PMS remains a controversial disease. A significant portion of the population experiences some premenstrual symptoms, with a small portion experiencing severe symptoms; however, it is not yet clear who should be labeled as having PMS. Further research is needed to better define PMS. The true etiology of PMS remains unknown; however, the most common theories revolve around prostaglandins, endorphins, or progesterone deficiency. Current treatment of PMS includes education and counseling, dietary changes, regular exercise, and possibly vitamin supplementation, diuretics, prostaglandin inhibitors, or progesterone. More well controlled, prospective placebo-controlled studies are needed to help elucidate the etiology and test the effectiveness of these treatments. With the uncertainties surrounding PMS in the 1980s, the potential for quackery is tremendous. In spite of our limitations in knowledge, there is much that can be done for patients with PMS. To serve our patients better, physicians must become better informed about PMS and spend time discussing it with their patients. By educating patients regarding the current state of knowledge of PMS and discussing rational treatment approaches, physicians may avoid driving their patients away to seek treatment with unproven and potentially harmful fad treatments.