MHM Magazine

Issue 6 | 2021 | MENTALHEALTHMATTERS | 13 MHM A few years ago, the notion that ADHD existed in women was some- thing new. We have known for some time that ADHD appears to be far more common in boys than girls, but when this ratio is examined more closely, it appears the differ- ence in prevalence depends on the sample studied. For example, in ep- idemiological samples, the female- to-male ratio is 1:3; and in clinical samples, the female-to-male ratio is between 1:5 to 1:9. Immediate- ly, this striking difference raises questions about who is diagnosing and why so many girls are being missed? Moving into adulthood, the prevalence and characteristics of ADHD in women has been similarly neglected in clinical practice and research. A worldwide meta- regression analysis of 11 studies of adults with ADHD found that although the differences in the ratio of boys to girls with ADHD decreased with age, women were still less likely to be diagnosed as adults. The ratio of 1:1.6 (females to males) was present in adults aged ≥19 years. Hence more men were being diagnosed in adulthood than women. Do these differences in diagnosis reflect a true variation in prevalence? Do divergent patterns exist for women and men when referred to the clinic for diagnosis and treatment? Does ADHD present differently in men and women and how does this contribute to diagnosis rates? These questions remain to be fully clarified.   Moving into adulthood, the prevalence and characteristics of ADHD in women has been similarly neglected in clinical practice and research. Recently, a worldwide meta-regression analysis of 11 studies of adults with ADHD found that although the differences in the ratio of boys to girls with ADHD decreased with age, women were still less likely to be diagnosed as adults. The ratio of 1:1.6 (females to males) was present in adults aged ≥19 years. Hence males still predominated. Whether these differences in diagnosis reflect a true difference in prevalence, differences in referral to the clinic for diagnosis and treatment or presentations remain to be clarified.  One of the intriguing new areas of research is how hormonal fluctuations throughout the reproductive cycle affect ADHD symptoms. With the background of differences in ADHD prevalence across the sexes, it is interesting to dig deeper into the physiology of the hormone fluctuations and how they impact on ADHD. This is the main focus of this paper. To begin with the role of oestrogens: they affect the development and aging of brain regions that are crucial to higher cognitive functions, like verbal memory. There is increasing Dr Dora Wynchank Psychiatrist Intensive Specialist Programme, ADHD The Hague, Netherlands CYCLING WITH ADHD? Women and their hormones across the reproductive cycle