Is Cycle awareness missing in Psychedelic Therapy?

Where is the woman's body in psychedelic therapy?

I don't mean the part where someone asks if she's pregnant, or if shes ticking the contraception box on the intake form. I mean the actual body.
The one that cramps, bleeds, ovulates, crashes, swells, dissociates, softens, opens, shuts down, spirals, sleeps badly, feels everything, feels nothing, or suddenly feels like herself again for the first time in weeks.

The body that might be premenstrual, or postpartum, or quietly tipping into perimenopause or post -pause without knowing it. The bodies that might be on hormonal birth control because someone told her it would help, only for it to slowly hollow her out, when it was supposed to make her feel, full?

That body walks into a psychedelic therapy room, a faccilitated group circle and often is somehow treated as background information.

That seems strange to me. And the more I've sat with it, the stranger it gets, psychedelic exploration only made me more aware of the cyclical nature of being, and to exclude it, especially with the amount of women I have seen seeking psychedelic assisted treatments, we are missing a gap where better outcomes could be found.

In psychedelic spaces, we talk a lot about set and setting. The set is your, mindset- your intention, the music, your preparation, the room, the therapist, or faccilitator, the medicine, the dose, the integration. All of it matters. I'm not ever going to arguing with anyone who mentions the importance of that.

But I keep coming back to another word: state. Psychedelic treatments in any setting, will likely mention - the altered state, psychedelic treatments work in my opinion because they alter our state. Many of us, cyclical beings that are women, often experience a multitude of state changes in 4 weeks, on top of many others.
The nervous-system state. The hormonal state. The sleep-deprived state. The premenstrual state. The grief state. The "I'm technically fine but I can feel myself about to come apart" state.

If we're genuinely practising trauma-informed care, we have to be asking what's happening in the body. Not just the diagnosis. Not just the mind. But the body.

The Australian psychedelic landscape

I’m not a psychedelic therapist, but I was at the forefront of some opf the discussions when it was being legalised here. And Australia is in having its own moment right now. Since 1 July 2023, a few authorised psychiatrists have been able to prescribe MDMA for PTSD and psilocybine for treatment-resistant depression under the TGA's Authorised Prescriber pathway. These substances remain unapproved therapeutic goods, accessible only under specific conditions, through specific prescribers, with significant regulatory oversight. You have to meet eligibility criteria and have a buttload of money to access these treatments.

So we're not talking about wellness culture or ceremony spaces. We're talking about clinical frameworks. Screening. Safety. Eligibility. Ethics. Risk. Investment.

And if we're talking about risk, then we need to talk about women's hormones with more depth than "are you pregnant?" and "what contraception are you using?", and if not, please start it before we commence treatment. Because if the body matters enough to screen for pregnancy, it matters enough to ask about the cycle in my non- doctor/therapist opinion.
Some might tell you. well theres just not enough evidence, and I would say, thats just not good enough.

The menstrual cycle is not background noise, it’s a prominent experience for 50% of humanity

For some women, the cycle is a minor inconvenience - a few days of discomfort, a mood shift, some pain or heavy breasts. For others, for many I have spoken with, it's nothing like that. It can and has shaped mood, sleep, pain, energy, anxiety, cognition, libido, confidence, emotional regulation, sensory sensitivity, and the capacity to hold things together under pressure. Some women take their lives, because the the suffering is too immense.

This isn't about saying every woman is ruled by her hormones, or using the cycle to paint women as unstable or irrational, i;’m rather against those ideas, because its a part of how anyone exists. We've had quite enough of that narrative, thanks. But when someone notices clear and consistent changes across her cycle, month after month and year after year, those changes deserve to be taken seriously, before they are misdiagnosed as something else.

A woman might feel clear, articulate, open and resilient one week, then raw, exhausted, ashamed, dissociated or fatigued and close to collapse the next.
If that woman is preparing for psychedelic therapy or trauma processing, pretending that context doesn't matter isn't neutral, its a huge oversight in the treament of womens health, again.

What I kept hearing from women

When I founded the Australian Psychedelic Society Women's Group in 2023, one of the things that came up again and again was how inconsistent women's psychedelic experiences and the integration afterward could be. I myself was delighted in this shared lesson, together we were all realising, we were not alone. Many women would describe one session as profound, clear, connected, even life-changing. Then slide on into their Luteal phase the days following which completely changes how she may relate to the initial experience. Then later in another session, sometimes with the same medicine and similar intention, would feel completely different because, they had their medicine at a different phase of their cycle. This is not to say, each experience should be the same and its unlikely that they will always be the same, but when year ofter year, month after month, women would discuss how in luteal phase one might find the experiece more confusing, raw or dark in content even. Or harder to land, harder to explain, harder to integrate. Someone in ovulation may freely discuss the experience, feeling light and open to create art, take more walks in nature, or engage in social group integration more-so than someone in their luteal phase. And if theyre Peri menopausal? Well, hats off to you and that unpredictability.

Women in the group would ask the usual questions- was it the dose, the facilitator, the music, the trauma, the medicine? All valid, all likely to effect the experience.
But I kept noticing that another question wasn't being asked with the same seriousness: where was she in her cycle? Was she premenstrual, postpartum, in perimenopause? Had she recently started or stopped birth control? Did she have PMDD? Had she spent years being told her hormonal distress was "just anxiety" or "just being a woman" maybe she’d been diagnosed as bipolar after one episode 20 years ago?

We weren't saying hormones explain everything. We were asking why hormones weren't being considered at all and wanted more.

Community spaces often notice things before institutions do and it can be years before the research catches on.
But we see the gaps when we gather in groups. Women talk. They compare notes. They ask each other the questions they haven't always been asked by doctors, therapists, researchers, or facilitators.
And while that is not formal research, it is a signal. And when the same signal keeps appearing, it deserves a thoughtful response.
One I am still trying to formulate right now.

Psychedelic therapy doesn't happen outside the body

Psychedelic therapy asks a person to enter an altered state. It may intensify emotion, soften defences, bring memories closer to the surface, shift body awareness, open grief, or reveal material that's been buried for years. That's precisely why preparation matters, why integration matters, why the container matters.

So it follows that we'd want to know what hormonal state someone is in when they enter that container.

Current research doesn't give us a neat clinical chart by stating, "psilocybin works best on day 12" or "avoid MDMA on day 24." That would be far too simplistic and lacking the individual differences of the women seeking treatment. But it does point to a gap.
A 2025 paper on females in psychedelic research argues that ovarian hormone fluctuations remain insufficiently examined in current psychedelic research and clinical protocols, and that menstrual phase, estradiol, progesterone and hormonal status should be better incorporated into both research and practice.
A 2024 review on biological sex differences in psychedelic action highlights the interaction between estrogen and the serotonin system which matters because serotonin pathways are central to how most classic psychedelics work and it notes that studies often include both sexes without examining what those differences actually mean in practice. Unsurprising…

I understand that we cannot just make assumptions here, but the absence of researched peer reviewed evidence isn't proof that our hormones are irrelevant. Sometimes it just means no one has asked the question properly yet or cared enough?

The contraception problem

I have no answer, just thoughts. But pregnancy prevention in psychedelic treatment makes sense, absolutely. There isn't enough evidence to say MDMA or psilocybine are safe during pregnancy, and screening for pregnancy and discussing contraception is a reasonable safeguard.

Many psychedelic clinics ask that women are on hormonal contraception if they are not already, they need to start. and I get the risk to unborn children, but what about the risk to the individual?

For many women, I know hormonal birth control is genuinely helpful, when freely chosen it can be safe, beneficial. It can reduce pain, regulate bleeding, manage endometriosis, provide autonomy that nothing else does. None of that is up for debate.
But it's not the same experience in every body. Some women feel better on it. Some feel nothing much either way. Some feel like they've quietly disappeared from themselves, mood flattened, libido gone, a vague sense of not quite being present. Some, like myself and many others I imagine it can have serious physical health and mental health risks. I personally have a genetic disposition that means I shouldnt take certain oral contraceptive medications, something I only found out this year, but aleways knew due to my poor responnse to them, however had I sought psychedelic treatment in a clinic, may I have been made to go on them prior to my treatement at my detriment, if I had no proof that; “these medicines do not agree with my biology”.

This tells me, that some women are medically less suited to estrogen-containing contraception for reasons they may not even know about yet. RACGP notes that low-dose combined oral contraceptive use is associated with a twofold to threefold elevated risk of venous thromboembolism above baseline, and that inherited coagulopathies particularly Factor V Leiden - a mutation in how the blood in your body clogulates - are major non-modifiable risk factors. Their hereditary thrombophilia guidance also notes that routine genetic screening before prescribing a combined oral contraceptive is not currently standard practice, which means many women don't know their predispositions before they're prescribed the pill.

If a woman is being asked to start or change hormonal contraception specifically to access psychedelic treatment, that's worth more than a checkbox. It's worth asking whether they have had it before, and if it changed her mood, her sleep, her anxiety or how her body felt. Whether she has a family history of clots. Whether hormonal contraception of any kind has ever made her feel worse. Those aren't just throw away questions, they're part of a genuinely informed consent process.

When hormonal distress is misread

Most women know what it's like to be told "it's just hormones, Just learn to live with it”. Which sounds like an explanation, but it often functions as a conversation-ender, because, you’re a woman, its just part of it, right? Does anyone remember the hysteria era, the amount of women on sedatives or valium with a glass of wine to keep your sadness at bay propaganda of the generations before us? Keeping us quiet, numb and flattened was the answer.

Hormonal distress gets minimised. PMDD gets treated like a personality issue. Perimenopause gets mistaken for sudden anxiety or depression. Endometriosis pain gets filed under stress and poor diet. Our cyclical patterns go untracked and therefore unseen. Then the same woman arrives in a psychedelic space expected to be open, regulated, prepared, ready to surrender but nobody has asked what phase she's in or how her body has been behaving for the past two weeks.

If she becomes overwhelmed during the session, is she having a “bad trip?” She’s dissociated, terrified, flooded with grief, or unable to communicate or articulate?
Is that the medicine? The trauma? The setting? The cycle?
The answer might genuinely be all of those things at once. But without that being part of the conversation going in, a hormonally vulnerable state can get labelled as unsuitable for further therapy, having resistance, while a late-luteal crash can get called poor integration, and distress that needed contextualising gets spiritualised or pathologised instead.

A trauma-informed model needs to be sophisticated enough to hold all of that.

A cycle-aware lens is needed, not a rigid rulebook

I am not suggesting every woman should schedule her entire therapeutic life around her cycle. Some great work can be done when working with the phases of the cycle, sometimes getting to the deep stuff requires the dissasociation that the later luteal phase and altered state work will allow, accessing the darker shadowy places we are sometimes unable to access when we are all ovulationed up and feeling pretty. And awareness of these states and stages will allow you and your clients to use the cycle to your advantage.

There are some women don't notice much variation across the month. Some don't menstruate at all for what ever reason. Some are on long term contraceptives, or HRT, post-hysterectomy, menopausal, some may be on gender-affirming hormones, or living in bodies that don't fit neat reproductive categories. Being clear, is about asking better questions.

One useful reflective framework is the inner seasons model - it is not a medical protocol, just a language some people find helpful for noticing patterns they already feel.

• Inner Winter: the bleed phase.
  This phase can feel slow, raw, tender, inward. For some people it supports grief work, rest, and gentle integration. For others it's physically depleting and not a great time for deep or activating work.
  A useful question: would something still and nourishing feel better than something expansive right now?

• Inner Spring: the follicular phase.
  Energy returns, clarity tends to improve. Often a supportive time for intention-setting, preparation, and therapy that requires some emotional flexibility.
  Worth asking: is this clarity grounded, or am I moving fast because I feel better than I did last week?

• Inner Summer: ovulation.
  Can bring confidence, connection, openness, sensuality. Can feel supportive in therapeutic or ceremonial contexts. Can also tip into performance, people-pleasing, or mistaking social ease for genuine internal readiness.
  A consideration to: Am I connected to my core, or to how I want to be seen?

• Inner Autumn: the luteal phase.
  Can be intuitive and revealing. Can also be where irritability, grief, threat sensitivity, insomnia, despair, shutdown, rage, or dissociation become more pronounced, especially for those with PMDD, PME, trauma histories, or hormone sensitivity.
  Do I feel steady enough to meet what might rise, or would waiting give me a more stable foundation?

The point isn't to make the luteal phase something to fear or ovulation something to chase. It's just to notice what's already happening and working with it to your own comfort.

What better screening could look like

I am not saying that Practitioners don't need to become hormone specialists. But building curiosity about this into standard intake processes isn't a big ask especially when I know these treatments are chasing best outcomes in these early phases of Legal Clinical Psychedelic treatments.

• A hormone-aware intake might ask:

• Do you menstruate, or notice cyclical changes?

• Where are you in your cycle today, if relevant?

• Do you notice mood, sleep, pain, anxiety, or dissociation at certain times of the month?

• Have you experienced PMDD, PMS, endometriosis, PCOS, perimenopause, menopause, postpartum distress, or hormone sensitivity?

• Are you using hormonal contraception, an IUD, HRT, SSRIs, or gender-affirming hormones?

• Have you recently started, stopped, or changed any of these?

• Have hormones ever changed your mood, libido, migraines, sleep, or sense of self?

• Is there any personal or family history of blood clots or clotting conditions?

• Are there times in the month where deep therapy feels more possible or less safe?

This isn't about diagnosing outside your scope. It's about noticing patterns, documenting context, and referring when something needs more support than the current pathway provides. Its about seeing women.
However, red flags are still red flags : ongoing suicidality, severe dissociation, acute instability all need clinical attention regardless of where someone is in their cycle. Hormone-aware care isn't an alternative to safety screening its a small and necessary part of the holistic picture.

But lets not start excluding women

Women have already been excluded, under-studied, dismissed, and over-pathologised in medical systems. We know this. A hormone-aware model should not become another barrier to access, or another way of saying "women are too complicated for this." That's not the argument I am making here.

My argument is that women's bodies deserve frameworks and considerations by treating practitioners, sophisticated enough to actually include them, because thats what we are, sophisticated. A person's cycle is information, not a liability to their sucsess.
Their contraceptive history or lack of should not hinder. Their late-luteal distress is a patterns are worth exploring, and should not be considered evidence of instability.
Their perimenopausal panic, health anxiety, insomnia, or altered sense of self isn't irrational, but it might be biological, psychological, relational, and existential all at once.

Usually it's all of those things together.

A more honest model of readiness

There is no one thing that will tell you if you are ready for this exploration, but it does or should involve self-assessment. Am I sleeping okay? Am I grounded enough? Am I in a phase where I tend to spiral or shut down, and how can i work or alert others to work around or with this?
Have I recently changed hormones or medication? How do I really feel? What comes up?
Am I mistaking urgency for relief from trauma for readiness? Do I have support lined up for integration? Do my supports have support and awareness of how this work may change how I feel?

For practitioners, the underlying question is: are we treating this person's body as part of the therapeutic field? Because if we're not, we're missing context that might matter more than we think.

The What, the How?

As some of us know Psychedelic medicine in Australia is moving quite quickly, it seems so much less fringe and that's genuinely exciting. But the gaps are real and evident in my mind since my work within these communities, and this topic is one of them.

If this field wants to be safe, ethical, and trauma-informed in the way it says it does, then women's hormonal lives need to be part of that conversation, not as a wee lill, footnote and not as a complication, but as relevant and quite interesting, in clinical context. The menstrual cycle, contraceptive history, PMDD, perimenopause, hormone sensitivity, all these things may help shape emotional readiness, the intensity of altered states, integration capacity, and what someone needs after treatment ends.

That doesn't mean every session needs to be timed around a cycle, or that hormones explain everything that happens in a room. It means the body is part of the picture, and if it can be and they are open to it being considered it should be, because a framework that claims to treat the whole person needs to be willing to ask about all of it.

Want more info?
For those who are interested in more, I have been developing Hormonal Cycle screeners for practitioners and resources.
These are not free - as years of work has gone into these, but please reach out if you’d like to be someone to access these documents- Contact me here!

Or check out my FREE cycle sense course below ❤️

References and further reading

Australian psychedelic framework

Therapeutic Goods Administration. Prescribe MDMA or psilocybine: psychiatrists.
Authorised psychiatrists, HREC approval, clinical protocols, MDMA for PTSD and psilocybine for treatment-resistant depression in Australia.

Therapeutic Goods Administration. MDMA and psilocybine hub.
Useful as the broader TGA entry point for Australian access pathways and current regulatory information.

Royal Australian and New Zealand College of Psychiatrists. Psychedelics.
Useful for the psychiatric college position and Australian clinical caution around psychedelic treatments.

Women, hormones and psychedelic research

Cohen, Z. Z., et al. 2025. Females in Psychedelic Research: A Perspective for Advancing Research and Practice.
Ovarian hormones, menstrual phase, estradiol, progesterone and hormonal status are under-examined in psychedelic research and clinical protocols.

Shadani, S., et al. 2024. Potential Differences in Psychedelic Actions Based on Biological Sex. Endocrinology.
Discussion of biological sex differences, estrogen-serotonin interactions, and the need to consider sex-based variables in psychedelic research.

Hormonal contraception and medical risk

RACGP. Bateson, D., et al. 2016. Risk of venous thromboembolism in women taking the combined oral contraceptive pill.
Low-dose combined oral contraceptive use is associated with a twofold to threefold elevated VTE risk above baseline, and that inherited coagulopathies such as Factor V Leiden are major non-modifiable risk factors.

RACGP. Hereditary thrombophilia.
Genetic screening before prescribing the combined pill is not currently indicated, even though hereditary thrombophilias such as Factor V Leiden can increase clotting risk.

Therapeutic Goods Administration. Combined hormonal contraceptives.
Useful as an Australian regulatory source listing known hereditary or acquired predispositions to venous thromboembolism, including Factor V Leiden, as relevant risks for combined hormonal contraceptives.

Pregnancy and fetal safety evidence

Singer, L. T., et al. 2012. One-Year Outcomes of Prenatal Exposure to MDMA and Other Recreational Drugs.
MDMA exposure in pregnancy- heavier prenatal MDMA exposure was associated with poorer infant mental and motor development at 12 months.

MotherToBaby. Psilocybin mushrooms, “Magic Mushrooms”.
Not enough human pregnancy data to determine whether psilocybin increases risks such as birth defects, miscarriage, preterm birth or later developmental concerns.