Title: Perception of menopause among women of Sarawak, Malaysia
Version: 2 Date: 17 Dec 2020
Reviewer's report:
The study’s goal is to explore menopause experience among women in Sarawak, Malaysia, and
to investigate socio-demographic factors that might impact their menopause perception. The
study uses semi-structured questionnaires including the Menopause Attitude Scale questionnaire
and focus group interviews. Collected data were stratified by menopause stage and by level of
education. Menopause experience in this population of indigenous Sarawak women has not been
investigated previously.
While the topic of this study is interesting, there are several problems with the manuscript that
makes it challenging to interpret the data and conceptualize the contents.
A major problem is the correct use of the English language. Use of wrong words and incomplete
sentences frequently detracts from the message of the sentences. The manuscript would benefit
from a reviewer native or experienced in the English language. To give a few examples: the word
‘either’ is used instead of the word ‘whether’ in the following sentences:  …51.7% were not sure
either women become less… (Abstract, result section) and …69.1% were not sure either to treat
menopause medically, while 62.1%, were not sure either natural approach… . The following is
not a complete sentence which makes it hard to understand the meaning: “Larroy et al. (2020) in
his study among Asian countries, menopause is treated as a natural aging process, and associated
with higher social status and wisdom among the the communities. [19,20,21,27].” I suspect
the sentence should read: “Larroy et al. (2020) in his study among Asian countries notes that
menopause is treated as a natural aging process and is viewed as being associated with higher
social status and wisdom among the communities.” Other language problems include a variety
of preposition mistakes, typos, and spelling mistakes.
In addition, it would be preferable to add the reference immediately behind the sentence that
quotes or describes outcome from the reference, and not, as is frequently done in this manuscript,
at the end of the paragraph.
The following paragraph in the discussion “However, study by Sinclair et al, noted that majority
of their respondents agreed with the view that, because the menopause is brought on by
diminished hormone levels, it should be viewed as a medical condition and treated as such,
while in two community studies done in Taiwan in recent years revealed Taiwanese women
were highly aware of menopause (97%), with a very positive attitude to accept menopause
and demonstrated great willingness to receive medical treatment. [19-25]” is redundant as it is
already discussed in the previous page.
The references 10 and 29 are identical.
For table 1 it might be preferable to provide age mean or median and age range instead of
numbers in age groups. I realize that the mean age is also given in the text. Also, in this table
please verify the range of household income: is it below 1000 and 1000-2000 or below 1200
and 1200-2000?
I would suggest to combine table 2 and table 3. Stratifying the data by menopause stage and
scale (agree, disagree, not sure) would help to clarify the impact of menopause stage. From table
2 it appears that some women don’t know yet what to expect. These are presumably the pre-
and peri-menopausal women as postmenopausal women should have a better idea of menopause
experience. I am not clear how the data in table 3 relate to those in table 2: shouldn’t the numbers
across the stages for each question add up to the numbers of women that agree to this question
in table 2? I have a similar problem with table 4. The numbers don’t add up to the total number
of women but also don’t add up to the total number of women that agreed (see table 2) to the
perception item. Perhaps it would help to clarify, how this data was derived.