Have you ever felt as though your attention deficit hyperactivity disorder symptoms have completely disappeared? If you’ve been or are currently pregnant, there’s a chance you’re nodding your head in agreement, says Carlene Bauwens, a certified ADHD life coach in Naperville, Illinois, who works with people of all ages who want to move past ADHD challenges. However, she says that ADHD symptoms haven’t actually disappeared during this time. Instead, you might want to chalk up these feelings to changing hormones.

“During pregnancy, estrogen spikes,” she says. “Many women have told me, ‘My ADHD went away.’ It hasn’t. It’s just that the brain is getting more of what it needs.”

[See: 10 Concerns Parents Have About Their Kids’ Health.]

The Brain: a Target Organ for Estrogen

Bauwens explains that “the brain is a target organ for estrogen,” which helps with dopamine and other transmitters — brain chemicals that the National Institute of Mental Health says “play essential roles in thinking and attention” — that are usually “sluggish in the ADHD brain.” Someone with ADHD typically has improperly functioning brain chemicals, she says, noting that as a key reason why symptoms may manifest. When estrogen increases, as it does during pregnancy, ADHD symptoms may significantly diminish. But after a baby is born, she says estrogen may plummet and ADHD symptoms could return, sometimes with even more intensity than before pregnancy. In that case, postpartum depression and anxiety may occur. On the flip side, when estrogen drops as it does during menstruation, she says there’s a surge, rather than a lessening, of ADHD symptoms, the hallmarks of which include inattention, hyperactivity or both.

Dr. Patricia Quinn, a developmental pediatrician in the District of Columbia and the co-founder of the nonprofit Center for Girls and Women with ADHD, says that all of this is normal. While the center is no longer in existence, Quinn says that ADDvance.com is the resource site that continues to advocate for girls and women with ADHD.

She’s personally observed women with worsening ADHD symptoms postpartum, but also says that changes in symptoms are common during menstruation as well as during perimenopause and menopause.

Medication Adjustments During Hormonal Changes

Quinn explains that usually, “women’s ADHD symptoms worsen before their periods.” To help manage this, she suggests increasing the dose of ADHD stimulant medication during certain times of the month. She’s done this for her own patients, adding that these women have told her that before the dosage change during this time, their ADHD medication was less effective. Some women may need an increase in dosage a few days prior to getting their period, she says, while others may only need it while menstruating. “What I do with these women is very individualized based on their symptoms,” Quinn says.

[See: 8 Things You Didn’t Know About Counseling.]

Quite simply, a woman who is menstruating and does not have ADHD is usually able to handle tasks effectively or manage distractions well, Quinn says. But in the instance of women with ADHD who are menstruating, the dip in estrogen can affect them differently. It may take their condition from something in which Quinn says they’re “barely able to hold it together” to a situation that renders them “not being able to function.” The latter, she says, may mean a woman becomes so distracted that she literally can’t get work done or runs out of time, whereas before perhaps she struggled with certain tasks but still carried them through.

Similarly, Quinn often recommends stimulant medication dosage adjustments for women going through perimenopause or menopause, appropriately increasing dosage as both her and each patient see fit. In each case, including during menstruation, she says the goal is to realize “improved functioning” on the executive function and cognitive front.

Beyond Stimulant Medication

“We hear little about the cognitive effects of lower estrogen levels,” says Kathleen Nadeau, clinical director of the Chesapeake ADHD Center of Maryland, which has satellite offices in the Baltimore and District of Columbia area. “Women don’t think as clearly and there are more difficulties with memory retention once estrogen levels are low.”

Nadeau agrees that medication can certainly help women facing hormonal fluctuations — or be beneficial in general for anyone with ADHD. However, she says women should also consider other options to help counter the effects of waning estrogen levels. She feels that the medical community can sometimes focus too heavily on ADHD medication, emphasizing its use while not mentioning or incorporating other helpful methods.

For example, she explains that especially during times of hormonal fluctuations, women need optimal brain function support. A key factor in optimizing brain function, she says, is sleep. In fact, the National Sleep Foundation notes that “from peri-menopause to post-menopause, women report the most sleeping problems.” To help remedy sleep-related issues, Nadeau suggest that all adults — but especially those with ADHD and women with the disorder — refrain from excessive use of laptops and other electronic devices. The blue lights emitted from them can disrupt the circadian rhythm — the body’s internal clock — and therefore interfere with optimizing a woman’s brain function as she experiences various hormonal stages, she explains.

What could help women who are experiencing serious sleep issues is something called cognitive behavioral therapy for insomnia, which Nadeau says may be worth considering. According to the Mayo Clinic, ” cognitive behavioral therapy for insomnia, sometimes called CBT-I, is an effective treatment for chronic sleep problems and is usually recommended as the first line of treatment.” The cognitive part of CBT-I, the clinic notes, involves teaching a person to be aware of and change the beliefs that may impede sleep, such as worrisome or negative thoughts. The behavioral aspect has to do with development of good sleep habits and refraining from engaging in behaviors that prohibit sound sleep.

[See: Hoarding, ADHD, Narcissism: Inside the Minds of History’s Great Personalities.]

Nadeau is also a fan of mindfulness training, explaining that her clinic has hired someone with such a background to help adults with ADHD. Focusing on the moment in an effort to shift from the deluge of thoughts that often bombard someone with ADHD can help.

“The bottom line,” she says, “is that everything that’s good for the brain helps” a woman during times in her life when hormones are changing. “Less stress, simplifying life, regular exercise, nutrition and adequate sleep — this all adds up to one of the most powerful treatment packages for ADHD.”

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What Role Do Hormones Play in Women With ADHD? originally appeared on usnews.com