Emily's Microdosing Protocol
Intentional dosing for premenstrual dysphoria
FOR RESEARCHERS: This case study is also transcribed as a semi-structured interview here.
TW: Before we get into Emily’s story, this article references suicidal ideation and may be triggering for some readers. Please proceed with caution if you are having thoughts of self-harm or wish to avoid this type of content. BIG hugs.
Please also see our MICRODOSING HARM REDUCTION GUIDE for female biology.
RESOURCES FOR THOUGHTS OF SELF-HARM
Call or text 988
Chat at 988lifeline.org
Connect with a trained crisis counselor. 988 is confidential, free, and available 24/7/365.
Visit the 988 Suicide and Crisis Lifeline for more information at 988lifeline.org
When I asked Emily how she came across microdosing psilocybin as a treatment option, her response was brilliant:
“I’m something like a shoe maker that didn’t have the right shoes.”
Emily has worked as a plant medicine facilitator and guide for the past 12 years, and has been microdosing for PMDD for over a year now after struggling with intense premenstrual symptoms. Guiding others through altered states of consciousness may be Emily’s occupation but she found herself battling with her own mental health and began seeking care for premenstrual dysphoric disorder, or PMDD.
While most women do not experience intense mood disruptions in the one to two weeks before their period starts, the luteal phase of Emily’s menstrual cycle manifested into life disrupting depression, hopelessness, suicidal ideation, anger, rage and anxiety.
Premenstrual Dysphoric Disorder, or PMDD, affects an estimated 3-9% of reproductive aged women. Symptoms may include heightened sensory sensitivity, dissociation, severe depression, suicidal ideation, severe anxiety, and emotional lability. Symptoms present in the luteal phase of the menstrual cycle and are relieved within a few days of starting the period.
Continuity of Care
After seeking help from numerous healthcare providers, Emily received a prescription for finasteride, a 5-alpha reductase inhibitor that is typically prescribed to treat male pattern baldness. Research on finasteride for PMDD is still in early stages, but Emily received an off label prescription to treat her symptoms.
“Before finasteride I was at a 0 during the luteal phase, with finasteride I was at a 3-6.”
Saw Palmetto is a supplement that may work in a similar fashion to finasteride. As with any prescription or natural supplement it’s important to understand the potential side-effects and interactions.
Emily found partial relief from PMDD symptoms with Finasteride, especially with the suicidal ideation, a dangerous and common symptom of PMDD. The doctor she was working with at the time was supportive and knowledgeable about this treatment option. When her doctor’s office closed, however, Emily struggled to find a new provider that would prescribe finasteride at the dose that was working for her.
Women in the PMDD community often struggle for years to find adequate treatment options and knowledgeable healthcare providers. Because of the lack of options, continuity of care can be a major problem for the PMDD community.
A recent analysis of PMDD experiences found that navigating the healthcare system with PMDD is dependent upon the patient’s ability to navigate the system and advocate for themselves:
“Participant experiences demonstrated that much of the diagnostic and treatment processes were burdened on the patient, and that successful navigation within the healthcare system was dependent on high levels of self-advocacy.”
Exploring diagnosis and treatment of premenstrual dysphoric disorder in the U.S. healthcare system: a qualitative investigation - BMC Women’s Health
Emily is an independent researcher and knows how to self-advocate for her own treatments. The more I interact with women in this community, the more I’m learning that we tend to embody researcher characteristics to survive in an oftentimes inadequate healthcare system.
Emily’s Microdosing Journey
While finasteride helped and Emily was able to continue this treatment after numerous consultations with her new provider, she was still struggling with chronic premenstrual symptoms.
After reading testimonials from other women with PMDD, she decided that microdosing psilocybin mushrooms may help.
“I started at 200 milligrams, but due to the sensitivity I kept lowering my dose. Now I take 50 milligrams and that’s the sweet spot for me. It would have been helpful to know that I didn’t need as much when I first started.”
Emily contributes her sensitivity and subsequent dose adjustment to both PMDD and her work with higher doses of psilocybin and ayahuasca in combination. Heightened sensitivity to psychedelics is not uncommon in women with PMDD even without prior work with higher doses:
To learn more about the potential increase in psychedelic bioavailability and sensitivity for women with PMDD, check out Menstrual Cycles and Serotonin: Implications for Psychedelic Research, and DMT: The P()ssy Molecule.
Microdosing Protocol
Everyone experiences PMDD differently and treatment approaches vary widely. Psychedelics are similar because no two people experience the effects the same way. For Emily, her protocol is individually tailored to her unique needs and is informed by consistent documentation over the course of 12 months.
Emily’s approach to developing her own protocol is a wise one rooted in self-observation, self-awareness, and education on psychedelic medicines:
DOSE
50 milligrams of psilocybin mushrooms. Increases dose up to 200 milligrams if required.
TIMING
After ovulation, waits 7 days then doses every day until starting her period. If symptoms start prior to her normal symptomatic window - 7 days after ovulation until her period starts - she doses as needed. Tries to focus on the normal window if possible.
RITUAL
Doses with food and focuses on intentional eating. Combines movement and exercise after dosing. Focuses on communicating with the mushroom and closes each day with gratitude journaling.
Results
“Microdosing makes a huge difference, I can almost have a life during those weeks. After about 45 minutes, I feel like I can breathe again. Microdosing helps give me the energy for intense exercise that helps with symptoms, I may have 1 or 2 days at a 3 or 4, but I’m able to manage it because it doesn’t last as long as before. Microdosing helps to alleviate suicidal ideation. On the bad days it allows me to more easily exit the suicidal thought loop. With microdosing combined with finasteride, diet and exercise I’m at a 7-8 during luteal.”
Emily highlights the impact of ritual and intention combined with the microdose to help provide structure and routine to her life during the luteal phase.
Emily’s Recommendation for Others Considering Microdosing for PMDD
“Rather than wasting the time, do it over not doing it. If there are changes or adjustments that need to be made, they can be made later. There’s so little risk with a microdose and there’s so much benefit that can come from it – we’re really doing a disservice to ourselves [by living with untreated or undertreated PMDD].”
*Emily’s case study is also documented here as a semi-structured interview for researchers seeking more detailed information.
For more information on microdosing and PMDD, check out the following articles from Menstrual Moods & Mushrooms:
