Group of symptoms caused by the monthly cycle of sex hormone production, occurring in women who are not on the pill or using other sex hormones. Many women experience the syndrome to a mild degree; the only consolation that can be offered is that a normal cycle is an essential prerequisite, and thus the syndrome is a sign that all is well for the woman concerned. Possible symptoms include fatigue, irritability, hypersensitivity, painful breasts, (sometimes with painful benign tumours in the breasts), a distended feeling in the abdomen, constipation, flatulence, retention of a few litres of fluid and headache or migraine. The symptoms usually disappear when menstruation begins. They are caused by sex hormones and their natural fluctuations. Symptoms do not always occur, and the necessity for treatment is viewed in various ways. There are experts and also women patients who blame the premenstrual syndrome for every misfortune and every squabble. This can be taken to excess. A woman once submitted a defence for murder on the grounds of diminished responsibility as a result of premenstrual tension. At the other end of the scale there are doctors and women who trivialize the problem completely. Naturally discomfort and pain are difficult to measure, and any genuine complaint should be taken seriously. If a contraceptive is needed the combined pill or minipill should be chosen. The sequence pill is less suitable, because it imitates the normal cycle to as large an extent as possible. In some cases progesterone therapy is prescribed. If the major problem is fluid retention, then diuretics may be taken once or twice. Some women prefer to follow a low-salt diet in the last two weeks of the cycle; others pamper themselves by resting in bed, taking a sauna or simply relaxing physically. Premenstrual migraine can be treated in various ways, of which one is acupuncture. Medical treatment should be by the family doctor or a gynaecologist.