Comparing Pain Sensitivity and the Nociceptive Flexion Reflex Threshold Across the Mid-follicular and Late-luteal Menstrual Phases in Healthy Women

Objectives: Understanding the relationship between the menstrual cycle and pain can contribute significantly to our knowledge of pain processing in women. Many early studies suggested that pain sensitivity was enhanced during the luteal phase of the menstrual cycle relative to the follicular phase; however, these studies were often limited by small sample sizes, lack of ovulation verification, focus on a single pain modality, inadequate assessment of menstrual cycle regularity, and low-powered statistical methods. The current study was designed to address these limitations and examine the difference in pain processing between the mid-follicular (days 5 to 8) and late-luteal (days 1 to 6 preceding menses) phases. Methods: Forty-one healthy, regularly cycling women attended testing sessions that measured pain sensitivity from mechanical pain threshold, electrocutaneous pain threshold/tolerance, and ischemia pain threshold/tolerance, as well as McGill Pain Questionnaire qsensory and affective ratings of electric and ischemic stimuli. Electrocutaneous stimulation was also used to assess nociceptive flexion reflex threshold, a physiological measure of spinal nociception. Results: When analyses were limited to data collected only in the targeted menstrual phases (N = 30), results indicated no menstrual phase effect on any pain outcome (all P's > 0.05), with the exception of lower electrocutaneous pain thresholds during the late-luteal phase. No outcomes differed by menstrual phase in the full sample (N = 41). This indicates nociceptive responding varies little between the mid-follicular and late-luteal phases. Discussion: The present study suggests that experimental pain processing does not significantly differ between the mid-follicular and late-luteal phases of the menstrual cycle in healthy women. This implies hormonal variation across these 2 phases (ie, progesterone) has a minimal effect on subjective and physiological responses to pain.