We read the interesting study by Phillips et al, which concluded that female patients older than 21 years of age should be informed about the delay in the recovery after third molar extractions, and that they need more pain medication before the removal of third molars. We would like to share our opinion.

The quality of life of patients after third molar surgery has become a health concern. Some studies in the literature have assessed clinical and health-related quality of life outcomes after third molar surgery. Phillips et al showed that female patients need more pain medication after third molar surgery. Hormonal, physical, and psychological fluctuations occur in the follicular and luteal phases of the menstrual cycle. Previous studies and meta-analyses have shown that thermal, pressure, ischemic, and venipuncture pain perceptions increase in the luteal phase compared with the follicular phase.

Studies have also demonstrated significant correlations between increased pain sensitivity and increased progesterone, and decreased estrogen levels. Estrogen can influence mood and well-being favorably. Progesterone has an inhibitory effect on neuronal activities, which are mediated by excitatory and inhibitory amino acids and neuropeptides such as beta-endorphin.

However, to the best of our knowledge, no study has addressed the effects of the phases of the menstrual cycle in female patients on their recovery after third molar surgery. Future studies are necessary to investigate the effects of the phases of the menstrual cycle on the postoperative recovery period.