Title: Factors Associated with Premenstrual Symptoms: A Study among Graduate-Level
Students of the Institute of Science and Technology, Tribhuvan University
Version: 3 Date: 05 Jun 2025
Reviewer's report:
Background: The background section is well-structured and provides a comprehensive overview
of PMS, its symptoms, global prevalence, potential causes, prevalence, and associated factors.
The section clearly highlights the significance of PMS as a common issue among women of
reproductive age and justifies the need for further research, particularly in the context of IOST,
Tribhuvan University.
A few comments to consider enhancing the introduction
1. The first two statements, in addition to other statements in the background, need referencing.
2. The symptoms of PMS are listed multiple times (e.g., in the first and second paragraphs).
Consider consolidating them to avoid redundancy and then focusing on other aspects
3. Consider using “women” instead of “females” for a more natural and engaging tone; also,
“females” can sometimes sound clinical or impersonal.
4. Ensure consistency in symptom descriptions (e.g., “breast tenderness” vs. “breast
discomfort”).
5. The hormonal fluctuation hypothesis is mentioned, but a brief explanation of how estrogen
and progesterone changes contribute to PMS would strengthen the argument.
6. Similarly, the link between nutrient deficiencies (e.g., calcium, magnesium) and PMS could
be briefly elaborated.
7. Use “PMS” and other acronyms consistently after first defining them.
Methodology
The Methods section is well-structured and detailed, providing a clear understanding of the
study design, data collection, and analysis procedures. Reporting Cronbach’s alpha for PSST
(0.961) and DASS-21 (0.848) demonstrates good internal consistency, reinforcing reliability.
The explanation for transitioning from ordinal logistic regression to binary logistic regression
due to violated assumptions is thorough.
A few comments to consider
1. The academic years of 2077 and 2079 within the “study design” are confusing; kindly clarify.
2. A flowchart or diagram illustrating the study design and participant selection process could
enhance clarity.
3. The section reports internal consistency values, but it would be helpful to discuss the
implications of these results.
4. Ensure consistency between “PSST tool” vs “Premenstrual Symptoms Screening Tool
(PSST)” to avoid redundancy.
5. For the DASS-21 Scoring, clarify how categories (normal/mild/moderate/severe) were
derived from multiplied scores (e.g., reference cutoffs).
6. Thoroughly check for grammatical errors, punctuation, and tenses.
Results
The Results section is well-organized and provides a comprehensive statistical analysis of
PMS prevalence, symptoms, and associated factors. The inclusion of multiple binary logistic
regressions and the interpretation of odds ratios strengthens the credibility of your findings. The
prevalence of PMS is clearly stated, and physical symptoms are well-documented with precise
percentages.
Specific comments
1. The link between dysmenorrhea and PMS could be contextualized (e.g., shared
pathophysiology like prostaglandin dysregulation).
2. Thoroughly check for grammatical errors, punctuation, and tenses.
Discussion
The Discussion section is insightful and connects well with existing literature. It effectively
interprets the study’s findings while considering cultural, physiological, and methodological
influences on PMS prevalence. Effectively compares the study’s PMS prevalence (40%)
with prior research (e.g., Kochi city, KIST Medical College), acknowledging methodological
differences.
Specific comments
1. The section jumps between different topics, making it hard to follow.
2. Consider briefly discussing the implications of the findings for practice, policy, or future
research.
3. Thoroughly check for grammatical errors, punctuation, and tenses.
Conclusion
1. The recommendation for stress management is vague. Specify practical strategies could be
suggested or a link to existing interventions.
2. The conclusion could benefit from a more detailed discussion of the implications of the
findings for practice, policy, or future research.
3. The section ends abruptly without a final thought or call to action.