Before we start…
We haven’t found any research on how MDMA affects intersex people or people going through hormone therapy, so we’re kinda stuck with using ‘male’ and ‘female’ in this article, sorry. If you come down on the oestrogen and/or progesterone-heavy end of things, these things might apply to you though.
Some of the studies we refer to in this post still use ‘men’ and ‘women’ in the cisgender way that refers to male and female humans respectively. We’re not doing that.
Also, we use the English spelling of oestrogen instead of the American estrogen. Same hormone though.
MDMA and hyponatremia
We recommend that you drink one glass of water per hour/DJ set when taking MDMA. This is because when you take MDMA, you can’t pee until you come down and your body hangs on to all that water which can end up in a trip to A&E.
Turns out that if you’ve got more oestrogen and progesterone than testosterone in your meat suit’s hormone cocktail there’s another reason to keep an eye on your water intake: you’re more likely to suffer from hyponatremia when you take MDMA.
Hyponatremia is where the levels of sodium in your body are too low. Sodium is an electrolyte (mineral) that regulates how much water is in your body. If your sodium levels are too low it means your body holds on to its water and your cells swell up. Swollen cells might not sound terrible, but if those cells are your brain cells, hyponatremia can cause seizures and coma, so it’s definitely not something to take lightly.
People that are biologically female are more likely to suffer hyponatremia because female sex hormones affect how the body retains water. There’s still a lot of research being done to figure out exactly why, but what we know so far is:
- Both oestrogen and progesterone have an effect on transcapillary fluid movement, so how much fluid is moving in and out of the bloodstream
- Thirst levels fluctuate depending on where in the menstrual cycle the person is
- In the luteal phase of the menstrual cycle people build up interstitial fluid, which is the fluid around the cells.
So if someone is in the luteal phase of their menstrual cycle where they’ve already built up fluid, and they take MDMA which prevents them peeing, and they drink a lot because they’re dancing, it’s a perfect set up for hyponatremia.
Hyponatremia symptoms include
- Nausea and vomiting
- Headache
- Confusion
- Restlessness and irritability
- Loss of energy, drowsiness, and fatigue
- Muscle weakness, spasms, or cramps
- Seizures
- Coma
Electrolytes vs. plain water
Drinking plain water on its own might not be the best way to go if you’re on MDMA, especially if you’re dancing a lot and getting hot and sweaty. You lose sodium in your sweat, your risk of hyponatremia goes up if you’re starting from a low sodium baseline and not replacing it. Alternating water and an electrolyte drink when you have your one drink after every DJ set will make sure you keep your hydration levels healthy.
Snacks
While not as quick-acting as electrolyte drinks, snacking on foods that are high in electrolytes will also get your sodium levels back up to baseline. These include things like
- Dark leafy greens like spinach and kale
- Nuts, but more specifically almonds
- Legumes like peanuts
- White fish like flounder
- Fruit like oranges and bananas
- Proteins like tofu or poultry
Get a full list of foods that help replenish electrolytes at the Healthline website
Food can be a little difficult to navigate when you’re coming down and for the couple of days after you’ve had your MDMA because your appetite might be AWOL. You can get around this by drinking soup or having snacks you can graze on rather than having a full meal. Those packets of instant soup are great at a festival because not only will they give you the sodium hit you need, but will warm you up on those cold nights back in your tent.
Read more about MDMA and hyponatremia:
Ecstacy-associated hyponatremia: why are women at risk? by Moritz, Kalantar-Zadeh, and Ayus; Nephrology Dialysis Transplantation, Vol 28, Issue 9, September 2013
Methylenedioxymethamphetamine (MDMA)-Induced Hyponatremia: Case Report and Literature Review by Elkattawy et al; Cuereus, Vol 13(5), 2021
Read more about sweat and sodium loss:
Sweat Rate, Sweat Sodium Losses, and Body Composition in Professional Male Soccer Players in Southwest Colombia by Suarez-Ortegón et al, Physiological, Biomechanical, and Psychological Aspects of Endurance Sports special issue of Medicina, 2024
MDMenstrual cycles
In the course of a menstrual cycle there will be varying effects on how strong the desirable effects of MDMA are.
So a ‘standard’ ovarian part of a menstrual cycle looks like this:
Menstrual cycles happen in two phases – the follicular phase and the luteal phase. Most people have a 28-day cycle, but some folks’ can be longer or shorter depending on their individual bodies, what their health’s doing, how stressed they are, and so on.
The follicular phase: Day 1 to day 14ish
This is where the body gets rid of the last ovum (egg) it released and gets the next ovum ready for fertilisation. If you bleed, the first day of that bleed is considered day 1 of your cycle.
Ovaries have your lifetime’s store of ova held in these things called follicles, and releases them one at a time month by month. The prep for this release happens in the follicular phase of the cycle.
Basically what happens is one follicle swells up, which separates it and the ovum that it’s holding out from the other follicles. It keeps growing and growing until about day 14, where it separates off from the ovary completely and makes its way to the uterus for fertilisation. That separation is what’s commonly known as ovulation.
Oestrogens start peaking at this phase and progesterones drop. You can feel an elevated mood, things can feel more enjoyable, and you might find you have more energy during the follicular phase.
The luteal phase: Day 14ish to day 28ish
This is where the ovum settles in for fertilisation. The ovum chills out in the uterus for about a week waiting for fertilisation. If it’s not fertilised by day 9-10ish after ovulation, the ovum will break down and be carried out with the lining of the uterus when it’s shed during your period.
Progesterone peaks in this phase and oestrogens drop. The week where the ovum is breaking down is generally where your premenstrual syndrome (PMS) falls. You may find yourself with a low mood, and you might have acne breakouts, headaches, bloating, and tenderness.
Get a full picture of what happens during the menstrual cycle at Clue.com
What has all of this got to do with your roll? Well…
This is your brain. This is your brain on oestrogen
During the follicular phase, there’s an abundance of serotonin, which drops in the luteal phase. Oestrogens stimulate the serotonin system – 17β-estradiol (E2) in particular stimulates production and inhibits degradation of serotonin, and slows down reuptake. So there’s more serotonin being made and hanging around in the spaces between the neurons.
So while oestrogens are predominantly secreted by the bits of your body and brain dedicated to reproduction, they’re still found in significant quantities in the hippocampus, amygdala, and dorsal raphe nucleus – all parts of the brain that are responsible for emotional regulation, memory, and learning. These bits of your brain also all have high levels of serotonin receptors, with the dorsal raphe nucleus holding one third of the body’s serotonergic neurons on its own.
So we’ve got a hormone that jacks up serotonin production in a place in the brain where the lion’s share of your body’s serotonin is used.
You can see where this is going, right? Taking MDMA in the follicular phase of the menstrual cycle means there’s more serotonin in the brain, and it’s going to hang around longer – specifically in the bits of the brain that use serotonin to regulate emotions. So MDMA can hit harder and you can roll longer.
…And this is your brain on progesterone
Progesterone essentially inhibits your neurons from firing or releasing other neurotransmitters.
Studies have also shown that progesterone increases serotonin degradation, as well as slowing down its release from the serotonergic neurotransmitters. Basically your progesterone is breaking down existing serotonin and limiting how much serotonin is being expressed into the space between neurons. This is why when you have PMS your moods can plummet and you can feel angry and/or sad for no external reason you can think of.
So if you take MDMA in the luteal phase of your cycle when progesterone increases and basically caps your serotonin levels, there’s not going to be as much serotonin for the MDMA to dump into your brain. And it’s going to get broken down quicker than it would be in the first half of your cycle. All those parts of your brain like the dorsal raphe nucleus that rely on serotonin to do their mood-regulation are suddenly going to find there’s way less serotonin to go around, even after the MDMA has dumped out all the serotonin you’ve got stored.
What does this mean in terms of your roll? Your peak might not be as intense, so you might not get the same kind of connection and euphoria. Your roll might not be as long as normal, too, with the progesterone breaking down serotonin when it’s in the synapses. Also, your comedown might be harder or last longer because the progesterone is preventing your neurons from expressing fresh serotonin.
Steroid Hormones and Their Action in Women’s Brains: The Importance of Hormonal Balance, Frontiers in Public Health, 2018
Influence of progesterone on serotonin metabolism: a possible causal factor for mood changes – PubMed
Proper planning prevents poor partying
Hormones can bring a sprinkle of chaos to any particular event if you’re not ready for them, and knowing what your cycle’s like can help you prep for your adventure.
Oestrogen high, progesterone low (Day 1 to 14)
This is where things can feel particularly good, so you might not need the same amount of MDMA as you would ordinarily. Dosing lighter will bring the same euphoria and connection, but not have the same load on your circulatory system or central nervous system.
You may also want to consider your setting when you roll in this half of your cycle, depending on how social you get. Having a tripsitter along for the adventure can be helpful when it comes to remembering boundaries concerning cuddle puddles, massage trains, and being able to look your conservative neighbour in the eye after throwing caution to the wind along with your clothes.
Progesterone high, oestrogen low (Day 14 to 28)
You might not get to the same intensity of an experience that you would in other parts of your cycle with your normal dose, which can definitely be disappointing. You might be tempted to take more MDMA, but we wouldn’t advise doing that. Your increased progesterone levels are going to keep the proverbial floodgates closed, so the only things that are going to feel the extra MDMA are your heart and central nervous system, and it won’t be in a fun way.
Also, prep your comedown. This is a good rule for life in general, but if you’re feeling particularly blue having a really good snug nest with all your favourite cosy things to burrow into can be a real comfort.
In closing
Having a body is a LOT. There’s a bunch of moving parts and the warning lights on the dash keep flashing and you can’t remember where you left the warranty so getting a replacement is out of the question. But there are some things you can do to make sure you have the fun you want without your meat suit breaking.