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American college of Obstetricians and Gynecologists (ACOG) described PMS in ten indexes (2). According to previous reports, the incidence PMS ranges from 19% to 90% (3-5). During menstrual cycle, fluctuation in sexual hormones results in attitude change and alteration in pain perception (6). Different studies reported some interactions between sex hormones and central nervous system (7-9), which might be linked to activity of serotonin and beta-endorphin (neurotransmitters) in the brain (10, 11). Pain perception differs during menstrual cycle (12). It has been recommended that estrogens might have an influence on somatic sensory process (13). Some Oxymatrine studies reported a significant effect of pain sensitivity with higher levels of progesterone (13, 14) and some other studies reported similar patterns for pain perception. There are reports of more complaint of pain in luteal phase of menstruation, which is suggested as the reason for functional changes in women during menstrual cycle (15). Studies suggest that symptoms of other disorders get worse selleck kinase inhibitor right before the menstruation (16). Furthermore, there is an association between stress and PMS. Stress suppresses the hypothalamus proper functioning, its control on the pituitary gland, and regulating hormones (17). Researchers suggest that stress might have direct impact on PMS through altering levels of sex hormones. In addition, cortisol affects PMS symptoms. For many patients, surgery is a physical and psychologic stressful event. Moreover, the postoperative period might be accompanied by significant pain and discomfort. As any stress, it might be affected by patient��s background including PMS history and the phases of menstrual cycle during the preoperative period (18). 2. Objectives This study aimed to assess the alterations of postoperative pain perception regarding the history of PMS in the patients undergoing surgery during the luteal and follicular phase of menstrual cycles. 3. Patients and Methods This cohort study included 140 women, mostly candidate of gynecologic surgery. Patient��s menstrual period and serum progesterone level were determined. In patients with regular menses, menstrual phase was clarified according to their last menstrual history and confirmed by serum progesterone level. Serum progesterone measurement was done few hours before surgery. selleckchem In patients with irregular menstruation, serum progesterone level > 60.19 nmol/L (20.5 mg/mL) was determined as the luteal phase and