Reviewer ’s report  
 
Title:  Why women  choose compounded bioidentical hormone therapy: Lessons from a 
qualitative study of menopausal decision -making  
 
Version: 0 Date: 28 May 2017 
 
Reviewer:  Christina  Bryant  
 
Reviewer’s report:  
 
This paper addresses an important clinical issue, namely the understanding that women have 
regarding bioidentical hormone therapy and the reasons they choose it. Although a qualitative 
approach to this question is appropriate, the paper is overly long and diffuse.  The data it reports 
were also collected 10 years ago and I am not sure how relevant those views are to the current 
landscape.  
 
 
Abstract  
 
The Abstract provides an accurate reflection of the manuscript's content.  
 
 
Introduction  
 
The Introduction provides an adequate overview of the key issues around the intersection 
between menopause and hormone use. The section on the history of HT is interesting but overly 
long. Some specific recommendations:  
 
* On page 4 the paragraph beginning  "This paper uses qualitative…" sounds like the 
conclusion to the Introduction, and as such, should I think be integrated with the final paragraph 
of the Introduction on page 8.  
 
* I think that the omission of any consideration of theories of decision makin g about health 
care is a significant shortcoming and suggest that the authors make some of the material on page 
5-7 more succinct and add a brief review of some of the theoretical underpinnings of health care 
decision making. For example, they may find it useful to refer to the article by Joseph -Williams 
et al. (2014).  
 
 
Methods  
 
* I note that data collection took place in 2007 -2008. The authors need to justify how these 
data are still relevant today.  
 
* Please provide a stronger justification for the use o f qualitative methods and what 
principles guided the selection thematic analysis. Although the term is not explicitly used, it 
sounds like this is the approach chosen.   
 
 
Results and Discussion  
 
* The Results are very detailed, and I believe the main points  could be conveyed more 
concisely.  
 
* On page 20, the authors refer to short -term memory loss and insomnia as  "severe 
menopausal symptoms", but it is not clear that these are established as  core menopausal 
symptoms. I would suggest greater caution in thi s regard, perhaps referring to "…symptoms, 
such as memory loss and insomnia, perceived by some women to be symptoms of the 
menopause" (or similar).  
 
 
Conclusion  
 
I would have liked the conclusion to relate the findings back to the existing literature, and o ther 
studies that have examined women's attitudes to the menopause and HT in particular (e.g., Jin et 
al., 2015, though there are many more). Without this, it is not clear what this study adds. In 
general, I applaud the focus on garnering women's views and  the notion that women are seeking 
more person -focused treatment, but I think the authors could be more specific about how we can 
improve clinical processes so that women do feel they are receiving the individualised care they 
need.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable  to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I de clare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
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