Hormones, Dopamine, and ADHD in Women: Evaluating Estradiol’s Role

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD) in women is characterized by substantial variability in symptom expression, with many individuals reporting marked fluctuations in attention, emotional regulation, and executive functioning across the menstrual cycle. Clinical and self-report evidence suggests that symptoms often intensify during periods of low estrogen, indicating a potential hormonal contribution to symptom severity. A recent review by Kooij et al. (2025) proposes that interactions between estrogen and dopamine may underlie these cyclical changes, given dopamine’s central role in the neurobiology of ADHD. However, despite the plausibility of this hypothesis, no comprehensive review has examined whether this estrogen–dopamine relationship is supported by existing empirical literature, nor how estrogen may mechanistically influence dopaminergic functioning. This narrative review addresses this gap by systematically examining preclinical and human research on the interaction between estradiol and dopamine, with particular relevance to cognitive and behavioral domains implicated in ADHD. Evidence from animal and cellular studies provides converging support for estrogenic modulation of dopamine synthesis, receptor expression, and synaptic plasticity. Nevertheless, direct investigations of estrogen–dopamine interactions in women with ADHD remain limited. This review highlights the need for hormone-informed research to better understand the neurobiological mechanisms underlying symptom variability in women with ADHD and to support more personalized diagnosis and treatment.