Background: Elective gynecological surgery is a critical component of women's healthcare, aimed at addressing various medical conditions, ranging from benign gynecological disorders to oncological procedures. This study aimed to determine the anxiolytic effect of preoperative sublingual melatonin and its associated impact on postoperative pain scores when two different doses used in females undergoing elective gynecological surgeries. Methods: This a randomized controlled study included 96 female patients underwent elective gynecological surgeries. The patients were divided into three equal groups: Group M1: received 3 mg of sublingual melatonin the night and 1 hour before the surgery. Group M2: received 6 mg of sublingual melatonin the night and 1 hour before the surgery. Group C: Control group did not receive any premedication anxiolytic drugs. Beck anxiety inventory (BAI) and Numerical rating Scale (NRS) were recorded. Side effects related to the drug and Time of 1st rescue analgesia request were assessed. Results: Both melatonin groups showed significantly lower BAI scores at 2 and 12 hours postoperatively compared to baseline and intraoperative scores (p