The premenstrual syndrome is a common sense one: the cyclic appearance of one or more of a large constellation of symptoms just prior to menses, occuring to such a degree that lifestyle or work is affected, followed by a period of time entirely free of symptoms. Symptoms are believed to the result from interaction between central neurotransmitters and normal menstrual hormonal changes. Pharmacologic management to support efficacy includes selective serotonin reuptake inhibitors administered daily or premenstrually and serotonergic tricyclic antidepressants. Anxiolytics and potassium sparing diuretics have demonstrated mixed results in the literature. Hormonal therapy is available towards producing anovulation. There is a good clinical evidence for GnRH agonist with addback hormonal therapy. Oral contraceptive pills prevent ovulation and should be effective for the treatment of PMS. Treatment usually begins with lifestyle changes, over-thecounter medications. Physicians should be aware of the risks from many alternative therapies commonly touted in the popular press.