Harm Reduction Guide for Female Biology
Psychedelic harm reduction, the menstrual cycle & related conditions
Harm reduction is an evidence based, public health approach designed to reduce the potential negative effects of drug use. Harm reduction is applicable to both legal and illegal drugs and seeks to educate in an effort to reduce harm. This guide covers psychedelic harm reduction for female biology and related conditions.
The basics of set and setting are well-documented within the psychedelic community, but there is limited discussion regarding the menstrual cycle and how it may interact with the process. In this guide, we’ll cover psychedelic harm reduction in general and include female specific considerations for the menstrual cycle and related conditions.
Information will be updated regularly based on feedback from the community and available research. For additions or recommendations please comment below or email us directly at info@dysphoricproject.org. We value your input on this psychedelic group project.
This guide is intended for educational purposes, but it cannot and should not replace one’s intuition about what is right for them. Psychedelics are unique substances and everyone experiences them differently. Utilizing discernment and intuition about the right course of action reduces harm in ways that this guide cannot.
This guide focuses on perceptual doses of classical psychedelics including psilocybin, ayahuasca, LSD, DMT, mescaline, peyote etc. Microdosing is covered here.
“After having personally conducted over the last fifty years more than four thousand psychedelic sessions, I have developed great awe and respect for these compounds and their enormous potential, both positive and negative. They are powerful tools and, like any tool, they can be used skillfully, inept, or destructively. The result will be critically dependent on the set and setting.” - Stanislav Grof
DISCLAIMER: This guide is not medical advice. Psychedelics may not be right for everyone. Please do further research and consider individual risk factors before consuming them. Psychedelics are illegal substances in some areas and we do not encourage or condone their use where it is against the law. However, we accept that illegal drug use occurs and believe that offering responsible harm reduction information is imperative to enhance safety and reduce harm. We believe harm reduction is achieved through education and a personal commitment to responsible use.
Contents
Harm Reduction 101
General psychedelic harm reduction
Timing
Menstrual cycle phase
Set
Mindset considerations
Setting
Physical environment
Dose
Amount of substance and subjective effects
Integration
Work done afterwards to integrate a psychedelic experience
Additional Resources
Links to reputable sources for additional harm reduction information
Frequently Asked Questions
FAQs related to sourcing and negative experiences
Harm Reduction 101
Set and setting are well known terms in the underground psychedelic community and refer to the suggestive nature of psychedelics. The influence of mindset and physical environment, or setting, can play a major role in psychedelic experiences and be the difference between a pleasant, euphoric experience and a challenging experience, otherwise known as a bad trip.
Bad trips are not inherently bad, rather the term implies that the experience was psychologically challenging. That can mean working through traumatic memories one is not ready to handle psychologically, or a physical environment that is not conducive to a positive experience such as a crowded party where there is little to no control over the environment.
While there is no surefire method to prevent a negative experience, knowledge and education can prevent negative experiences that may result from improper set and settings.
Health Conditions
Consulting with a qualified medical professional regarding underlying health conditions prior to consuming psychedelics is highly recommended. If qualified healthcare is not accessible, research on individual health conditions and psychedelic use is highly recommended.
Interactions with Medication
Some medications such as SSRIs may be contraindicated with psychedelics. Qualified medical advice should be consulted. If qualified healthcare is not accessible, research on potential interactions with psychedelics is highly recommended.
Menstrual Cycle Timing
Timing of the menstrual cycle may be an important factor in the psychedelic process for some women. Fluctuating ovarian hormones such as estrogen and progesterone may interact with the psychedelic process making timing a potential consideration, especially for women with menstrual related conditions.
Research on psychedelics and the menstrual cycle is extremely limited. The anecdotes listed in this section will be revised over time as more research is made available.
Gender differences related to serotonergic drugs have been reported
Fluctuating ovarian hormones may impact the serotonin reuptake process, a key biological target in psychedelic medicine.
Classical psychedelics such as psilocybin, ayahuasca, DMT, LSD, and peyote are believed to produce their psychoactive and euphoric effects by interacting with the serotonin system.
Women with menstrual related conditions such as polycystic ovarian syndrome (PCOS), endometriosis (ENDO), premenstrual dysphoric disorder (PMDD), premenstrual exacerbation of underlying conditions (PME) or menopausal related conditions should consider how menstrual cycle phase and related symptoms may affect a psychedelic experience.
Irregular periods are not uncommon. Some women, especially those with PCOS or peri-menopause, may have irregular periods making timing difficult to address. If that is the case, one could exercise caution with dose and be mindful of any symptoms prior to consuming psychedelics.
Important Considerations for Each Menstrual Cycle Phase:
Menstruation
The first day of the menstrual cycle is when a women begins to bleed, also known as menstruation or menses. Changing tampons, pads or menstrual cups while under the influence may impact the psychedelic experience, or trip.
For some, this can be a positive, transformational experience:
"I have had some really positive experiences taking mushrooms while on my bleed. It enables me to go deeper with my bleed and release on a deeper level, as well as help with being able to embody a restful somatic exploration and ritual space.”
Another user on Reddit wrote: "For me, when I go to the bathroom on a trip to change my pad/tampon/cup, I usually feel hyper-connected with my biology and femininity, and it seems even more normal than usual."
Hystelica, Taking Psychedelics While Menstruating - Is It Good Idea?
Despite the potential for positive experiences, dealing with menstrual blood during a psychedelic experience may be challenging for some.
Because of cultural stigma and religious beliefs related to menstruation in various cultures some women may hold negative belief patterns and shame regarding menstruation.
Psychedelics have the potential to draw attention to negative belief systems and confronting menstruation during a psychedelic experience may be challenging for some women.
Heavy bleeding, cramps and endometriosis should be considered because of the potential for psychedelics to exacerbate or draw attention to these symptoms.
The physical environment, or setting of a psychedelic experience or trip, should accommodate the requirements that make an individual feel most comfortable if they choose to consume during this time.
Shamanism
For retreat settings that involve shamanism, it’s important to ask prior to the experience if menstruation is a problem. Some shamans may refuse to work with menstruating women.
The practice of excluding bleeding women from psychedelic ceremony may seem misogynistic, but in some indigenous cultures menstruation is associated with spiritual and energetic power. It is sometimes believed that a menstruating woman can disrupt the shaman’s ability to work with the energy of the group.
Before booking a retreat or ceremony, it’s important to ask if menstruation is a problem to prevent unexpected cancellations:
“Competing energies, among various traditional beliefs about the women's cycle, mean some psychedelic guides, healers and retreat canters may advise their participants to avoid ceremonies when menstruating. I actually remember myself, being on a plant-medicine pilgrimage, and, despite her paying almost four figures for the healings, the shaman refused to let a woman participate in the ceremonies because she was bleeding.”
Hystelica, Taking Psychedelics While Menstruating - Is It Good Idea?
Follicular Phase
The follicular phase is marked by rising estrogen levels and lasts until ovulation. This phase of the cycle may be ideal for women with premenstrual dysphoric disorder (PMDD) or premenstrual exacerbation (PME) because they have better control over mindset, an important consideration we will cover in a later section.
If there are concerns about tripping while symptomatic, the follicular phase may be a better choice for PMDD or PME until the individual is more comfortable and familiar with the psychedelic experience.
Negative reports of tripping during the luteal phase for women with PMDD is reported in a study conducted by Cookman.
Luteal Phase
The luteal phase starts after ovulation, lasts until menstruation and is marked by rising progesterone levels. This is the symptomatic window for women with PMDD or PME.
Dose may need to be adjusted during this phase for women with PMDD or PME.
Based on a recent study, women with PMDD may have an increase in SERT density during the luteal phase.
SERT density is believed to be an important component of the psychedelic process and may increase the bioavailability of serotonergic psychedelics.
Anecdotes from the PMDD community tend to agree that reducing dose during the luteal phase is wise: “As an Ayahuasca guide, Colleen reduces her dose significantly during the luteal phase of her cycle noting that she doesn’t need as much to produce the same psychoactive effects.”
There’s no way to know the correct dose adjustment because of the lack of research, but a good rule of thumb is to start at 50% less than one would consume during the follicular phase and adjust from there.
Additional Reading on Timing
How Psychedelics Interact With Hormones Hystelica
Taking Psychedelics While Menstruating - Is It Good Idea? Hystelica
PMDD and SERT Density Menstrual Moods & Mushrooms
Set
Set refers to the mindset of the individual prior to consuming a psychedelic substance. Psychedelics are suggestive in nature, so mindset can play a big role in the experience:
“Hallucinogens amplify one's current state of mind, mood and outlook: a positive mindset will likely become more positive and a negative one will become even more negative. As a result, hallucinogens should generally be avoided during acutely stressful or negative periods of life. Users should be fully aware of the ways in which hallucinogens, particularly psychedelics, are able to force one to face their internal problems that they may not be psychologically prepared to handle at that time.”
Responsible Drug Use, psychonautwiki.org
Consuming psychedelics while symptomatic goes against the basic principle of set.
Some women with PMDD/PME consume psychedelics during the luteal phase to reduce symptoms.
Very little is known about how women with PMDD/PME may experience psychedelics differently than the general psychedelic population.
Additional Reading for Set:
Responsible Drug Use psychonautwiki.org
Scroll down the page to the “hallucinogens” section
Setting
Setting refers to the physical environment including location, other people and any other internal and environmental factors heavily influence psychedelic experiences:
Under all circumstances the individual should not drive, operate heavy machinery or be responsible for caring for children.
It’s important for the individual to have full control over their environment for the duration of the experience.
There shouldn’t be any responsibilities or outside factors that may disrupt the trip.
For therapeutic purposes, research suggests closed eye or blindfolded experiences are superior to open eye visual experiences.
Trip sitters or guides are recommended to watch over someone under the influence of psychedelics.
It is imperative that the individual is comfortable with and trusting of other people present during the trip due to the physical and emotional vulnerability associated with psychedelic states.
Additional Reading for Setting:
Responsible Drug Use psychonautwiki.org
Scroll down the page to the “hallucinogens” section
Dose
It’s vital to know the correct dose of the substance being consumed and the potential effects of that dose.
For perceptual mushroom doses, this is a general guide. Keep in mind that there are too many variables to list here, so more research is required to understand the potential effects of each dose level.
.5 - 1.5 dried grams - Mini dose
Beginner Level
Light effects with potential visuals, may enhance creativity, meditation etc. Some decrease in motor function and ability to perform normal tasks.
2-4 dried grams- Macro dose
Intermediate Level
Heavier effects with some visuals, decreased motor function and ability to perform normal tasks.
5 - 6 dried grams - Heroic dose
Experienced Level
Intense effects with visuals, potential loss of the sense of self, otherwise known as ego death. *Based on Cookman’s study, this dose range for PMDD may not be wise.
Dose varies widely based on the psychedelic substance and potency.
A detailed account of subjective effects based on dose is listed on psychonaut.wiki.org under the subheading “Experience Reports”.
Case studies on PMDD can be referenced here
It’s highly advisable for beginners to start with low doses while they are becoming acquainted with the psychedelic experience.
Additional Resources for Dose:
Responsible Drug Use psychonautwiki.org
Scroll down the page to the “hallucinogens” section
Psilocybin Mushrooms Erowid
Nostalgic site that offers a wealth of in depth content related to psychedelics
r/PsychedelicWomen Reddit
Subreddit for female psychedelic users
r/psilocybintherapy Reddit
Subreddit for psilocybin therapy
r/psilocybinmushrooms Reddit
Subreddit for psilocybin mushrooms
Integration
Integration therapy is the process of working through insights gained from altered states of consciousness to foster lasting, positive change. If one is seeking the therapeutic benefits of psychedelics, integration is highly recommended.
The vast majority of psychedelic research for mental health includes some form of therapy following the experience to produce lasting effects.
Psychedelic integration therapy can take many forms including psychotherapy, talk therapy, group therapy etc.
Integration is typically referred to in the context of a psychedelic experience, but for optimal therapeutic potential, integrating mental health experiences like PMDD or PME may improve therapeutic outcomes.
If therapy is inaccessible, creative outlets like writing, painting, or storytelling may be helpful for integrating psychedelic experiences.
Talking with others in the psychedelic community can help as well.
For PMDD or PME, the
DysphoricProject offers a free peer-support community. You can RSVP here.
Additional Resources for Integration:
For PMDD | PME
info@dysphoricproject.org
https://www.reddit.com/r/PsychedelicWomen/
Additional Resources
Dysphoric Project Peer-Support Community
The Dysphoric Project offers a free peer-support community for women with premenstrual conditions. You can RSVP here to receive an invite to the private group.
Fireside Project
The Fireside Project is a volunteer supported hotline for people experiencing a bad trip. This is an important resource to have on hand for inexperienced psychedelic users and new trip sitters or guides.
Psychonaut Wiki
psychonautwiki.org was started by Josie Kins over 10 years ago and is the most comprehensive website for psychedelic harm reduction. Josie’s YouTube channel is an additional source for the subjective effects of psychedelics.
Erowid
Erowid is a nostalgic site that offers a wealth of in depth content related to psychedelics.
Reddit
Reddit is a popular platform for psychedelic users of all types. The following subreddits may help with research and support:
https://www.reddit.com/r/PsychedelicWomen/
https://www.reddit.com/r/PsilocybinTherapy/
https://www.reddit.com/r/PsilocybinMushrooms/
https://www.reddit.com/r/Psychonaut/
Frequently Asked Questions
FAQ: How can I source psychedelics safely?
The safest way to source psychedelics outside of medical systems is to grow psilocybin mushrooms. The next safest option is to purchase psilocybin mushrooms from a trusted source that grows them. Purchasing drugs online or from an untrustworthy source has inherent risks and should be avoided.
For free advice on growing psilocybin mushrooms:
https://www.reddit.com/r/psilocybingrowers/
FAQ: How can I avoid a bad trip?
While there is no surefire way to prevent a bad trip, proper set, setting and dose principles can significantly reduce the chance of having a negative experience.
Challenging or negative experiences are often the result of psychological resistance. To navigate or prevent a negative experience one should try to surrender to it rather than attempting to control it or escape from it.
If psychological surrender is possible, there are often valuable insights just around the corner.
“If one decides to terminate the trip, benzodiazepines and other sedatives such as some antipsychotics can be considered analogous to an "eject button" of a downhill-headed or extensively long trip. These substances tend to be very effective tools in preventing panic attacks, paranoia, and possible traumatic experiences.
However, experienced users generally advise trying to wait out difficult parts of a trip if possible. Challenging moments are often temporary and can turn out to be catalysts for the greatest learning experiences.”
Responsible Drug Use, psychonautwiki.org
If you’ve made it this far, consider becoming a free or paid subscriber to support harm reduction outreach and research advocacy for psychedelics and women’s health.