Medical Cannabis for PMDD: Breaking the Silence on Women's Hidden Suffering
A discussion with Dr Emma Gordon on how cannabinoid therapy is offering hope for women with premenstrual dysphoric disorder in Australia.
Read time: 5-6 mins
The Hidden Epidemic: Understanding PMDD
Premenstrual Dysphoric Disorder (PMDD) represents one of female medicine's most overlooked conditions, affecting an estimated 6% of menstruating women. The true prevalence may be much higher when considering chronic underdiagnosis of women’s health conditions. Unlike the familiar premenstrual syndrome (PMS), which affects approximately 75-90% of menstruating people, PMDD is characterised by severe, debilitating symptoms that fundamentally impact quality of life and relationships.
Dr Emma Gordon, a Byron Bay-based GP specialising in medicinal cannabis, explains that PMDD is "a severe hormone-sensitive mood disorder" which requires a period of daily symptom tracking for accurate diagnosis. PMDD manifests during the luteal phase of the menstrual cycle, with symptoms improving within days of menstruation onset and remaining minimal until the following post-ovulatory phase.
The five specific symptoms are required for diagnosis, including at least one severe mood symptom (mood swings, irritability, depression, or anxiety) plus four additional symptoms from a constellation that may include sleep disturbances, bloating, fatigue, appetite changes, concentration difficulties, and anhedonia (loss of interest in usual activities).
The Long Road to Recognition
The often drawn journey to a PMDD diagnosis reflects broader systemic issues in women's healthcare, specifically the medical gender bias. "The average age of diagnosis is around 30, early 30s," Dr Gordon notes, "while the average age of menarche in Australia is around 12." Although PMDD can manifest at any time across a womens reproductive lifespan, this represents a potentially devastating gap, during which women's suffering is frequently minimised or misattributed. It’s not unusual for women to experience up to five years between symptom development and diagnosis.
PMDD was only formally recognised in the DSM-5 in 2013, making it a relatively new diagnostic category. Dr Gordon candidly admits, "I didn't learn about it in medical school and didn't even hear about it until a few years ago." Gaps in education and a plain lack of medical data on female bodies perpetuate the dismissal of hormone-linked conditions that have historically plagued women’s health conditions.
For doctors with little or no training in the breadth of conditions affecting female hormones, it is still a far too regular occurrence for women to feel dismissed or even trivialised by practitioners not aware of PMDD. There’s no blood test to confirm it and when psychological symptoms are viewed in isolation, they can be mistaken for general anxiety or other mental health conditions.
The cyclical nature of PMDD symptoms creates diagnostic challenges. As Dr Gordon observes, "Because of this cyclical pattern of symptoms, it's almost harder until you've had a prolonged period to then retrospectively look back, because they're not in this permanent state of depression." Windows of relative normalcy between symptom flares can obscure patterns that help in diagnosis. Compounding this picture is research showing that patients often underreport or misattribute symptoms, which may further confound accurate and timely diagnosis.
The Cannabis Connection: A New Therapeutic Frontier
Currently, whether PMDD should be treated as a neuropsychiatric or endocrine issue is far from being obvious. However, our growing understanding of how interconnected the endocannabinoid system (ECS) is in regulating hormones and other chemical messengers is beginning to elucidate a more nuanced view of our current understanding of PMDD.
While randomised controlled trials specifically examining medical cannabis for PMDD are currently absent, emerging evidence and clinical experiences suggest promising therapeutic potential. The physiological rationale centres on the endocannabinoid system's crucial role in mood regulation, stress response, and emotional processing.
Dr Gordon explains the underlying mechanism: "We think PMDD arises from an abnormal central nervous system sensitivity to normal luteal phase hormonal fluctuations. This leads to dysregulation in key neurotransmitter systems, serotonin, GABA, and the endocannabinoid system."
When it comes to current hypotheses on why plant-based therapies have been effective in the discussion revolves around CBD1, CBD2 receptors in the ECS. Describing how connected these receptors could be to PMDD pathophysiology, Dr Gordon shares the ECS is “deeply involved in regulating mood, stress, pain, inflammation, sleep, all of which are involved in PMDD. Physiologically, it makes sense. It would be nice if we had more data and clinical research.”
Personalised Cannabinoid Protocols
Clinical experience reveals that PMDD management requires highly individualised approaches, with treatment goals dictating cannabinoid selection. Dr Gordon's clinical protocol typically begins with CBD as the foundation, noting that "almost inevitably, PMDD patients benefit from CBD" due to its anxiolytic and anti-inflammatory properties.
Depending on the constellation of her patients symptoms, her treatment approach can incorporate:
CBD as the primary therapeutic base for its anxiolytic and anti-inflammatory effects
Low-dose THC inclusion or sometimes full-spectrum oils to enhance efficacy and cost-effectiveness
Emerging minor cannabinoids like CBG (for additional anxiolytic properties) and CBN (for sleep and pain management)
Cyclical dosing adjustments with THC requirements typically increasing mid-cycle through the luteal phase
"I find that the THC requirement creeps up as we enter mid-cycle and approach the luteal phase," Dr Gordon explains. "We'll increase that dose often later in that luteal phase and even during menstruation."
Treatment Timelines and Expectations
Establishing effective treatment protocols requires patience and realistic expectations. Dr Gordon typically sees patients at four to six weeks initially, then again at three months to assess full therapeutic benefit. "If you've been in chronic stress and chronic anxiety and chronic pain for a long time, that's not going to happen overnight," she cautions patients.
The goal isn't necessarily complete symptom elimination, but rather a noteworthy improvement in quality of life and functional capacity. Many patients experience cyclical patterns in their cannabis requirements, sometimes weaning down during stable periods and using treatment "almost like a PRN [as needed]" during symptom flares.
Healthcare Barriers and Socioeconomic Patterns
From her Byron Bay clinic Dr Gordon is a GP for a wide range of patient demographics. Her observations from the diverse cohort of ages, occupations, education levels, and socioeconomic backgrounds reveal significant healthcare disparities. Dr Gordon observes distinct patterns in both preferred treatment methods and accessibility:
Higher socioeconomic patients tend to:
Show greater caution regarding THC due to professional concerns
Prefer oil-based formulations
Express worry about driving regulations and workplace implications
Lower socioeconomic patients often:
Have prior experience with recreational cannabis
Prefer inhaled delivery methods
Face greater challenges with CBD compliance and cost barriers
These distinctions reflect broader healthcare access issues that disproportionately affect women, particularly those from marginalised communities.
Moving Forward: The Need for Recognition and Research
PMDD represents a critical gap in women's healthcare that reflects broader systemic issues in medical research and clinical practice. The condition's late recognition, coupled with ongoing diagnostic challenges and the overall lack of clinical data on women’s hormones and health, perpetuates the unnecessary suffering of many women.
The emerging role of the endocannabinoid system and medical cannabis in PMDD management offers hope, but success requires:
Increased clinician education about PMDD recognition and diagnosis
Expanded research into cannabinoid therapeutics specifically for women’s health and hormones
Patient-centred approaches that validate women's experiences and open up to the understanding of how cyclical symptoms can affect patients
For healthcare providers, PMDD awareness represents an essential educational opportunity. The condition's prevalence, combined with its significant impact on quality of life, requires proactive screening, and the complex nature of this condition calls for individualised treatment protocols. Within this framework, cannabis-based medicines may offer benefit as part of a broader biopsychosocial model of care, addressing physiological symptoms as well as emotional and functional impairments that define this debilitating condition.
About the Expert: This article draws from clinical insights shared by Dr Emma Gordon, a Byron Bay-based GP specialising in medical cannabis treatment for women's health conditions.
References:
Scotchie, J. G., Savaris, R. F., Martin, C. E., & Young, S. L. (2015). Endocannabinoid regulation in human endometrium across the menstrual cycle. Reproductive sciences, 22(1), 113–123. https://doi.org/10.1177/1933719114533730
Tanaka, K., Amoako, A.A., Mortlock, S. et al. Gene expression of the endocannabinoid system in endometrium through menstrual cycle. Scientific Reports 12, 9400 (2022). https://doi.org/10.1038/s41598-022-13488-4
Walker, O. S., Holloway, A. C., & Raha, S. (2019). The role of the endocannabinoid system in female reproductive tissues. Journal of ovarian research, 12(1), 3. https://doi.org/10.1186/s13048-018-0478-9
Dr. Emma Gordon, a General Practitioner based in Byron Bay, Australia, brings a holistic approach to patient care. After graduating from Cardiff University with a Bachelor of Medicine and Bachelor of Surgery (MBChB) and a Bachelor of Science in Physiology in 2013, she gained diverse medical experience across multiple institutions, including the NHS in Bristol and various Australian hospitals. Dr. Gordon currently practices at Ananda Clinics and Meadows Medical Centre, specialising in women's health, medicinal cannabis, and dermatology. Her commitment to comprehensive care is evidenced by her additional qualifications, including completing the Australian Institute of Dermatology Diploma and the Advanced Certificate of Skin Cancer. As a member of the Australian Menopause Society and the Australian Medical Cannabis Association, she remains at the forefront of advancing medical knowledge while strongly focusing on evidence-based, compassionate patient care.
Disclaimer: This information is shared with a global readership for educational purposes only and does not constitute medical or business advice. All patient-related information has been de-identified OR fictional to protect privacy. Nothing in this article is intended to promote the use or supply of medical cannabis to members of the public.
