Leadership as decision architecture: an organizational framework for understanding and eliminating physical restraint in human services.

Menstrual disorders represent one of the most common health issues among women of reproductive age, primarily encompassing primary and secondary dysmenorrhea. Primary dysmenorrhea is defined as menstrual pain occurring in the absence of any underlying pelvic pathology. Its core mechanism involves excessive secretion of endometrial prostaglandins, particularly prostaglandin F2α (PGF2α). This prostaglandin induces excessive and uncoordinated contractions of the uterine smooth muscle, subsequently leading to ischemic pain (–). This condition often coexists with abnormal bleeding patterns, such as heavy menstrual bleeding and prolonged menstruation, suggesting possible common disturbances in endometrial or vascular regulation (). Furthermore, psychological factors, including anxiety and depression, can significantly increase the risk of dysmenorrhea and exacerbate its severity. These findings underscore the important role of psycho-physiological interactions in the pathogenesis of this condition (). Secondary dysmenorrhea is typically caused by organic pathologies such as endometriosis and adenomyosis (, ), necessitating a differential diagnosis from primary dysmenorrhea in clinical practice. Epidemiological data show that approximately 80–95% of women of reproductive age experience menstrual-related symptoms, resulting in a significantly diminished quality of life (). Among specific populations, such as healthcare workers and athletes, the risk of menstrual disorders is particularly pronounced (, , ). Currently, non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptives remain the first-line agents for managing menstrual disorders, including dysmenorrhea (). However, NSAIDs are associated with adverse effects, including gastrointestinal and cardiovascular events (, ), while oral contraceptives exhibit interindividual variability in efficacy and pose restrictions on applicable populations (, ). For secondary dysmenorrhea, hormonal therapies such as the etonogestrel implant have demonstrated certain therapeutic benefits (); nevertheless, their safety profile requires further validation. Hormone replacement therapy (HRT) for menopausal syndrome also faces long-standing controversies regarding long-term safety. Moreover, the existing studies suffer from methodological flaws such as small sample sizes and inadequate implementation of blinding, which reduces the reliability and generalizability of the evidence (, ). Against this background, the pursuit of safe and effective complementary and alternative therapies has become an important direction. Complementary and alternative medicine, represented by phytotherapy and aromatherapy, is increasingly being applied in the field of gynecology. For example, blood-activating and stasis-resolving herbs and their essential oils have become common alternative options for patients managing dysmenorrhea, owing to their effects on regulating uterine contractions and inhibiting inflammatory pathways (). Modern studies have confirmed that essential oils such as those from Citrus species and lavender can ameliorate premenstrual symptoms and improve menopausal sleep quality (, –). Peppermint oil is a natural plant extract containing terpenoids, including menthol and menthone, as its core bioactive components. These compounds exhibit significant antioxidant, anti-inflammatory, and smooth muscle relaxant properties (), demonstrating considerable potential in alleviating menstrual disorders and menopausal symptoms. However, its efficacy and safety require systematic evaluation. Basic research has provided preliminary evidence for the modulatory effects of peppermint oil on the reproductive system (). At the cellular level, menthol has been shown to inhibit prostaglandin synthesis in endometrial cells and exert anti-inflammatory effects through modulation of the MAPK and PI3K-Akt signaling pathways (). In lipopolysaccharide-stimulated macrophage models, the inhibitory effect of menthol on NF-κB activation has been verified, further supporting its potential to modulate inflammatory signaling pathways (). Animal studies have provided complementary evidence, with peppermint essential oil also demonstrating anti-inflammatory effects in a 2, 4-dinitrochlorobenzene-induced mouse model of allergic dermatitis (). Collectively, these findings suggest, at both cellular and animal levels, that peppermint oil possesses anti-inflammatory activity and the ability to modulate uterine contractility. However, the evidence remains fragmented and largely derived from non-reproductive-specific models, and the long-term effects on reproductive tissues remain unclear. However, existing studies have largely focused on the analgesic effects of peppermint oil. There remains a marked lack of systematic investigation into its regulatory effects on the menstrual cycle and menopausal symptoms, as well as its underlying molecular mechanisms (, ). Furthermore, clinical trials are hampered by heterogeneity