Influence of menstrual cycle phases on post-endodontic pain: a comparative clinical study with male patients

Post-endodontic pain is a major concern that negatively impacts patients' quality of life. To date, there is no study examining the effect of the menstrual cycle on post-endodontic pain. Thus, this study aimed to elucidate any significant differences in post-endodontic pain perception between genders and across different menstrual phases. This clinical study included 97 patients (21 males and 76 females) requiring endodontic treatment for asymptomatic necrotic mandibular molars. Female participants were categorized into menstrual (n = 24), proliferative (n = 22), and secretory (n = 30) phase groups according to self-reported menstrual cycle timing. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 8 h, day 1, day 2, and day 3 after treatment, and analgesic intake was also recorded. Repeated pain measurements were analyzed using a linear mixed-effects model adjusted for age, treatment time, and baseline pain score. No significant differences in postoperative pain scores were observed among the menstrual, proliferative, and secretory phase groups at any evaluated time point. At 8 h, postoperative pain scores were significantly higher in the menstrual phase group (p = 0.002) and the secretory phase group (p = 0.025) than in the male group, whereas the proliferative phase group did not differ significantly from males (p = 0.112). No significant differences between female phase groups and males were detected at postoperative day 1, day 2, or day 3. The highest proportions of pain reporting and analgesic use were observed in the secretory phase group. Menstrual cycle phase was not associated with significant differences in post-endodontic pain among female patients. However, female patients in the menstrual and secretory phases experienced higher early postoperative pain than males at 8 h. These findings suggest that menstrual cycle phase may be relevant to early post-endodontic pain perception, particularly when comparing female patients with males.