(PMT) A distressing group of symptoms usually timed for the lead up to a period, then relieved as menstruation takes place, although many women experience different timing; includes downheartedness or depression (certainly an absence of well-being), aggression, fluid retention and weight gain, painful breasts ('mastalgia'), headaches and pain in the pelvis; caused by a periodic fall in the brain's endorphins, in turn usually precipitated by falling levels of progesterone in the second half of the luteal phase, although similar symptoms often accompany the use of progestogens, especially in older women; may be better during superovulation cycles because of generally higher hormone levels, but this is not always the case and PMT at the end of an unsuccessful cycle of assisted conception is particularly hard to put up with. Usually treated (up to a point) symptomatically, with perhaps fluid tablets (diuretics) and analgesics, although it's claimed that the drug Prozac has a specifically beneficial effect on mood, and encouragement of endorphin release with exercise can also be useful. Because progesterone and progestogens are the culprits, an operation to remove the ovaries (plus hysterectomy to simplify estrogen replacement therapy without needing progestogens) is usually curative, but drastic.

Opium-like substances produced naturally in the brain, which give a feeling of well-being. Production of endorphins is stimulated by many natural circumstances, and also by profound exercise (to which people can become "addicted"!). Depressed in premenstrual tension.

A distressing dysfunction of the intestines, in which there's both overactivity of the involuntary contractions of the intestines' muscular wall and increased pain signals coming from those contractions. Treatment is based on decreasing the contractions (with a diet high in fibre, sometimes with antispasmodic drugs) and attempting to reduce the action of the pain-carrying nerves, both by sedating them (this means general sedation too, so it's often not very acceptable) and by re-educating them to be less sensitive. Treatment is time consuming and, ultimately, not always satisfactory. The symptoms of the irritable bowel syndrome are often confused with those of endometriosis; they are sometimes made worse with, and at the time of, premenstrual tension, or, in my experience of patients with it, by performance of a laparoscopy. Typically (but not always), there is an alternating tendency towards diarrhea or constipation; sometimes there is nausea with the spasms.

The place of ovariectomy in the management of endometriosis and incapacitating premenstrual tension. Synonym: oophorectomy.

A form of light intermenstrual bleeding consistently timed over a few days to a week before the period starts properly, although it might not happen every month. About 80 percent of the time it signals the presence of endometriosis, making it the most predictive symptom for this condition; about 10 percent of the time it means an abnormality of the uterus such as fibroids, an endometrial polyp or endometritis; the remaining 10 percent of the time there is no explanation found. It has nothing to do with premenstrual tension, which if present is a coincidence.