Reviewer’s report
Title: 
Menopause Is a Natural Stage of Aging: A Qualitative Study
Version: 
0 
Date: 
26 Aug 2020
Reviewer's report:
The paper aims to explore the experience of menopause among women Lanka.
Most research in this area has been focused on western experience, so the paper
is of great interest.
The paper needs careful review and editing for English language errors.
In the abstract, the conclusions seem to bear no relation to the findings.
Introduction
The first paragraph is difficult to follow. The logic behind the first sentence
'Menopause, which is a biopsychosocial phenomenon encompassing the
transition in a woman's life from being fertile to becoming infertile [1], will be
an issue of increasing concern' is not clear. First, women will live the latter
stages of their life in a post-menopausal state, not a 'menopausal' state. Second, it
is not clear why, at this stage, this is a matter of 'concern'. 
And what are
'emotional myths'? 
What are 'midlife events influenced by environmental,
cultural, and historical context'? 
It would be helped by some examples to explain
meaning.
Para 2 - 'low rate of reported menopausal symptoms' - does this meaning
problematic symptoms or just symptoms? 
It would be helpful to point out here
that the experience of menopause varies considerably between women. 
The
following sentence seems to be self-contradictory: 
'There are reasons to believe
that symptoms related to menopause are equally frequent independent of
geographic location, although Asian women report few menopausal symptoms'.
Para 3 - The sentence 'A majority of Sri Lankan women have one or more
menopausal symptoms significantly associated with chronic illnesses and
menopausal symptoms negatively influencing health-related quality of life' is
incomprehensible. It needs expanding. What are these menopausal symptoms
that are associated with chronic illnesses?
Method
Much more detail is required about methods. 
How and where was the study
advertised, how were women recruited? Were gatekeepers used? How was
coercion avoided? How were interviews recorded? What questions were asked?
Was there just one question ("Could you please tell me in your own words about
your menopausal experiences?" )? Ethical approval procedure needs to be
explained. 
'Conventional content analysis' is not specific enough, particularly as the
reference given is entitled 'three approaches to content analysis'. I didn't
understand the analysis process - it needs to be better explained. COREQ is
mentioned in 'methods' but it is no clear how it has been used.
Results
It would help if the results section began with a table summarising the
categories. But surely there are more categories than two? 
For example, women
talk about 'Talking to friends about menopausal problems helped the women to
manage health problems during and after menopause'. How does this fit into the
category 'remaining valuable'. There are 20 interviews between 30-60 minutes
long. The data analysis seems too superficial to do the data justice. The results
section is too short.
The first quotation ends with (20). It is not explained what (20) means.
Participant number?
Discussion & Conclusions
The discussion is well written and very interesting. 
But ….
The discussion and conclusions should relate to the findings of the study - what
these women said. 
Some of these don't bear any relation to the findings; why
recommend HRT when we are given no evidence that this is what women
need/said they need? Is it that the researchers believe that this is what women
need? 
'This conclusion confirms that Sri Lankan women's health-seeking
behavior related to menopausal changes is dependent on a busy life, mainly due
to family involvement'. 
What did the findings tell us about health-seeking
behaviour? 
Do the findings tell us that these women found menopause to be
problematic, and problematic enough to need HRT? 
All this information is
required to justify the claims for the need for primary health care interventions
described in the final sentence. The problem here is that the results section is so
thin, that we cant tell from the conclusions whether they reflect more of the
authors'opinions than their reflections of the findings.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
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Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
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