According to experts in this field, premenstrual syndrome can be defined as distressing physical, behavioural and psychological symptoms not due to organic disease which regularly recur during the same phase of each menstrual (ovarian) cycle and which disappear or significantly regress during the remainder of the cycle. It is the severity of symptoms and the resulting deterioration in interpersonal relationships and interference with normal activities which distinguishes PMS form the minor physical and emotional changes which often precede the onset of menstruation in normal women. Defined in this way, PMS affects between 5 and 10 % of women.
The underlying cause of PMS remains unknown, but cyclical ovarian function appears to play an essential role in the genesis of symptoms. The condition depends upon ovulation as PMD does not occur before puberty, during pregnancy or after the menopause. The underlying cause may be related to changes in the ovarial hormones or their metabolites from the time of ovulation which have an influence on neurological functions.
The symptoms include mood swings, irritability, anger, loss of energy, loss of libido, depression, and the physical symptoms of headaches, breast pain and abdominal bloating.
Various treatments have been tried but the most effective way to treat severe PMS is to stop ovulation and remove the cyclical hormonal changes of this event.  For many women, suppression of the menstrual cycle will be neccesary. Hysterectomy with ovarectomy has often been done in the past. Progestogen therapy is widely prescribed as a first-line treatment but, the symptoms commonly return when the medication is stopped. Danazol is effective at high doses. However, both have often severe side effects and compliance is, therefore, poor. Gonadotrophin therapy is also effective but expensive and there is concern about the long term safety. It is known that oestradiol implant suppress the ovarian cycle but in non-hysterectomised patients, unopposed oestrogens are contraindicted due to the risk of endometrial malignancy.
In practice, women with severe PMS benefit enormously from the use of oestradiol implants, or moderately high dose transdermal oestradiol, combined with an intrauterine system releasing levonorgestrel. This treatment results suppression of the menstruation. The intrauterine system is also an extremely effective form of contraception if required. This treatment can be continued for many years. A small dose of the male hormone, testosterone, can be added for energy and libido.

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