Reviewer’s report
Title: 
The role of water intake in the severity of pain and some menstrual
distress among females suffering primary dysmenorrhea: A semi-experimental
study
Version: 
1 
Date: 
11 Sep 2020
Reviewer's report:
The authors have done an interesting job of non-pharmacological intervention
based on increasing water intake to decrease menstrual pain in young women
with dysmenorrhea. I believe that the manuscript may be potentially publishable
if improvements are made taking into consideration the following comments:
1-In the title they specify that it deals with primary dysmenorrhea, in the
objective only dysmenorrhea is cited (in general) and in inclusion/exclusion
criteria it is not specified whether an assessment was made by a health
professional to rule out secondary dysmenorrhea or whether women with pelvic
pathology were ruled out...This aspect is relevant, there must be coherence in
title, abstract, objective, inclusion/exclusion criteria in this regard.
2-When citing the inclusion criteria, it is advisable to add references from other
studies that also used it or scientific societies that define it. E.g. self-reporting of
pelvic pain during the first three days of
menstruation in 3 consecutive menstrual cycle over the last 6 months.
3-Under the heading of measures, reference should be made to all baseline and
follow-up measures. It would be interesting to include the questionnaires used
and to add clear information about the times when each one was used.
4-They collected confusing variables? More reference should be made to
variables that are known to influence the intensity of menstrual pain in the
results (if they collected more confounding variables) and especially in the
discussion. Some references I suggest you include: 
-Onieva-Zafra MD etl al. Relationship between Diet, Menstrual Pain and other
Menstrual Characteristics among Spanish Students. doi: 10.3390/nu12061759.
-Bajalan et al. Nutrition as a Potential Factor of Primary Dysmenorrhea: A
Systematic Review of Observational Studies.doi: 10.1159/000495408
5-Did you collect information on other menstrual symptoms related to menstrual
pain?
6-In methods they should better clarify what was compared in control and
intervention groups. That is, the intensity of menstrual pain on the VAS scale
recorded and compared was the highest score for each cycle? Was the compared
analgesic intake recorded per day and compared the highest per cycle and person
between both groups?
7-Please add more information about the sample size calculation, such as what
data you started with.
8-The explanation of data analysis should be more comprehensive. And they
should include the level of significance established.It is not clear to the reader
whether the participants in the control and intervention group were compared
without regard to having followed the instructions.
9-Was there any strategy to avoid abandonment of participants, any technique
and criteria for considering adherence to the intervention?
10-Some information included in results should go in method: figure 1, dates
when the study was developed....
11-In the discussion: it is advised to review and add the following reference to
discuss its results regarding water intake in women with and without
dysmenorrhea.Fernandez-Martinez et al. (2018).Lifestyle and prevalence of
dysmenorrhea among Spanish female university students. doi:
10.1371/journal.pone.0201894 it is also advisable to add the references
previously suggested in this report discussing their results and referring to
possible non-confusing variables collected/analyzed
12-Also the authors should check the whole manuscript since I found some
errors like: p (in upper and lower case in the text throughout the manuscript), in
some data the % is missing after the number...
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