Title: A study on women’s health information needs in menopausal age
Version: 2 Date: 27 Aug 2021
Reviewer:  Karin Stanzel
Reviewer's report:
Thank you for asking me to review this paper which reports the findings from a study on
the health information needs of women in midlife in Iran. Being able to make well informed
decisions about health and health behaviour has shown to increase participation in health
screening, reduce admissions to hospitals and accessing emergency care. Hence, understanding
the health information needs of women in midlife is important in order to provide the health
information needed during this time to optimize health and well being in older age.
I have the following comments and questions:
Abstract:
Authors:
Menopause is a regular, natural life event that women experience in their mid-life ages. In order
to help women, cope with their condition when undergoing menopause.
Reviewer's comment:
Authors refer to menopause as a natural event but then use terms such as conditions which is
contradictory as this could be interpreted as a “medical condition”.
Authors:
A valid and reliable researcher-made questionnaire…
Reviewer's comment:
This implies that the validity and reliability has been tested. However, there is no description in
the methods section how validity and reliability has been established.
Introduction:
Authors:
Menopause is a regular, natural life event that all women experience.
Reviewer's comment:
Not all women experience natural menopause some experience surgically or medically induced
menopause. Be more specific.
Authors:
… , women are spending about a third of their lives in menopause coping with the effects it has
on their quality of life and health, especially in their later years.
Reviewer's comment:
You state that menopause is a normal life phase but then you describe the experiences as having
to “coping” with. This wording suggests a negative view of menopause and one that is often
used in the medically informed discourse of menopause. Please review.
In addition, this is an opportunity to raise and discuss the increase risks of non-communicable
diseases after menopause and the benefits about how information may inform women’s health
behaviour.
Authors:
Women usually experience different symptoms in menopause, such as hot flashes, weight
gain, ...
Reviewer's comment:
1) Not all women experience symptoms related to menopause. There is a body of evidence that
suggests that 20% of women experience no symptoms.
2) There is no evidence that weight gain is a symptom of menopause. In fact, most people gain
0.5 kg every year (recent systematic review)
3) A paper by Weidner and colleagues found that only vasomotor symptoms are the only
symptoms specifically linked to menopause.
4) Check the most current evidence on which symptoms are related to menopause.
Authors:
… inner psychological status, and personal attitudes towards menopause.
Reviewer's comment:
1) What is meant by inner psychological status?
2) The evidence whether personal attitudes influence the menopausal experience is controversy.
Anthropologists have argued that women experience less symptoms and have a positive attitude
towards menopause in societies where women gain in social position.  Other scholars however
have argued that there was no relationship.
Methods:
Reviewer's comment:
The method section needs to be reviewed in terms of clarity. It is very difficult to follow and
if it were to be replicated this would not be possible based on the description and information
provided.
A researcher-made questionnaire is usually described as a “study specific” questionnaire.
Discussion:
Reviewer's comment:
Some sections of the table need to be re-aligned.
Authors:
In Iran, cervical cancer has mainly occured in post-menopausal women between 55 to 65 years
of age. The incidence rate of cervical cancer in Iran is low but the mortality rate is high.
Reviewer's comment:
1) Provide more detail, e.g. state what the incident of Cervical cancer is and the provide detailed
information as to the mortality rate.
The discussion is lengthy and at times does not follow a line of thought. It requires editing to
provide a compelling argument.
Conclusion:
Reviewer's comment:
This study recruited in a clinical setting. Hence, it is unlikely that the findings are representative
of the general female population. This could be added as a limitation.