This has been defined as ‘any combination of emotional or physical features which occur cyclically in a woman before MENSTRUATION, and which regress or disappear during menstruation’. It is characterised by mood-changes, discomfort, swelling and tenderness in the breasts, swelling of the legs, a bloated feeling in the abdomen, headache, fatigue and constipation. The mood-changes range from irritability and mild depression to outbursts of violence. It may last for 3–14 days, usually at the same time in each cycle. Only the more severe cases are seen by doctors, but it has been estimated that one in ten of all menstruating women suffers from it severely enough to seek treatment. A small number of women find their symptoms significantly affect their life and their more severe disorder is sometimes referred to as Premenstrual Dysphoric Disorder (PMDD). Many of the associated symptoms include such unpleasant feelings as hopelessness, sadness, anger, anxiety, loss of interest in usual pleasures (anhedonia) and low self-esteem. In view of the many suggested, but unproven, causes that have been put forward, it is not surprising that there is an equal multiplicity of treatments. For those with mild symptoms, lifestyle changes may be sufficient, perhaps with the addition of painkillers such as NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS). Oral contraceptives can also relieve some of the symptoms. Bloating and sore breasts may be relieved by DIURETICS (available over the counter at pharmacies). Women with PMDD may be advised to take an antidepressant such as one of the SELECTIVE SEROTONIN-REUPTAKE INHIBITORS (SSRIS), but these should only be taken under close medical supervision and after full discussion of possible side-effects. Whatever drug may be prescribed, counselling is equally essential and, in many cases, is all that is required.