BACKGROUND This case report reviews the aeromedical factors associated with considering a return to flight status of an aviator treated with sertraline 25 mg PO QD 5-7 d x mo(-1) for premenstrual dysphoric disorder (PMDD). Particular emphasis is given to her performance on serial neuropsychological assessments while both on and off of the medication. METHODS Each testing occasion included a comprehensive battery of neuropsychological functioning, coupled with a blinded flight evaluation by a standardization pilot. The first testing occasion was on day 6 of menses while the aviator was taking 25 mg sertraline PO QD. The second testing occasion was completed 1 mo later, on day 6 of menses, while off the sertraline. The aviator's performance was compared with normative data at each testing occasion, as well as for possible significant change between testing occasions. CONCLUSIONS An interpretation of this aviator's overall neuropsychological performance is discussed, with particular attention given to the potential cognitive effects of sertraline. In light of previously published aeromedical considerations related to selective serotonin reuptake inhibitor use by aviators, the aeromedical considerations regarding this aviator's use of sertraline for PMDD are also highlighted.