Pioneering research highlights the potential for treating the symptoms of Premenstrual Dysphoric Disorder (PMDD).
Written by Eleanor Taylor
After the birth of my son I was diagnosed with PMDD. Thanks to my therapist my diagnosis was unusually swift, it typically takes more than a decade to be diagnosed[1]. If you’ve never heard of it, PMDD is a hormone-based mood disorder with symptoms arising during the luteal phase of the menstrual cycle (just before menstruation) and leaving as menstruation begins. It affects an estimated 31 million women worldwide[2].
For me it manifested as monthly bouts of despondency and despair so deep that I withdrew from the world, considered leaving my husband and even contemplated taking my own life. Every. Single. Month.
I religiously tracked my cycle and experimented constantly. I found sleep to be a huge contributing factor to my symptoms, I still don’t drink caffeine and rarely alcohol. I’m lucky that I have my own business which has allowed me to work around my cycle; limiting my interactions with clients during the run up to my period.
Self Experimentation
I wanted to experiment with psychedelics but my plans to join a retreat were scuppered by covid. Not to be dissuaded I read up on how I might deliver myself a “therapeutic” dose. In 2021 I took 3 grams of dried golden teacher magic mushrooms, supported by my husband, who sat for me. I took the mushrooms during my “hell week” before my period (I was very happy to lose one of those days). That month I had the worst symptoms I’d ever had. But, after that my symptoms all but disappeared. Since then I’ve taken regular doses, every 4-6 months and my PMDD symptoms have not come back.
Sponsoring Exploratory Research
Of course I was fascinated, I started to research, lurking around in forums to see if other women had experienced anything similar. I even interviewed a couple of women and read some research papers. There was nothing coming out of universities on PMDD and zero mentions of menstrual health in any Psychedelic Research. I started to think about doing some more formal research myself. Then, serendipitously, I met Alana Cookman, who is conducting research on PMDD and narrative as part of her PhD in Organisational Health. She agreed to work with me.
My objective in sponsoring this independent research was to understand whether other women had experienced something similar to me, and to see if any advice could be offered to other women in the immediate term. And I wanted to inspire future research, not just for PMDD but for other menstrual conditions.
Since this topic had no existing research whatsoever, Alana recommended an exploratory approach; we met with numerous researchers, journalists and specialists to build up the basis of knowledge.
Psilocybin and PMDD
The exploratory research includes a light literature review including some possible theories for why psilocybin might improve PMDD symptoms, I summarise these below:
Psilocybin’s impact on serotonin receptors [3] could help manage mood-related symptoms.
Enhanced neuroplasticity from psychedelics [4] may help in changing negative thought patterns associated with PMDD.
Natalie Gukasyan and Sasha Narayan [5]. present a hypothesis that the changes in menstrual health could be a result of psilocybin’s action on the HPG axis; controlling hormone regulation.
PMDD is associated with higher incidence of early life trauma [6]. Psilocybin is showing promise as a trauma treatment [7].
Psychedelics impact on epigenetics is already being explored[8]. There is evidence of altered gene expression in PMDD patients, therefore this might present another avenue of exploration.
Psilocybin appears to have some potential in regulating inflammatory pathways [9]. Women with PMDD can have a higher level of chronic inflammation at the cellular level.
Semi-structured, in depth interviews
The participants for the study were recruited from online forums, with an invitation for women with a PMDD diagnosis who had already experimented with moderate to large doses of psilocybin mushrooms. If they met the criteria they were invited to be interviewed via online video.
Listening to the testimony of these women was emotional, I cried for almost every one. It was humbling to listen to their accounts of PMDD, the despair, the rage, the feeling of being two different people at different times, the total lack of agency over their reactions to the world. PMDD impacts their relationships, their ability to work and most crucially, their feelings towards themselves. We had over 30 women raise their hands, but finally only 11 were able to commit, I wonder if this drop-out was partly due to the pathology of the disorder itself.
Findings
The interviews gathered a huge amount of rich data. The thematic analysis picked up on the themes and patterns across the experiences the women had, one core finding was just how unique and personal these journeys are.
I strongly recommend reading Alana’s write-up of her findings [10]. Here I highlight the primary insights which I, personally, took from the research:
Need for Clinical Research: Almost all of the women interviewed found their symptoms were reduced after taking psilocybin. This shows great promise as an avenue for research. But, I must mention the selection bias involved in research like this, those women who tried psilocybin and didn’t find it helpful are much less likely to have raised a hand to be interviewed.
Importance of Starting Low, Going Slow: Moderate doses were associated with 1 to 3 months of relief from symptoms and an ability to “get on with life”. Women with PMDD are naturally more sensitive and many of the women interviewed shared their challenging experiences. This all supports the idea that starting with low doses and creeping up slowly is much the best approach.
Support Required For Self-Experimentation: Many of the women interviewed had ventured into this journey entirely without support, certainly not “psychedelic therapy” as we have come to understand it. This trend of independent, self-experimentation is unlikely to go away. Women often didn’t know exactly how much they had taken. We need guidelines, safety protocols and other materials to support women on their personal journeys in an accessible, low cost way.
Bias Towards Prior Experience: Almost everyone interviewed had some prior experience with psychedelics, often as teenagers, thus had enough confidence to use themselves as a guinea-pig. What does that mean for women who have never tried it before? Will they wait decades for psilocybin-based medication to be approved? We are talking about years of impact on their quality of life.
Need for Experienced Support for Larger Doses: When combined with deeper integration, preparation, support and personal research, larger doses showed the potential for more transformative effects. Several women found that they had been able to reframe their PMDD as a “gift” – their body’s way of telling them what they needed to work on or change in their lives. This level of transformation is obviously incredibly promising, hopeful and almost unbelievable to women with PMDD, but one must stress that larger doses also present risks. Even though most had experimented alone, every woman interviewed recommended against embarking on this voyage without an experienced guide, and one with experience in PMDD would be ideal.
Importance of Community: One common theme that cropped up in the interviews and in the write-up is the importance of community. Feeling seen and heard can be life changing, especially for those with PMDD who often feel isolated and ashamed. Finding community within the psychedelic space, PMDD space or, where possible, combining both, offers a huge potential for support and healing.
More and more women with PMDD will lean into psychedelics to support their symptoms, we are not going to get ahead of this snowball.
What they need are freely available, accessible protocols and guides for self experimentation to help them to mitigate the risks. They need community, safe sources to acquire the psychedelics and ideally PMDD informed guides to help them to process and integrate.
The Future
I am delighted to report that there is more pre-clinical research on the horizon. There are a few surveys in the pipeline looking specifically at microdosing for PMDD and microdosing for menstrual health as a whole. These steps are promising and I wholeheartedly celebrate advances to support women’s health.
I’d also like to make a call for more therapists, facilitators and doctors specialising in PMDD to educate themselves on the role psychedelics could play in supporting their patients. I encourage you to start by reading Alana’s research paper[10]. I would love to see accessible, low cost support for those who are considering self-experimentation – helping them to avoid risks and find relief safely.
If you have any questions or would like to discuss in more detail, please don’t hesitate to get in touch.
References
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.
Thomas J. Reilly, Siya Patel, Ijeoma C. Unachukwu, Clare-Louise Knox, Claire A. Wilson, Michael C. Craig, Katja M. Schmalenberger, Tory A. Eisenlohr-Moul, Alexis E. Cullen, (2024) The prevalence of premenstrual dysphoric disorder: Systematic review and meta-analysis, Journal of Affective Disorders, Volume 349, 534-540.
Vollenweider, F. X., & Kometer, M. (2010). The neurobiology of psychedelic drugs: implications for the treatment of mood disorders. Nature Reviews Neuroscience, 11(9), 642-651.
Ly, C., Greb, A. C., Cameron, L. P., Wong, J. M., Barragan, E. V., Wilson, P. C., … & Olson, D. E. (2018). Psychedelics promote structural and functional neural plasticity. Cell reports, 23(11), 3170-3182.
Gukasyan, N., & Narayan, S. K. (2022). Menstrual changes and reversal of Amenorrhea induced by classic psychedelics: A case series. Journal of psychoactive drugs, 1-6.
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.
Bird, C. I., Modlin, N. L., & Rucker, J. J. (2021). Psilocybin and MDMA for the treatment of trauma-related psychopathology. International Review of Psychiatry, 33(3), 229-249.
Sheng, J. A., Bales, N. J., Myers, S. A., Bautista, A. I., Roueinfar, M., Hale, T. M., & Handa, R. J. (2021). The hypothalamic-pituitary-adrenal axis: development, programming actions of hormones, and maternal-fetal interactions. Frontiers in behavioral neuroscience, 14, 601939.
Burmester, D. R., Madsen, M. K., Szabo, A., Aripaka, S. S., Stenbæk, D. S., Frokjaer, V. G., … & Fisher, P. M. (2023). Subacute effects of a single dose of psilocybin on biomarkers of inflammation in healthy humans: An open-label preliminary investigation. Comprehensive psychoneuroendocrinology, 13, 100163.
Cookman, A (2024), An Exploration of Psilocybin use in women with Premenstrual Dysphoric Disorder (PMDD)