An Exploration of Psilocybin use in Women with Premenstrual Dysphoric Disorder (PMDD)

Alana Cookman, January 2024

*This qualitative research was completed and the following article produced by Alana Cookman and Elenor Taylor. This was an independently funded exploratory research. Hystelica is proud to present the report here -

An Exploration of Psilocybin use in women with Premenstrual Dysphoric Disorder (PMDD)

Summary

This research explores the use of psilocybin in women with PMDD, a condition that has not yet been studied in psychedelic research. The findings suggest potential benefits but highlight the need for further targeted research. This could inform building nuanced and diverse narratives around psychedelic use for various health issues, supporting realistic and balanced public understanding and both clinical and underground practice.

Objective: The study aims to document the experiences of women with PMDD using large doses of psilocybin, to provide an initial step for future research around women’s health.

Methodology: Utilising an exploratory qualitative approach, the study involved semi-structured interviews with 11 participants from diverse demographics, recruited from online platforms. Ethical considerations were addressed, and data analysis involved thematic analysis.

Findings:

-  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; and

-  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.

Limitations: Small sample size and reliance on retrospective accounts limit the study's generalizability and subjective bias. Though the small sample was demographically diverse.

Recommendations for Future Research:

-  Understand the specific interplay between PMDD and psilocybin with targeted studies, considering the role and timing of the menstrual cycle beyond anecdotal evidence;

-  Prioritise minimising harm, risk, and access barriers, particularly for vulnerable women seeking urgent relief and those from underserved communities; and

-  Investigate the potential for microdosing psilocybin to improve the experience of symptoms of PMDD.

We wish to express a huge amount of gratitude to all of those who so courageously shared their challenging and inspiring experiences, and who continue on this path of discovery.

Introduction

This paper 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 paper will take the reader through the journey of the participants, combining their shared perspectives in the findings chapter. 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 Disorders1 (IAPMD) is a cyclical, hormone-based mood disorder. 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-52 (Diagnostic and Statistical Manual of Mental Disorders) as a depressive disorder, and was also recently included in the ICD-113 as an international diagnosis. 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 study that included 599 women with PMDD found that 34% have attempted suicide (Eisenlohr-Moul et al, 2022). Despite increased recognition and recent research efforts, PMDD remains relatively under-funded and under-researched, particularly outside the field of neuroendocrinology, exacerbating the lack of direct understanding of its aetiology (Epperson et al, 2012). Despite affecting an estimated 1 in 20 menstruating women (Yonkers et al, 2008) the median age to start PMDD symptoms is 15, and the median age to receive a diagnosis is 35 (Osborn & Brooks, 2020), with symptoms spanning 8.6 years, equating to one week per cycle over 450 cycles. For those experiencing symptoms from post-ovulation until menstruation this duration could double. Diagnosis relies on subjective diaries and symptom collection, with the most reliable method believed to be the Premenstrual Symptom Screening Tool (PSST) (Steiner et al, 2003). Unfortunately, widespread recognition and understanding of PMDD remains low in health systems and there is a clear gap across medical expertise (Hantsoo et al, 2022).

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 Greb 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 (Jayashri et al 2022) and links have been established between PMDD and post traumatic stress disorder (Wittchen et al, 2003). The well-documented potential of psilocybin in treating trauma-related mental health issues (Kulkarni et al., 2022) opens up a promising hypothetical area for exploration. 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 (NIH, 2017).
Finally, the anti-inflammatory effects of psilocybin have been studied in terms of regulating inflammatory pathways (Flanagen et al, 2018) and women with PMDD can have a higher level of chronic inflammation at the cellular level4, thus offering another potential therapeutic pathway.

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 https://www.reddit.com/r/PMDD/ subreddit and https://www.reddit.com/r/PsychedelicWomen/. 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 the Reddit page. Of these initial respondents, a sample of 11 participants followed up, met the inclusion criteria5 and were interviewed remotely, online. 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

This involved a thematic analysis process, adapted from Braun and Clarke's reflexive approach (Braun & Clarke, 2019). 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 chapter, 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 chapter 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.

Findings
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 to 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 (Gray and McNaughton, 2000): 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’). 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 (Kleinstäuber, 2016).

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 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 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 a number of 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, and books like ‘A Really Good Day’6 and resources like ‘The Woman in the Basement’7, fostered a sense of hope and agency. 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.

See Appendix, table 1: Dosage size, frequency, setting and timing in cycle declared by participants.

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 with 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 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 could not 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, which included a clean, comfortable 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 that 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 level of dose, as those with smaller doses would need less time for both preparation and aftercare.

Dosage & 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 really 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 on, as microcosms of the PMDD symptoms, too (Participant 9). Considerable time to ‘land’ and process learnings after the trip was also necessary for those doing more intensive journeys. Having profound internal shifts could potentially be unsettling when returning to external lives that remain unchanged. 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 were able to 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. When it came to the preferred timing in the menstrual cycle, the answers were varied; some women avoided the luteal phase due to sensitivity, physical load and fear of exacerbating symptoms and, interestingly, several women did not 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 really did need to be held in very supportive hands. These combined insights appear to 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 for those on a more intensive psychedelic journey - spoke of ‘flourishing’, being happy and grateful, and ‘being able to live their life’. 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 bi-polar, which should also be taken into account when experimenting with psilocybin (Kim et al, 2004).

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. And for others, they have stopped due to injury, location, or “not needing to do it right now”, and are still in the process of 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 a 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 not available 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 can 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, a 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 and 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, 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 of her behaviours on an intellectual level to a conscious effort and practice to implement lessons from it into her 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 broader relationship to self and 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, 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 that that 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, and 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 a even a sense of being is steeped in fear and shame (Participant 11), and 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 participant responses. That a call to acknowledge the uniqueness of individual experiences and to foster acceptance of the broad spectrum of human emotions was necessary in preventing 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 disorder.

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 that comes 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 that 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 did integrate - or make 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 close this section of the findings the words of advice, or what research participants wish they had known, or what they want to share with others thinking of going on this journey, are presented:

●  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. And participants referred to ceremonies not being held in careful hands as not uncommon;

●  Concerns about access, safety of product, facilitation of the experience, overindulgence and reliance on external substances do 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; and

●  Conduct extensive online and literature research to gain confidence and guidance for your own exploration with psilocybin.

Conclusion

‘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 potential 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 far more research is required to draw any conclusions on this. Those suffering with 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 for specific research.

An interesting finding was that smaller doses appeared to be 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, but 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 is in stark contrast to the feelings of being 'divided' or fragmented that some participants mentioned before. This shift in perspective supported a sense of agency over recognition and management of symptoms that were previously felt to be 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 better understand the specific PMDD-psilocybin relationship.

The self-selecting recruitment method via social media could bias results towards positive outcomes, although difficult times and adverse experiences aspects 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.

The Future

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 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. A holistic, patient-centred and empathetic approach in health systems was regarded as critical to support this by participants.

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, lead 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 the development of 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 your thoughts and advice in this exploratory research.

Conflict of Interest

There has been no institutional, private or public sector funding for this project, and no conflicts of interest to declare. Eleanor Taylor, a private citizen, sponsored the project with no financial motivations, only a personal interest.

Links

1 https://iapmd.org/about-pmdd
2 https://en.wikipedia.org/wiki/DSM-5
3 https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1526774088

4 https://swlondoner.shorthandstories.com/understanding-premenstrual-dysphoric-disorder/index.html
5 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.

6 https://www.penguinrandomhouse.com/books/545767/a-really-good-day-by-ayelet-waldman/ 7 https://www.womaninthebasement.com/pmddblog-1/menstrual-mushrooms

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