Evaluation of haloperidol decanoate initiation dosing in inpatients with serious mental illness.

Menstrual health is a fundamental component of women's overall health. However, it remains one of the most substantially understudied areas in biomedical research (, ). This gap reflects not a lack of clinical relevance, but a longstanding underrepresentation of menstrual health and women of reproductive age across all areas of health research (). Premenstrual syndrome (PMS) and dysmenorrhea (menstrual pain) are two of the most prevalent and burdensome, yet insufficiently understood, menstrual health conditions in women of reproductive age. About 95% of Japanese women suffer from PMS, with the prevalence of moderate-to-severe PMS and premenstrual dysphoric disorder (PMDD) to be 5.3% and 1.2%, respectively (, ). PMS comprises psychological and physical symptoms that emerge during the late luteal phase or premenstrual phase of the menstrual cycle. PMS typically occurs 1 to 2 weeks before menstruation, resolves within a few days after onset, and are absent in the week following menstruation (, ). These symptoms include anxiety, depression, impaired concentration, reduced energy, sleep disturbances, appetite changes, overeating, headaches, and somatic pain (). Dysmenorrhea is characterized by cyclic pelvic pain associated with menstruation (). Globally, the pooled prevalence of dysmenorrhea has been estimated at approximately 70%: similar rates have been observed across countries regardless of economic status (, ). Both PMS and dysmenorrhea are associated with reduced quality of life, impaired academic and work performance, and increased healthcare utilization, representing as substantial but often overlooked public health burden (). The menstrual cycle represents an infradian rhythm, which is defined as a biological rhythm with a period longer than 24 h, with an average duration of 28 days and typical cycle lengths ranging between 25 and 30 days (, ). This infradian rhythm of the menstrual cycle interacts with the circadian rhythm, which is the 24-h rhythm of physiology (, ). Almost all living organisms have adapted to the Earth's 24-h day and night cycle by developing an internal biological clock known as the circadian rhythm (). Most of the behaviors and biological processes essential for healthy physiological functioning are synchronized with the circadian rhythm. This synchronization involves 1) daytime activity and eating and 2) nighttime sleep and fasting (). However, industrialization has disrupted these behavioral patterns. Widespread access to artificial lighting has led to increased wakefulness and reduced nighttime sleep. Advanced food production and preservation have made food available around the clock (). These changes in eating and sleep behavior led to circadian misalignment. The circadian system plays a central role in hormonal secretion, including estrogen (), inflammatory response (), pain perception (), and mood regulation (), all of which are implicated in PMS and dysmenorrhea pathophysiology.