Reviewer ’s report  
 
Title: Prevalence and severity of menopause symptoms among perimenopausal and 
postmenopausal women aged 30 -49 years in Gulele sub -city of Addis Ababa, Ethiopia  
 
Version: 0 Date: 22 Dec 2016  
 
Reviewer: Nancy Reame  
 
Reviewer's report:  
 
 
This report describes some basic characteristics of menopause s ymptoms in a group of women 
ages 30 -49 years from an urban area of Addis Ababa, Ethiopia. Although it is important to better 
characterize the perimenopause experience of women from lower -income, less developed 
countries, especially in non -westernized regio ns of the world, there is a lack of clarify as well as 
several significant methodologic problems in this report in its current form. A list of major 
problems and omissions, and minor concerns are below.  
 
Major concern:  
It appears that this report is a sub study of a larger national (?)study with the restrictive age range 
of 30 -49..this is a significant methodologic problem if the goal as noted in the intro (page 4, line 
12) is to examine menopause symptoms across the perimenopause and postmenopause age 
range, which commonly extends through the mid -50s. Why this particular "slice" of the data 
were analyzed for this purpose, given such a shortcoming, requires stronger rationale. Related to 
this problem, no recruitment methods are provided, no inclusion/exclusi on criteria are given. 
Also, the % of women who did not meet the peri or post definitions is not given.  
There are a number of important inconsistencies that make it difficult to evaluate the key 
findings and their interpretations. For example, the definit ions of menopause  (line3, page 2), and 
premenopause (page 4, line 13) overlap with those used to define perimenopause (page 4, line 
12). Please explain these discrepancies.  
The data in Table 3 suggest that all symptoms were higher in the Postmenopause gr oup, yet, the 
discussion reports that psychologic symptoms were higher in the peri group (line 3, page 12). 
Please clarify and refer to specific tables when reporting these findings.  
Typically before comparing two groups on the outcome variables of intere st, an analysis is 
performed of demographic characteristics in each group in order to determine their potential as 
confounding variables. For eg, were the two peri/post groups similar in age?..education? 
ethnicity?..all of these demographics are known to i nfluence menopause symptoms in other 
populations. Alternatively, why wasn't a multiple regression performed to provide some insights 
on your findings?  
Also, the authors report that the average age of the sample was 40 yrs, and that the average age 
of "meno pause" was also age 40 (see Conclusion) - a surprising finding well -short of the 
worldwide average of age 51. In addition, a third of the group was classified as postmenopausal 
(n=75) , yet just 9 were reported to have experienced induced menopause, so how  to explain this 
somewhat high rate  in such a young sample? Please clarify.  
 
Other points:  
All findings and data tables should be rounded up to just one decimal point or use whatever is the 
journal's conventional standards.  
Descriptive data categories for  education status should be subdivided using more conventional 
groupings. The group " grade 1 -University" provides no insight about the median level…or % 
across the range..a more typical grouping would be: less than high school, high school only, 
universit y, The category "able to read and write vs not able" is confusing: does this apply to 
those below grade 1?  
Please explain the ethnic groups presented in Table 1 - without a clear explanation in the legend 
or text, this information is not helpful for non -African readers. Also how is "orthodox" different 
from Protestant?..  
Why was "loss of interest in sex" used as the menopause symptom to estimate sample size for 
this study.. is this a particularly culture -specific experience in this region? Ie more so than h ot 
flashes, for eg??  
I cannot comment on the appropriateness of the sampling method - an epidemiologist should 
review this section.  
The methodologic limitations described above (especially the upper age limit) should be 
presented in the discussion. Also, the statement "since only menopausal women were selected for 
participation, no comparable group exists" is confusing, as other studie s have used age -matched 
cohorts of premenopausal and even male cohorts (as controls) for symptom comparisons.  
In its present form there are errors in English grammar and syntax; although understandable, 
these erros serve to detract from the quality of th e work. The authors should seek assistance from 
an experienced editor  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
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.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs  some language corrections before being published  
 
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 sa lary 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 public ation 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  declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my repo rt to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creati ve Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to th e open peer review policy of the journal