Osteoarthritis (OA) is a degenerative cartilage disease characterized by progressive deterioration and functional loss.1 In females, the incidence, severity, and prevalence of osteoarthritis increase during the menopausal period.2 The cessation of ovarian functions during menopause leads to a decline in estrogen levels, resulting in increased osteoclastic activity, reduced apoptosis, and consequently, an increased susceptibility to knee OA.3 Various factors underlie the pain mechanism of OA, including joint nociceptors, peripheral and central sensitization mediators, and psychosocial problems.4 Chronic pain associated with knee OA adversely affects the quality of life by impeding functionality, daily life activities, sleep quality, mental health, social relationships, and the ability to fulfill occupational responsibilities.5

Current guidelines for the treatment of knee OA recommend the combined use of pharmacological and non-pharmacological methods.6 Aromatherapy is a complementary therapy utilized in the treatment of joint diseases such as knee OA.6,7 Aromatherapy involves the therapeutic use of essential oils and plant extracts containing essential oils in a safe and supportive manner.8 The components of essential oils used during aromatherapy massage are reported to reduce pain by affecting the release of neurotransmitters such as dopamine, endorphins, norepinephrine, and serotonin through lymph and blood vessels in the epidermis.9

Bergamot (Citrus aurantium bergamia), a small tree belonging to the Rutaceae family among citrus fruits, grows in the Mediterranean region and is particularly indigenous to the southern coasts of Italy.10 Bergamot essential oil (BEO) is a volatile oil produced by the cold-pressing procedure or steam distillation of the fruit's peel.10 BEO has been widely documented for its pharmacological antinociceptive efficacy in both nociceptive and neuropathic pain models.11 Generally, the pharmacological effects of BEO on nociceptive and neuropathic pain include mechanisms such as reducing pain, suppressing inflammation, alleviating neural damage and maintaining nerve health. Aromatherapy massage with essential oils such as lavender, eucalyptus, ginger, and rosemary is reported to be applied in the treatment of knee OA.6,12,13 However, there is no literature available on the application of aromatherapy massage with BEO in individuals with knee OA during the menopausal period.

Knee OA affects function and sleep quality in addition to pain. Considering that the incidence of OA increases during menopause, it is also important to reduce menopausal symptoms in treatment. The aim of this study was to determine the effect of aromatherapy massage with BEO in addition to routine physiotherapy on pain, function, sleep quality and menopausal symptoms.