Background and Aim: Hormonal supplementation (Oestrogen and progesterone) significantly influence pain sensitivity in women. Neuropathic pain prevention and nociceptive actions are strongly affected by progesterone and oestrogen. The present study aimed to investigate the gonadal hormones on women's pain sensation. Materials and Method: this case-control study was conducted on 46 females (study group) on the combined oral contraceptive pill (COCP) and 46 healthy males (control group) at the Department of Physiology, Lahore General Hospital, Lahore from November 2020 to July 2021. As a stimulus source, a cold pressor test was used. The participant’s least dominant hands were placed in a water bath with a temperature between 0◦C and 2◦C and were instructed to notify when the pain was first sensation feel which represents the pain threshold of participants. Pain tolerance was referred to the duration from the initial threshold to a stage where pain severity increased beyond the participant’s coping with pain. A visual analog scale was set to measure the unpleasantness and pain intensity. SPSS version 23 was used for data analysis. The Chi-square test was used, and p values less than 0.05 were considered significant. Results: Pain tolerance and unpleasantness was not significantly differ in men and women taking combined oral contraceptive pill. However, women on combined oral contraceptive pill had significantly higher (p<0.001) pain tolerance on average scale. Average pain threshold had insignificant association with age. Comparing to naturally menstruating women the unpleasantness pain on average scale was less severe in women taking hormonal pills. The average pain intensity was considerably differ between women on COCP pills and normal women. Conclusion: Our study suggests that gonadal hormone levels changes had a lower effect on experimental pain and unpleasantness in women. COCP influence the average pain reported by participants. Upon comparing normal and women on COCP pills, a significant increase in pain tolerance was observed in females on pill therapy. Women utilizing hormonal contraceptives should be kept under supervision for unpleasant and severe pain. Keywords: Hormonal supplementation, Pain tolerance, Combined oral contraceptive pill

Background: Burden of PCOs is increasing throughout the world with a prevalence of 8% - 13% of females getting affected around the globe. Many studies have also reported autonomic dysfunction among participants with PCOs with poor response to the parasympathetic nervous system and increased response to the sympathetic nervous system in contrast to that in normal counterparts. This study will aim to assess the parasympathetic reactivity of the cardiac system and oxidative stress among participants suffering from PCOs in a tertiary care hospital in Pakistan. Females with PCOs will be compared to normal counterparts of similar age and weight. Methodology: A cross-sectional study was conducted in the Department of Physiology of Jinnah Hospital, Lahore Pakistan from January 2021 to December 2021. Participants were recruited by purposive sampling following meeting inclusion and exclusion criteria. PCOs participants were matched with non-affected females with similar weight and age. The participants were assessed for oxidative stress by undergoing examination of serum catalase and MDA levels. Autonomic reactivity was assessed by recording ECG on taking deep breaths, on standing and following Valsalva maneuver. Both groups were compared for outcomes and measurement. Results: The outcomes of this study showed that the group with PCOs females showed a significantly higher rate of heartbeat per minute, resting systolic and diastolic blood pressure in comparison to their normal counterparts. The serology reports showed PCOs affected group to have lower levels of catalase and increased levels of MDA in opposition to non-affected females. Furthermore, it was seen with serology and ECG measurement that E: I ratio, E-I difference, 30:15 ratio, and Valsalva ratio were all found to be positively associated with levels of plasma catalase, whereas all measurements were negatively associated with serum MDA levels in a group consisting of PCOs affected females. Conclusion: This study concludes that a variation is seen in the parasympathetic stimulation among participants suffering from PCOs and this alteration of autonomic reactivity correlates to reduced response to parasympathetic inputs leading to a deficiency. The results of the study did not signify ay neuropathy which could be suggested by measurement of assessment of cardiac autonomic function. However, it cannot be overlooked that these measurements were different from that of normal counterparts. Lower catalase levels and increased levels of MDA among the PCOs group signify oxidative stress. Keywords: Parasympathetic reactivity, Oxidative stress, Polycystic ovarian syndrome