Premenstrual Dysphoric Disorder

Key Insights

• Participants often turned to psilocybin after conventional treatments had failed. Long diagnosis times and insufficient care from the health sector calls for systemic change.
• Experiences with and approaches to psilocybin were diverse, with most reporting improved quality of life and reduced symptoms, though this was not without challenges.
• Psilocybin use was largely part of broader self-exploration and lifestyle changes. Not a quick-fix option, especially with PMDD symptoms and when trauma is prevalent.
• Moderate doses mitigated symptoms with less disruption. Larger doses appeared to hold transformative potential, but with increased risks, particularly with excessive dosage (which limited the ability to understand confronting insights), or when taken without support.
• Becoming self-advocates and taking research and treatment into their own hands supported agency and deeper self-knowledge. Understanding of PMDD emerged as interconnected within a broader cultural context that challenged Western societal norms.

Author: Alana Cookman. Alana is a health researcher specializing in Women’s Health within work contexts. She employs a systems-thinking approach to exploring health narratives. She has a rich background in social change and health system transformation. She’s the primary author of this report, which was made under the support and sponsorship of Eleanor Taylor.

Introduction

This topic page presents findings from an exploratory research project. The primary aim was to illuminate and understand how women with Premenstrual Dysphoric Disorder (PMDD) use psilocybin (magic mushrooms or truffles). The research was prompted by the growing number of women seeking guidance on using psilocybin for PMDD on online platforms, like Reddit and Facebook, having exhausted other treatment options.

This exploratory study is entirely independent and, as such, mirrors the grassroots efforts encountered in the research. Please consider the limitations of resources while reading this report. It has been a challenge to include the full richness of the fascinating stories shared, which have undeniably highlighted the need for more targeted future research.

This page will take the reader through the participants’ journey, combining their shared perspectives in the findings section. Starting with their PMDD diagnosis and their subjective experience of PMDD before they experienced psilocybin, it will also share the various approaches to the actual experience of psilocybin, followed by how they think psilocybin has influenced their experience of PMDD. The interviews close with participants sharing what they wish they had known, and words of advice for others with PMDD hoping to explore psilocybin.

Current Research Landscape / Background in Brief

PMDD, as stated by the International Association of Premenstrual Disorders (IAPMD), is a cyclical, hormone-based mood disorder [1]. It is not a hormone imbalance, but rather characterised by abnormal brain sensitivity to normal hormonal fluctuations, leading to emotional, cognitive, and physical symptoms.

Manifesting in the latter half of the menstrual cycle post-ovulation, PMDD is in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) as a depressive disorder, and was also recently included in the ICD-11 as an international diagnosis [2,3]. The symptoms of PMDD need to significantly impact daily life, work and relationships for a diagnosis to be confirmed, and is very different from PMS. One survey of nearly 600 women with PMDD found that 34% have attempted suicide [4].

Despite increased recognition and recent research efforts, PMDD remains relatively underfunded and underresearched, particularly outside the field of neuroendocrinology, exacerbating the lack of direct understanding of its causes [5]. PMDD impacts approximately 5% of menstruating women, with symptoms typically beginning at age 15 [6,7]. However, the average age of diagnosis is 35, resulting in about 8.6 years of symptoms. This equates to one week of symptoms per cycle, over 450 cycles. For individuals whose symptoms extend from post-ovulation to menstruation, the duration of symptoms may effectively double.

Diagnosis relies on subjective diaries and symptom collection, with the most reliable method believed to be the Premenstrual Symptom Screening Tool (PSST) [8]. Unfortunately, widespread recognition and understanding of PMDD remains low in health systems, and there is a clear gap across medical expertise [9].

So why may psilocybin be a potential treatment option?

PMDD is a complex mental health challenge, with symptoms overlapping various psychiatric conditions. Despite growing interest in psychedelic-assisted therapy for mental health, specific research investigating PMDD at the time of writing this report does not yet exist.

Speaking with several researchers in this field helped to understand several theories as to why psilocybin may potentially work on PMDD symptoms. One potential link involves serotonin receptor modulation by psilocybin. Kometer and Vollenweider (2010) suggest that psilocybin’s affinity for the 5-HT2A receptors may offer a pathway to manage mood-related symptoms of PMDD. However, this connection requires deeper exploration to ascertain validity.

Another possible area of interest is the interaction between serotonin and the Hypothalamic-Pituitary-Gonadal (HPG) axis. Gukasyan and Narayan (2023) point to this interplay, which could be significant in PMDD symptomatology. Again, the complexity of this relationship is not firmly established.

The concept of enhanced neuroplasticity through psychedelics, as posited by Ly et al. (2018), presents another speculative theory in that increased neuroplasticity could help in altering negative thought and behaviour patterns associated with PMDD.

The prevalence of early-life trauma in women with PMDD is also documented, and links have been established between PMDD and post-traumatic stress disorder (PTSD) [10,11]. The well-documented potential of psilocybin in treating trauma-related mental health issues opens up a promising hypothetical area for exploration (Bird et al., 2021).

Epigenetics offers another speculative connection, as hormonal changes in PMDD might act as epigenetic triggers, exacerbating symptoms in those with trauma histories. While there is evidence of altered gene expression in PMDD patients, the exact nature of this relationship is still under investigation [12].

Finally, the anti-inflammatory effects of psilocybin have been studied in terms of regulating inflammatory pathways (Flanagan & Nichols, 2018). Women with PMDD can have a higher level of chronic inflammation at the cellular level, thus offering another potential therapeutic pathway [13].

Methodology & Methods

As this is an area currently devoid of any substantial research, this research adopts an entirely exploratory and qualitative approach to understanding the novel landscape. Initial consultations were conducted with researchers and practitioners specialising in women’s health, and demonstrating an interest in psychedelic substances. These discussions facilitated guiding the semi-structured interview questions, and understanding the complexity and perspectives concerning the potential physiological interactions of psilocybin on PMDD.

The study population was recruited through targeted advertisements, placed on various online platforms, namely the ‘PMDD’ and ‘PsychedelicWomen’ subreddits [14,15]. The recruitment advert asked for women with a PMDD diagnosis and experience of using macro doses of psilocybin to get in touch. Approximately 30 women responded to the advert, either via email or directly on Reddit. Of these initial respondents, a sample of 11 participants followed up, met the inclusion criteria and were interviewed remotely, online.

Inclusion criteria: Women with a PMDD diagnosis who have used larger doses of psilocybin and noticed any kind of change with their
symptoms. English speaking, willing to have a digital interview.

Ethical considerations were addressed through the provision of a Participant Information Form, summarising the study’s objectives, confidentiality measures, and data handling processes. Verbal consent was obtained from each participant before the interviews, which were subsequently transcribed and anonymised before analysis, with the original transcripts and recordings being deleted.

The 11 women represented a diverse cohort of women with PMDD, with varied demographics and differing experiences of psilocybin use. Semi-structured interviews were conducted to capture detailed narratives regarding the participants’ journeys, from their initial PMDD diagnosis to their experiences with different treatment approaches and the use of psilocybin.

Data Analysis

The data analysis involved a thematic analysis process adapted from Braun and Clarke’s reflexive approach [16]. Starting with ongoing rereading of the transcripts and gaining a deep understanding of the answers, codes were generated and eventually ordered into main themes. The themes formed the basis of the findings/discussion sections, which were combined for ease of flow through the collective shared accounts.

Given the large amount of data gained from each interview and the breadth we wanted to capture as a foundational exploratory project, this section also followed the journey of the interview questions and themes to allow for a more coherent yet nuanced narrative. The data was always tied back to the overall research question, with direct (anonymous) participant quotes to illustrate the themes.

Results

The PMDD experience and the route to psilocybin

PMDD really messes with the ego and really distorts your perception of yourself, your perception of others. You perceive everything as a threat.

Participant 1

Participants shared that their main PMDD symptoms before using psilocybin were severe mood swings, irritability and rage, suicidal ideation, extreme sensitivity (emotional and sensory) and damaging interpersonal conflicts. Trauma was a key component of the PMDD experience for almost all participants.

Some linked their symptoms to trauma experienced previously (war trauma, sexual abuse and childhood trauma were all discussed). Many described their PMDD experience in terms of common trauma responses: fight (resulting in destructive conflicts with others, self-criticism and self-injurious thoughts and behaviour), flight (strong desire to leave – relationships, jobs and even life through suicidal ideation and dissociation), and freeze (manifesting as a feeling of being trapped and unable to communicate, with one participant even discussing the sensation of ‘feeling choked’) [17].

PMDD itself was described as traumatic. Living with PMDD was likened to a ‘bad trip’, and the feeling of having two selves inside was described: the loving connected self and the rageful agitated self, or the self that is paralyzed in sadness and fear. ‘Those are scary moments, because there’s someone inside me who’s me, who’s like, this isn’t what we do. And then there’s another part that just keeps me where I am’ (Participant 4). This notion of divided self is reported in other research on PMDD [18].

Various routes to PMDD diagnosis

It’s a really long story up until the point of finding out.

Participant 4

Many participants underwent a prolonged journey to receive a PMDD diagnosis, with some experiencing undiagnosed symptoms for up to two decades, leading to significant personal distress. Diagnosis often followed experiences of increased symptoms from hormonal treatments or stopping birth control, changes in life stages, such as childbirth or stopping breastfeeding, or when symptoms became unmanageable. Self-advocacy, autonomous research and meticulous symptom tracking to share with doctors were deemed crucial in making progress.

Meeting with knowledgeable specialists proved expensive, inaccessible, and often had disappointing results. Many women encountered dismissive and demeaning attitudes from medical professionals, leading to feelings of mistrust and a need to take control of their health independently. Not being believed, being shut down, being ignored, or doctors being disinterested was a very frustrating part of this process for several women, especially with people of colour and those experiencing economic disadvantage. Only a couple of people had positive experiences with PMDD-informed doctors or therapists, who noted this as ‘amazing’.

Treatment options and the route to psilocybin

No help was coming, there’s no support for PMDD.

Participant 1

For the participants interviewed, initial treatment options for PMDD, including hormonal treatment and SSRIs, largely proved ineffective, came with undesirable side effects, or even made things worse.

It was felt by most that these treatments suppressed both their natural cycles and emotions and fuelled the feeling of a lack of agency over their bodies and managing their, as they did not know where they were in their cycle. Most were fearful of options like chemical menopause or hysterectomy, and felt a lack of options available: ‘Every single thing made me worse…I had no other choice; I knew it was going to kill me’ (Participant 2).

Limited access to treatments due to location or financial constraints led to the exploration of alternative therapies: ‘I had to fully treat it with psilocybin because I got to the US and I had no health insurance and I had no way of getting Effexor [Venlafaxine, SSRI] anymore’ (Participant 3). Some experienced negative outcomes, with approaches like Chinese herbs or acupuncture, which exacerbated symptoms.

Some women had luck for a while with several treatments simultaneously (various diet protocols and medications, supplements and exercise). Some participants experimented, too, with antihistamines and Finasteride, having researched these or having been diagnosed with Mast Cell Activation Syndrome. For the most part, things seemed to work, until they didn’t. Exhausting available options and a lack of trust in offered treatments drove many participants to consider psilocybin.

Research into the psychedelic renaissance and philosophy through literature, podcasts, and online resources, such as Reddit conversations, books like ‘A Really Good Day ’ and resources like ‘The Woman in the Basement’, fostered a sense of hope and agency [19]. Looking at information from other communities also proved helpful (i.e. those suffering from cluster headaches and depression). Familiarity with other “illegal” substances, such as marijuana, and initial catalytic experiences with ayahuasca, and positive experiences with mushrooms in previous years, or microdosing further, encouraged participants to explore psilocybin, with an element of trust. It was also suggested that it felt helpful in the context of the links between childhood trauma and PMDD, as it ‘lets you access some things that you haven’t been able to before, without it’ (Participant 9).

The actual psilocybin experiences

Participants were asked to describe the experience(s) that they thought had most influenced their PMDD.

Preparation

Most participants considered their reasons and intentions for undertaking this journey, noting a lack of available guidance. Many set intentions for the process, often focused on healing and forgiveness going into the experience, some expressing this as a sign of ‘respect for the plant medicine’ (Participant 2).

Several participants noted how intentions acted as an anchor, and some put extra effort into creating an intentional healing space after being caught off guard by previous very emotional experiences: ‘I sobbed uncontrollably for hours’ (Participant 7) or challenging recreational experiences. An example of this was ‘journaling through fears’ for two weeks to help feel more prepared (Participant 4).

Fear came up several times for participants, whether it was a fear of surrendering or letting go, fear of losing their mind, or fear of not finding answers. Participant 5 experimented with mushrooms at a time when she was feeling at rock bottom and was considering suicide. While her suicide ideation did lessen after, she ‘had a very bad trip, like it was difficult, and I wasn’t prepared, and I was throwing up, and I had a lot of anxiety’. She said, ‘I wished I had done more prep, but no framework was available’.

Knowing how to work through resistance and ‘doing the work to be prepared for what may be overwhelming’ was stated as an important consideration for women with PMDD, due to the links with trauma. In a similar thread, many participants spoke of challenging experiences, either when too strong a dose surfaced so fast they couldn’t make sense of them, or feeling disappointed they had not developed ‘superpowers’ afterwards. One spoke of ‘frustration, like especially when you hear other people talk about their recovery or, you know, they did one trip and then they’re healed. So it’s like, ohh yeah, if I would have maybe done it differently, maybe I’m not doing well enough. Maybe I’m not present enough or stuff like that’. These points highlight the need for balanced narratives in the psychedelic space. These thoughts could potentially escalate for those with rumination and negative inner critic tendencies.

On a practical note, most participants shared ways to make the experience more comfortable, including a clean environment, access to soothing music and, critically, knowing that there was sufficient time for aftercare, especially with bigger doses. Preference of time of day varied, and the support of others, either nearby or on call, depending on whether they were undertaking the journey alone, was important. Ensuring they had nourishing, familiar food, time to be alone in nature and time with friends and pets after the experience were also mentioned as helpful in planning. Note that some of these preferences varied depending on the dose level, as those with smaller doses would need less time for preparation and aftercare.

Dosage and Timing

Diverse approaches to the psilocybin experience were adopted. These were often dependent on life circumstances, experience and the resources available. Some women found that moderate doses every couple of months worked well in managing and largely reducing PMDD symptoms, and with much less disruption, allowing them to stay consistent in jobs they loved, for example. These experiences were often described as resetting, washing, or rebooting and while remaining functional, still illuminating with feelings of love, connection and awe.

Other participants chose a more intensive psychedelic journey that involved several macro doses. These appeared to be potentially more transformative, with a couple of people in our sample, who had significant shifts in their worldview and very intense ‘travel’ and hallucinogenic experiences. Yet this came with caveats of needing a lot more time for preparation, as commented above – people felt anxiety, fear of letting go, and issues of control and resistance before and during the trip. Interestingly, these were reflected as microcosms of the PMDD symptoms, too (Participant 9). Considerable time to ‘land’ and process learnings after the trip was also necessary for more intensive journeys. Having profound internal shifts could be unsettling when returning to unchanged external lives.

Additionally, the larger doses, which could expose fast traumatic scenes or images, were noted as difficult to make sense of in the context of everyday life, which was difficult to deal with. Having ‘the right support’ was deemed a necessary part of this process by all doing larger doses, even when they didn’t have this themselves. The slower and more subtle insights from smaller doses could be remembered and processed with more ease, and anxiety or fear around the process with moderate doses was absent.

Responses to different doses are entirely individual, with some people sensitive to smaller doses and others encountering barriers with larger ones. For some, a retrospective learning point was wishing they had carried out more preparation in terms of dose, and spent more time understanding their personal needs, unique context and state of mind more deeply, before exploring. A core learning was someone wishing they hadn’t done such a large dose alone, and that they would not advocate this for people moving forward.

The answers were varied when it came to the preferred timing in the menstrual cycle. Some women avoided the luteal phase due to sensitivity, physical load and fear of exacerbating symptoms, and, interestingly, several women didn’t know where they were in their cycle. It was noted by one person that they used to explore psilocybin during the luteal phase as a means to gain deeper insights into what they needed to work on, but could no longer do that, as they ended up in a very fearful and dissociative state. They commented that women experiencing psilocybin during the luteal phase did need to be held in very supportive hands.

These combined insights challenge the idea that ‘heroic’ doses were necessary for symptom mitigation and profound experiences.

Perception of self and PMDD after psilocybin

Changes in symptoms

Women at both ends of the scale – who used psilocybin as an ongoing functional treatment and those on a more intensive psychedelic journey – spoke of ‘flourishing’, being happy and grateful, and ‘being able to live their life’. The most noticeable improvements included diminished suicidal thoughts, anger, and relationship issues. ‘Hell week’ was either eliminated or shortened, and when it was there, it was often linked to increased stressful life events, of which psilocybin appeared to aid a greater awareness.

Some were able to stop taking antidepressants, feeling similar benefits without the side effects. Participant 8 noted shorter, less severe episodes, avoiding catastrophic outcomes: ‘I can go into that place. But they don’t last as long. They’re not as bad. Most of all, I don’t burn down my whole life when it happens’.

However, some experienced symptom resurgence due to time lapsed between doses, life changes (diet, injury, medication) or stressful events, resulting in, potentially, considering a return to SSRIs. Participant 5, with suspected co-occurring conditions, noted that, after several months of psilocybin experiences and increased symptom tracking, ‘I would become more dysregulated, more insomniac. My thoughts would change, so more like obsessive thoughts, OCD’. It is not uncommon for PMDD to co-occur with other mood and anxiety disorders, such as bipolar, which should also be taken into account when experimenting with psilocybin [20].

The combined data of the participants implies that psilocybin is one part of an ongoing treatment plan and certainly not curative. Over half the women interviewed are not using psilocybin presently, two microdose in the luteal phase, and one uses it every other month. Some participants work in this space, and host women’s circles, and one attends experiences in more of a social/ceremonial setting, both with much smaller doses. Of those not currently using psilocybin, two are waiting to be ‘called for’ another journey. For others, they have stopped due to injury, location, or ‘not needing to do it right now’ and are still making sense of their last journeys.

Most of the women interviewed see psilocybin playing a role in their ongoing treatment of PMDD.

Core themes in beneficial shifts

Increased self-awareness and moving from self-harm to self-care

It’s awareness. The self-awareness is probably the biggest component.

Participant 8

It was shared that psilocybin has enabled deeper self-knowledge and aided different personal meanings of PMDD for people. ‘After I found out about the PMDD I was like, well, this is a new truth about myself that I wanna explore. So now it’s time again to get the boost to get the unveiling’ (Participant 9).

The understandings gained from this varied across women, from feeling ‘grateful for new insights, and realisations around acceptance and letting go’ all the way through to seeing PMDD as a ‘gift’. (People who shared this understand it may be triggering and do not in any way want to diminish or invalidate the lived experiences of people with PMDD, as they themselves have experienced it in its full intensity).

This perspective shift included understanding PMDD as illuminating ‘the triggers and insecurities in the luteal phase that need healing and working on’, which needed attention all month round, even if they only showed up in the luteal phase. This also enabled a purging process when a period arrives: ‘I’m able to bleed, I’m able to purge, purge that out and work with the cycle. So it’s such a blessing. I see it so differently.’ (Participant 2). Participant 7 said ‘when we’re in PMDD, a lot of us are highly sensitive. We can have a way to, like, pick up on things that other people don’t, and it’s like, well, actually, we have a really beautiful gift’. Participant 4 also spoke of finding ‘a weird beauty in my depression’ where ‘me and myself are finally working together’ and ‘instead of PMDD like showing up in controlling me like a puppet. I am now like – OK, I feel that you’re here. What do you need from me?’. This has helped her and her partner a lot as a communicative tool, which was unavailable before.

Working with psilocybin has allowed women to develop a sense of compassion, acceptance and forgiveness for themselves that was missing before. This materialised in various ways, from having experiences on psilocybin that released deeply stored grief and being shown a journey through their life, which led to ‘the deepest self-compassion and self-acceptance’. Another was shown through working with psychedelics what she needs to do to take care of herself, ‘And having really zero fucks about what anyone else thinks about that. Like, I’m gonna take care of myself because it’s the best for me, and it actually does then make everyone else happier too’ (Participant 7).

Participant 8 spoke of psilocybin aiding the ‘reraising of herself’ as the experience showed her a deep sense of love and connection she could tap into when she needed it, that she had not experienced in her upbringing: ‘I didn’t experience that in my real life until I had the opportunity to experience it with psychedelics. And then that helped me really open the door to like joy and love and fun and laughter’. Overall, greater permission to love self and care for self has grown through working with psychedelics, which critically has reduced the need to self-harm, from critical self-talk to thinking about and attempting to end one’s life. Many people discussed an increased sense of trusting one’s own body, and listening to its signals, which had huge implications on PMDD symptoms.

There is also a shame and fear element, where personal trauma and PMDD can collide. This was expressed throughout the interviews as feeling like hiding away, being trapped, or the feeling of a ‘block’, but not quite knowing what it was, or how to get to it (Participants 8, 4, 9 and 11). Using mushrooms helped dial down these feelings enough to ‘be with ourselves without those triggers in place, without the fear and shame’ (Participant 11). This helped people access the things that were hurting them without it being so painful.

Connection to others – being seen, heard and held

I feel like that can be the most healing element of it all, you know, is that space between you and the other?’

Participant 10

Participants highlighted the challenges of connection, isolation and self-silencing in relation to mental health issues and PMDD. For example: ‘I personally have a tendency to isolate deeply. And not communicate things that are painful and are important to me’ (Participant 10). Or being unable to go to work or visit friends: ‘I’d be crying in the car outside someone’s house. And I’m like, what is going on and just a lot of anxiety, paranoia, things like that’ (Participant 4). On the flip-side of this, when asked what effects they noticed on their PMDD since using psilocybin, Participant 6 stated, ‘I don’t feel the intense hatred and irritation and just like wanting to completely cut myself off from all interactions with people’.

In the context of the actual psilocybin experiences, it was suggested that ‘I feel the people that have the most difficult time with it are isolated or fearful that they’re gonna get in trouble and they can’t talk about it’ (Participant 11). These points reiterate the importance of community, being around trusting people, friends and guides and the significance of being able to express oneself. ‘And so when I think of what the greatest benefits are, if it’s a heart-centred psilocybin journey, is when you do have that chance to connect and maybe open up and have a clarity of mind that may otherwise be difficult to raise’ (Participant 10). For another, connecting with their partner during the journey was noted as one of the most significant parts of their every two-month protocol, ‘And then you just feel that love with someone and you’re like, OK, my whole soul has been restored. I’m good for two months’ (Participant 3).

Given that ‘the biggest factor is that PMDD, like many have experienced, has most impacted my intimate relationships, my professional relationships, my friendships’ (Participant 7), it perhaps makes sense that the supportive connections forged during psychedelic experiences, fostering trust and authentic engagement were noted as profound. The experience of being seen, heard, and witnessed, especially in community or group settings, played a significant role in the healing process. As an example, ‘I actually think it helps for PMDD to just really be seen in all of our authentic parts like when we are in a ceremonial context, we are seen in whatever shit is coming up, and if we’re in a safe space’ (Participant 7). (It was also indicated that this is often not the case, and these spaces are not held by trauma-informed guides, so people need to be discerning with what, where and who they access).

The process of being in an intimate space with others during a psilocybin experience was also linked to participants being able to ask for help and trusting others during ongoing PMDD episodes. The importance of interpersonal connections was consistently underscored by participants, emphasising the role of facilitators, guides, partners and friendships in releasing anger, letting go of past burdens, and feeling love and connection. For many participants, being in community or group contexts with other women, and a strong feminine and maternal energy, felt especially beneficial. Several participants recognized their sensitivity and intuition, benefitting from nurturing environments and supportive communities, as opposed to feeling like it was something wrong.

Behaviour change through witnessing, pausing and responding

I have this opportunity to catch it right before I start really diving into that deep hole, where I feel like I no longer have control over my body or my mind or my emotions.

Participant 6

Following their experiences with mushrooms, many participants noted a significant change in their ability to respond to triggers with greater awareness and patience. For example: ‘If upset about something, I’m able to walk myself back a bit with a sense of control I don’t have when not treating PMDD’ (Participant 6). Or it supports ‘a stronger witness in the depths, sort of this kind of observer that can stand apart from it, no matter how hard it gets. That supports a lot of resiliency for me’ (Participant 10). This shift led to a more observant and mindful approach to their emotional reactions. Others (e.g., Participant 9) linked their psilocybin experience to embodied change, moving from understanding their behaviours on an intellectual level to a conscious effort and practice to implement lessons from it into their daily life.

Participant 7 discussed processing many ‘gut wrenching’ traumatic memories and sadness in difficult trips, before she experienced pleasurable ones, and put this down to her needing to learn all the ways she was harming herself and others, and implementing those lessons. For Participant 5 mushrooms seemed to be the catalyst for her seeing ‘that I was reacting in a habitual way’ and was able to ‘notice this gap’ and believe a different way was possible. They also discussed how the interruption of negative thought loops enabled them to ‘bring in space for more thoughts of compassion, self-compassion or love towards other people’.

Overall, the practice of self-witnessing, particularly during the psychedelic experiences, had effects such as broadening thinking: ‘So I was able to see the psychological machinery slowing down, feel grounded, and turn the threat around’ (Participant 1), which supported a ‘zooming out’ for many. These points played a vital role in promoting personal growth, enabling individuals to move from reactive responses to conscious choices, empowering them with a sense of agency and emotional control, impacting their relationships.

Psilocybin isn’t a cure – one tool in a holistic toolbox

I think that I think this has given me one more tool to feel that distance from my emotions and my negative thought patterns.

Participant 11

Despite the positive impact of psychedelics with both PMDD and a broader relationship to self and the world around them, the clear consensus among the participants was that psilocybin does not serve as a definitive cure for PMDD. Instead, interviewees emphasised that psilocybin is one tool used within a broader process of experimentation with treatments and self-exploration: ‘There were so many things that were starting to change in my perception of the world. So not just with my psychedelic journeys, but my life was changing’ (Participant 8).

Modalities such as different types of therapy, medication, specific PMDD coaching, incorporating many lifestyle changes such as diet and exercise, and immersing oneself in research around health and philosophy and psychedelics were all noted as contributing to significant change. This was the case for people, regardless of their choices on dose and frequency. It was strongly highlighted by Participant 7 that the holistic picture is extremely important when taking into account serious mental health issues, including suicide ideation and working with psychedelics, and there is ‘no way that this alone will ‘fix’ that’.

The sense of agency and self-experimentation with this group of women has been expressed throughout the interviews. This has been difficult to manage alone, or when symptoms are intense. Many have sought ongoing support online, but this doesn’t always feel like enough, especially in group contexts, or when the content feels heavy. The varied approaches are also reflected online too: ‘It’s pretty random when and how people use it, even on like the Reddit group’ (Participant 6), which feels like something researchers need to consider. The ability to zoom out, and make small steps in all parts of one’s life feels critical to work towards a healthy ‘whole’. It was commented that there is no magic wand, but we all need to create our own toolboxes relevant to our unique context.

There are so many things that are natural to this world that heal us. That supports us healing ourselves, I guess is more what it is. I think psilocybin is like I said, it is a tool.

Participant 4

PMDD is a ‘we’ problem, not a ‘me’ problem – cultural considerations

Many participants gained a broader perspective on their PMDD from experimenting with psilocybin. They recognized PMDD as part of a larger interconnected context, with societal and cultural conditioning, and external stressors, all affecting their symptoms.

Working with psychedelics has also enabled an understanding that PMDD has intergenerational links. It didn’t ‘just belong to me’, and they have also internalised things from their past: ‘This is probably generational trauma and shit that like women have been carrying and especially people who are more sensitive – so, like, my family, my lineage, my mother’ (Participant 7).

These shifts led to a significant reduction in the “weight of the world” associated with their individual experience of their symptoms, whilst allowing for detachment from their PMDD, further fostering a sense of agency and more ownership over their experiences. For some, this alleviated a victim mindset: ‘I’m not trapped, I guess, anymore. Like I can have both. I can both have PMDD and live my life’ (Participant 4).

Moreover, psilocybin facilitated an understanding that PMDD was linked to societal pressures and unrealistic expectations, which they referred to as the problematic ‘shoulds.’ One noted that, especially for women in society, there is a sense of autopilot, where even a sense of being is steeped in fear and shame (Participant 11). It wasn’t until they connected with their deeper self on psilocybin, away from that fear and shame, that they realised how much they were always engulfed by it. The realisations for many empowered them to break free from the moulds that they felt suffocated by, and create lives that worked for them, such as living in community or working hours and jobs that suited them, resulting in substantial improvements in managing PMDD.

It’s a way of being really aware and really sensitive to the way that our body moves in the world and that’s not honoured.

Participant 7

Working with psilocybin, other psychedelics, and in various communities supported different knowledge and cultural understandings of PMDD for some people. Examples include: ‘Being highly sensitive in some cultures is seen as a gift’, but ‘is pathologised in the West’ (Participant 7). They also discussed the feeling that they don’t align with capitalist society ‘because there is not enough awareness and acceptance of women’s cycles and that we need rest and different things’.

This was reflected in the fact that many women interviewed had to leave their jobs, work for themselves, or choose between kids and careers. This has resulted in feeling like there is something wrong with them because society is pathologizing them for ‘telling us we are wrong for having mood shifts’.

There was a sense of solidarity in the participants’ responses. That a call to acknowledge the uniqueness of individual experiences and to foster acceptance of the broad spectrum of human emotions was necessary to prevent further harm. The labelling of their experiences as dysphoric, or disordered was challenged, in that it wasn’t so much an individual disorder, but an individual response to societal, family and relational disorders.

The ongoing work

It’s like, you know, the body keeps the score. So it’s like that trauma that’s in there, whether it’s from our past or even the trauma that’s kind of like created through the years of PMDD. It’s all in there. So really just make that time for that to to be worked through.

Participant 10

The work after the psilocybin experience was noted as potentially transformative, as people made sense of any insights, and changed ways of being in the world. Additional and ongoing work was needed to have a smooth reunion with everyday life and relationships within the contexts in which people live. This could also be a very vulnerable time that felt disruptive, especially in terms of work, and a reason why some choose to do more moderate doses.

Despite an intentional integration process not being taken up by everyone (especially those doing smaller doses), those who did engage in it in some form tended to do so alone. Interestingly, most advised specialised support with this process despite not having had it themselves. The ways people integrated – or made meaning from their experiences on psilocybin – included reading books and articles, talking with friends, talking with a therapist, using systems like Internal Family Systems, meditation, journaling, and doodling.

For those who experienced challenging trips where trauma surfaced, or perhaps felt they had ‘too much too soon’, the messages felt harder to grasp and were too fast and all over the place ‘like popcorn’, or they felt they had no way to make sense of or integrate them.

Others spoke of the challenges that come along when trying to live with profound insights and trying to ‘figure them out alongside the stressors of real life’, which always come back. Challenges are experienced a few months after for some, when real life is going strong, and one can ‘start dismissing’ the value of the psilocybin experience. In this sense, the ‘best integration is when you go through it with friends that hold you accountable to what you learned in your life, long healing journeys, your life-long friendships’ (Participant 11).

Quality relationships to support this process were mentioned frequently, reiterating the point above about support from connection and community potentially being a large part of the healing process in and of itself.

These combined points for integration feel especially important in the context of PMDD, which was seen as a ‘moving beast’ – changing and shifting over time and exacerbated by life stress, age, hormonal changes and other factors.

Psilocybin in the future – harm reduction is key

I’m my own facilitator in that space. So it might be different. I probably would make more of an effort if I had someone that was beside me. The Shoemaker doesn’t always have the best shoes.

Participant 10

To conclude this section of our findings, we present the insights and advice from our research participants. These reflections encapsulate what they wished they had known before embarking on their journey and what they hope to impart to others considering a similar path.

• A gradual and mindful approach for women with PMDD is strongly advocated. This point was especially reiterated by women who had a challenging time with larger doses and found them hard to understand, which did not make them feel well afterwards. Instead, there appears to be much benefit from a ‘slow unfolding of insights about yourself, and the slow unfolding of understanding our trauma’ that is more gentle and subtle for those trying it and, crucially, those around them too.
• Prioritising understanding one’s holistic life context (family, stressors, relationships, triggers, etc.) and fostering love and joy before exploring the deeper shadow aspects with psychedelics, especially for women with PMDD, was suggested – viewing it as a tool to build own inner strength and deeper self-acceptance over time, not a quick fix (for those wanting to do larger doses).
• Seeking skilled and understanding practitioners familiar with trauma, PMDD, and emotional health, to manage potential life-changing effects effectively, to support a smoother landing back into the world and relationships.
• Being able to trust knowledgeable guides, particularly those with a nurturing feminine presence, as the right support can significantly impact the experience for those with PMDD. Without the right people supporting you ‘may potentially make things worse’. Support was deemed more helpful for larger doses, while not necessary for smaller ones. Participants referred to ceremonies not being held in careful hands as not uncommon.
• Concerns about access, the product’s safety, facilitation of the experience, overindulgence and reliance on external substances exist. As do the nuances of legislation and discrimination. These fears can add to the experience and are worth taking into account when researching and preparing a psilocybin experience.
• Conduct extensive online and literature research to gain confidence and guidance for your own exploration with psilocybin.

Discussion

This is my life’s work and I feel like there’s nothing better for PMDD, for trauma, for dissociative disorders, if it’s held in the right hands.

Participant 11

This study set out to discover how women with PMDD experienced using larger doses of psilocybin, and a complex and nuanced landscape was revealed among the small sample. The women interviewed largely turned to psilocybin due to symptom severity, after conventional treatments failed, their journeys marked by self-advocacy, meticulous symptom tracking, and distrust in the medical system.

The study highlights psilocybin as a potentially valuable component in the holistic management of PMDD, yet it emphasises that it is not a panacea. The findings suggest that psilocybin has the potential to offer significant symptom relief, including decreased suicidal thoughts, but more research is required to draw any conclusions on this. Those suffering from suicidal ideation should seek urgent medical advice.

People spoke of reduced emotional distress, healthier relationships with others and a deeper self-awareness, leading to a more compassionate relationship with oneself. However, the benefits of psilocybin were not uniform, not without some difficulty, and the large variability between factors such as dosage, frequency, timing of cycle and individual contexts underscores the importance of specific research.

An interesting finding was that smaller doses appeared significant for symptom mitigation, with less disruption to daily lives and less fear in the process overall. Larger doses, and a more intensive psychedelic journey, do appear to have transformative potential. Still, as the risk for more challenging experiences appears to be greater too, the need for a harm reduction approach, with specialised or trauma-informed support, is also higher. This is in addition to ensuring adequate time before and after journeys and preparation – which isn’t always possible for everyone.

For some participants, psilocybin facilitated a new understanding and acceptance of PMDD as a part of them, as opposed to a separate yet defining characteristic. This starkly contrasts some participants’ feelings of being ‘divided’ or fragmented. This shift in perspective supported a sense of agency over the recognition and management of symptoms previously felt confined to the ‘out of their control’ luteal phase and unmanageable.

Some felt that their PMDD was guiding them to identify specific areas in their lives that needed attention and improvement. The ability of psilocybin as a tool to foster a more cohesive, integrated sense of self, along with the accompanying sense of agency over their condition, highlights a promising area for further exploration and research. Some felt that their PMDD was guiding them to identify specific areas in their lives that needed attention and improvement.

Limitations

The study’s limitations include its exploratory nature and broad scope, due to the lack of existing research, which may affect the specificity of its findings. Being independent and not institutionally or commercially funded, this study aimed to inspire future research. Funding is needed for future studies, which could benefit from controlled environments and focused variables, to understand the specific PMDD-psilocybin relationship better.

The self-selecting recruitment method via social media could bias results towards positive outcomes, although difficult times and adverse experiences were also reported. The sample size was small yet demographically diverse. Data, being self-reported and retrospective, may carry memory biases. However, the study’s interpretative approach was valuable in understanding the personal meanings women with PMDD derived from their experiences.

Future Directions

Whilst the findings of this exploratory research are compelling, more comprehensive, evidence-based research is needed to determine any causal links between psilocybin and symptom mitigation, particularly diminished suicide ideation. Such research should consider the complex interplay of physiological, psychological, and cultural factors in the intersection of PMDD and psilocybin, including the timing of the menstrual cycle.

There is a need for a balanced and nuanced narrative in the psychedelic space to reflect the reality of experiences and support others moving forward to avoid disappointment and feelings of self-blame when things don’t go as expected. There is no one ‘right way’, and individuals will explore a variety of paths relevant to their unique circumstances. Participants regarded a holistic, patient-centred and empathetic approach in health systems as critical to support this.

Many women who were microdosing also contacted us at the start of the project, claiming its success as a treatment, and it was also a widespread topic on Reddit. Research on this is underway, surveying women with PMDD who are microdosing, led by Suresh Muthukumaraswamy at the University of Auckland.

Aside from delving more deeply into psilocybin for PMDD, many communities would also benefit from research in other areas, such as PCOS, endometriosis, perimenopause and menopause. Studying microdosing in these settings could also be very beneficial, as many women are already doing this, and there is reduced risk involved.

Acknowledgements

Special thanks are offered to Dr Grace Blest-Hopley (Hystelica), whose input was invaluable in developing the interview guide. Natasha Gukasyan and Sasha Narayan’s seminal case series on menstrual changes brought about by psychedelics was especially inspiring. Gratitude is also expressed to Rachel Sumner, Kate Godfred, Tina Williams, and Floris Wolswijk for their thoughts and advice in this exploratory research.

Eleanor Taylor privately invested in this research for personal reasons. She found psilocybin helpful in dealing with PMDD and wanted to generate conversation within the psychedelic research community, to inspire clinical research. But, most importantly, to help other women with PMDD, on the cusp of their own self-experimentation, to understand and find safe guidelines for its use. She lives in Lisbon, is a wife and mother and is the founder of a marketing and data consultancy business.

External references for PMDD and Psychedelics

All resources available on Blossom are directly linked on this topic page. Find even more background about this topic with these external references.

1. What is PMDD? Premenstrual Dysphoric Disorder. | IAPMD. (n.d.). IAPMD. https://iapmd.org/about-pmdd

2. ICD-11 for Mortality and Morbidity Statistics. (n.d.). https://icd.who.int/browse11/l-m/en#

3. Premenstrual Dysphoric Disorder (PMDD). (2023, September 3). PsychDB. https://www.psychdb.com/mood/pmdd

4. Eisenlohr-Moul, T., Divine, M., Schmalenberger, K., Murphy, L., Buchert, B., Wagner-Schuman, M., … & Ross, J. (2022). Prevalence of lifetime self-injurious thoughts and behaviors in a global sample of 599 patients reporting prospectively confirmed diagnosis with premenstrual dysphoric disorder. BMC psychiatry, 22(1), 199. https://doi.org/10.1186/s12888-022-03851-0

5. Epperson, C. N., Steiner, M., Hartlage, S. A., Eriksson, E., Schmidt, P. J., Jones, I., & Yonkers, K. A. (2012). Premenstrual dysphoric disorder: evidence for a new category for DSM-5. American Journal of Psychiatry, 169(5), 465-475. https://doi.org/10.1176/appi.ajp.2012.11081302

6. Yonkers, K. A., O’Brien, P. S., & Eriksson, E. (2008). Premenstrual syndrome. The Lancet, 371(9619), 1200-1210. https://doi.org/10.1016/S0140-6736(08)60527-9

7. Osborn, E., Wittkowski, A., Brooks, J., Briggs, P. E., & O’Brien, P. S. (2020). Women’s experiences of receiving a diagnosis of premenstrual dysphoric disorder: a qualitative investigation. BMC women’s health, 20, 1-15. https://doi.org/10.1186/s12905-020-01100-8

8. Steiner, M., Macdougall, M., & Brown, E. (2003). The premenstrual symptoms screening tool (PSST) for clinicians. Archives of Women’s Mental Health, 6, 203-209. https://doi.org/10.1007/s00737-003-0018-4

9. Hantsoo, L., Sajid, H., Murphy, L., Buchert, B., Barone, J., Raja, S., & Eisenlohr-Moul, T. (2022). Patient experiences of health care providers in premenstrual dysphoric disorder: examining the role of provider specialty. Journal of Women’s Health, 31(1), 100-109. https://doi.org/10.1089/jwh.2020.8797

10. Kulkarni, J., Leyden, O., Gavrilidis, E., Thew, C., & Thomas, E. H. (2022). The prevalence of early life trauma in premenstrual dysphoric disorder (PMDD). Psychiatry research, 308, 114381. https://doi.org/10.1016/j.psychres.2021.114381

11. Wittchen, H. U., Perkonigg, A., & Pfister, H. (2003). Trauma and PTSD–An overlooked pathogenic pathway for Premenstrual Dysphoric Disorder?. Archives of Women’s Mental Health, 6, 293-297. https://doi.org/10.1007/s00737-003-0028-2

12. Sex hormone-sensitive gene complex linked to premenstrual mood disorder. (2017, January 17). ScienceDaily. https://www.sciencedaily.com/releases/2017/01/170103084608.htm

13. Understanding Premenstrual dysphoric Disorder. (n.d.). https://swlondoner.shorthandstories.com/understanding-premenstrual-dysphoric-disorder/index.html

14. https://www.reddit.com/r/PMDD/

15. https://www.reddit.com/r/PsychedelicWomen/

16. Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative research in sport, exercise and health, 11(4), 589-597. https://doi.org/10.1080/2159676X.2019.1628806

17. Grey, J. A., & McNaughton, N. (1982). The neuropsychology of anxiety. An enquiry into the functions of the septo-hippocampal system. Oxford Psychology Series. Oxford University Press.

18. Kleinstäuber, M., Schmelzer, K., Ditzen, B., Andersson, G., Hiller, W., & Weise, C. (2016). Psychosocial profile of women with premenstrual syndrome and healthy controls: a comparative study. International journal of behavioral medicine, 23, 752-763. https://doi.org/10.1007/s12529-016-9564-9

19. Williams, T. (2023, March 30). Psilocybin and PMDD — the woman in the basement. The Woman in the Basement. https://www.womaninthebasement.com/pmddblog-1/menstrual-mushrooms

20. Kim, D. R., Gyulai, L., Freeman, E. W., Morrison, M. F., Baldassano, C., & Dube, B. (2004). Premenstrual dysphoric disorder and psychiatric co-morbidity. Archives of Women’s Mental Health, 7, 37-47. https://doi.org/10.1007/s00737-003-0027-3