Title: Prevalence of Menstrual Symptoms Change and Influencing Factors among International
Female Students Studying in China during Acculturation Period
Version: 1 Date: 17 Feb 2022
Reviewer:  Nouman Rafique
Reviewer's report:
Thank you for inviting me to review the article entitled" Changes in Menstrual Symptoms
and Influencing Factors among International Female Students Studying in China during
Acculturation Period"
The topic is interesting, I have the following comments .
1: TITLE
Changes in Menstrual Symptoms and Influencing Factors among International Female Students
Studying in China during Acculturation Period
The title should be changed  “Prevalence of Menstrual symptoms and Influencing Factors among
International Female Students Studying in China during Acculturation Period”
2:ABSTRACT
Methodology section must be elaborated. It should provide the details of study tools i.e. at least
the names of all the questionnaires used in the study.
3:  INTRODUCTION
Introduction needs to be rewritten.
Authors should highlight and mention various types of menstrual irregularities i.e. Menorrhagia,
dysmenorrhea, polymenorrhagia, amenorrhea , premenstrual syndromes.
The authors have mentioned about only one type of menstrual irregularity in introduction, which
is dysmenorrhea. They have not mentioned anything about other types.
Authors should explain the pathophysiological basis of menstrual irregularities in Acculturation
Period. They should clearly mention that the main factor during this period is stress, which
can cause menst irregularities. And effects of stress on menstrual cycle should be explained via
physiological mechanism.
4: METHODOLOGY
# How was the sample size calculated?
# How was the questionnaire validated? Any test retest technique was applied?
# The exclusion criteria should also exclude all the students who have some diagnosed
gynecological disorder, like primary amenorrhea, polycystic ovaries etc.
# Authors should mention the importance of scaling in all above questionnaires e.g: classification
into mild moderate and severe stress scores.
Classification of scales for normal or poor sleep quality. and same for others.
# Regarding menstrual symptoms, the authors should provide more details. As this is the main
objective of the study.
# Authors should have focused on various menstrual problems including:  Menorrhagia,
dysmenorrhea, polymenorrhagia, amenorrhea , premenstrual syndromes.
# The symptoms which authors have mentioned [ cramps , irritation (14.78%), abdominal pain
before and during menstruation (12.46% and 11.3%, respectively), fatigue (12.46%), headaches
(9.85%), backaches before and during menstruation (9.27% and 6.95%, respectively), nausea
(9.27%), weakness (8.69%), spasm (6.95%), and abdominal discomfort (6.95%).]…All of these
belong to the category of premenstrual syndrome+ dysmenorrhea.
# The most commonly encountered menstrual problem in stress is amenorrhea or irregular
menstruation. The authors have not asked any question related t it.
# The authors have given the reference of this study
“ Chesney MA, Tasto DL. The development of the menstrual symptom questionnaire. Behavior
Research and Therapy. 1975;13:237-44.” , for the menstrual symptom questionnaire. But when I
read the details of this article, their article is focusing on dysmenorrhea and symptoms associated
with dysmenorrhea , not on overall menstrual symptoms.
The authors should clarify this point in the methodology section. And should elaborate this
questionnaire and its details in the methodology section.
RESULTS
Remove headings from the results section
DISCUSSION
Discussion is well written.