a reproductive one. It’s associated with:


  • Chronic inflammation

  • Immune system dysregulation

  • Estrogen dominance or altered estrogen signaling

  • Central sensitization (the nervous system becoming more reactive over time)


Chronic pain and inflammation affect the brain. They change how stress is processed, how emotions are regulated, and how safe the body feels.

This helps explain why many people with endometriosis also experience:


  • PMDD

  • ADHD-like symptoms (or worsening of existing ADHD)

  • Anxiety, depression, or trauma responses


Pain is not just physical; it's cognitive and experienced by the brain. We must not forget that the brain and body are in constant conversation and seek to work together.


The Common Thread: Hormones, Inflammation, and the Brain


When we zoom out, a clear pattern emerges. PMDD, ADHD, and endometriosis intersect at:


  • Hormone sensitivity (not necessarily hormone imbalance)

  • Dopamine and serotonin pathways

  • Chronic inflammation

  • A sensitized nervous system

  • Higher trauma and stress exposure over time


This combination can make people feel like they are “losing themselves” every month, especially when their experiences are dismissed, misdiagnosed, and unmanageable.


Why This Matters for Treatment


When these conditions are treated in isolation, people often feel like nothing fully works.

Effective care usually requires:


  • Trauma-informed mental health treatment

  • Hormone balancing therapies (e.g., seed cycling, supplements, and birth control)

  • Support for executive functioning and ADHD traits

  • Validation of chronic pain and medical trauma

  • Collaboration between medical and mental health providers


Women deserve providers who are not only knowledgeable about this relationship. We deserve providers who know how to address the issue from multiple angles to promote effective management.


When Faith and Biology Feel at Odds


For Christian women, this intersection can carry a unique spiritual burden.

Many are striving to live as “new creations in Christ,” yet find themselves cycling through despair, irritability, brain fog, or emotional overwhelm month after month. This can lead to shame, guilt, confusion, and self-doubt:


  • Why did I just curse him out? I thought I had stopped doing that since I got saved.

  • There must be something wrong with me. Why can't I just do what God expects of me when I feel like this?

  • I keep praying and asking God to change me, but I keep doing the same thing over and over. He must be sick of me asking him. He must be ashamed of me too.


But the presence of PMDD, ADHD, and endometriosis literally impairs your ability to maintain your deportment. And scripture reminds us that transformation does not erase the flesh that fights against our Godly nature. We are renewed in Christ but we are still imperfect. We still live in bodies affected by hormones, pain, inflammation, and trauma. God knows this because He formed you and knew you before you were even born. Caring for your mental health and honoring biological limits are essential to survive and live the life you were meant to live. Struggling with this because these comorbid conditions are so deeply impactful shouldn't be an indictment on your character. For many women, healing begins not with trying harder on your own, but with releasing condemnation and allowing our Heavenly Father to show up strong in our weaknesses.


An Invitation to Join the Discourse

Do you live with one or all three of these conditions? If so, you are not alone. Even your lovely author struggles with all three!


If you live with PMDD, ADHD, endometriosis, or any combination of the three, your experience isn't as outlandish as you think. You are not “too much.” You are responding to a body and brain that are working incredibly hard to survive. This conversation is still evolving, and your voice matters so much to me. I look forward to having a rich discussion with you here on this post or over on my social media handles (@cheerfulheartmhcpllc on Instagram and Facebook).


To keep the conversation going, consider these questions. More questions on Instagram and FB.


  • What patterns have you noticed in your own cycle, mood, focus, or pain?

  • What do you wish your providers understood?


And wait a minute! I take care of my ladies! Don't leave empty-handed! Resources and more are down below.

References & Further Reading

Emotion Regulation and PMDD


ADHD, Emotional Dysregulation, and the Menstrual Cycle

  • Wynchank, D., et al. (2025). Menstrual cycle–related symptom changes in women with ADHD. Journal of Clinical Medicine.https://www.mdpi.com/2077-0383/15/1/121

  • Quinn, P. O. (2008). Attention-deficit/hyperactivity disorder and the female hormone cycle. Current Psychiatry Reports.


Therapy in a Nutshell Explains the Neuroscience ADHD and Emotional Dysregulation: https://youtu.be/qcryeu8g2fA?si=QXz87wG-JObxoMY6


PMDD and ADHD Comorbidity


Endometriosis, Pain, and Mental Health

  • Facchin, F., et al. (2017). Mental health in women with endometriosis: A systematic review. Human Reproduction Update.

  • Carey, E. T., et al. (2017). Central sensitization and chronic pelvic pain. Obstetrics & Gynecology Clinics of North America.

Helpful PMDD Resources

If you’re navigating PMDD, Premenstrual Exacerbation (PME), or related symptoms, the following trusted resources offer education, community support, and tools to help you better understand your cycle and advocate for care.


International Association for Premenstrual Disorders (IAPMD)A global, patient-led nonprofit dedicated to PMDD and PME education, advocacy, and support.Website: https://www.iapmd.org


What you’ll find:

  • Free, moderated peer support groups

  • A PMDD/PME self-screening tool

  • Symptom tracking tools (including the Daily Record of Severity of Problems – DRSP)

  • A provider directory for clinicians familiar with PMDD

  • Downloadable educational guides and treatment information


PMDD Self-Screen & Symptom Tracker (via IAPMD)Evidence-based tools to help you track symptoms across your menstrual cycle and bring clearer data into medical or mental health appointments.https://www.iapmd.org/self-screen


Me v PMDD (App & Education Platform)A symptom-tracking and education app designed to help people recognize patterns, prepare for symptom shifts, and feel less alone.https://www.thepmddcoach.com/resources


Belle Health – PMDD Support Groups: Online peer support groups for individuals living with PMDD, facilitated in a supportive and validating environment.https://bellehealth.co/pmdd-support-group


Mental Health America – PMDD Overview: An accessible overview of PMDD symptoms, coping strategies, and mental health support resources.https://mhanational.org/resources/pms-and-pmdd


Anxiety & Depression Association of America (ADAA):Information on PMDD, mood symptoms, and treatment approaches, with additional mental health resources.https://adaa.org/find-help-for/women/pms-pmdd


This information is provided for educational purposes and is not a substitute for individualized medical or mental health care. If you are experiencing severe mood symptoms or thoughts of self-harm, please seek immediate support.

Downloadable One Pager (Updated 1/18/26)

EMDR Group for Women with Endometriosis (Downloadable and Shareable)

Group therapy illustration with women sitting in a circle, surrounded by green patterns. Text: "A Space for Healing" and contact info for Cheerful Heart Mental Health Counseling
Join a supportive EMDR group for women battling endometriosis, offering a comforting space to express feelings and heal together. Reach out to Cheerful Heart Mental Health Counseling for more information.
This post is for educational purposes and is not a substitute for individualized medical or mental health care.
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About the Author

Shakira O'Garro, LMHC-D, LPCC, LPC, NCC is a licensed mental health counselor and founder of Cheerful Heart Mental Health Counseling PLLC. She specializes in working with BIPOC Christian women navigating medical trauma and chronic illness that triggers a crisis of faith. Trained in EMDR therapy and Christian counseling, Shakira offers virtual sessions in NY, NJ, PA, SC, and CA.


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