JerMa88/BMC_Womens_Health_Peer_Reviews huggingface dataset:
Title: Early Menopause as an Independent Risk Factor for Postoperative Atrial Fibrillation in
Women Undergoing Coronary Artery Bypass Grafting: A Retrospective Cohort Study
Version: 2 Date: 19 May 2025
Reviewer's report:
Haokai Qin et. al. explored the association between early menopause and the occurrence of
postoperative atrial fibrillation (POAF) after coronary artery bypass grafting. This study showed
that the early menopause group adjusted with the inverse probability of treatment weighting
(IPTW) analysis had higher rate of occurrence of POAF. Authors also revealed that the early
menopause might be the predictive factor of the POAF using the univariate and multivariate
logistic regression analysis or the subgroup analysis. This study is very interesting and valuable
for the clinical practice.  However, several issues need to be addressed to strengthen the
manuscript.
1. The authors are encouraged to assess the preoperative use of cardioprotective medications,
including the so-called "fantastic four" (particularly beta-blockers) and statins, as these agents
may have a protective effect against the development of POAF. Clarifying medication data could
enhance the interpretability of the subgroup analyses. For instance, these analyses may reveal
that POAF is mitigated by these medications in patients with hypertension or dyslipidemia, and
that early menopause may attenuate the protective effects of such therapies, thereby contributing
to POAF development.
2. If patients who underwent emergency surgery were included in the study cohort, the
proportion of emergency procedures should be reported and incorporated into the statistical
analysis.
3. Please provide a rationale for the selection of variables included in the multivariate logistic
regression analysis.
4. In the subgroup analysis, it is unclear why patients aged over 70 years were affected by early
menopause. This finding may imply that the duration between last menopause and surgery, rather
than the age at menopause itself, is a determinant of POAF risk. If the duration is indeed the key
factor, then late menopause might confer a protective effect, rather than early menopause being
detrimental. I recommend the authors to investigate the association between the last menopause-
to-surgery interval and POAF incidence.
Title: Early Menopause as an Independent Risk Factor for Postoperative Atrial Fibrillation in
Women Undergoing Coronary Artery Bypass Grafting: A Retrospective Cohort Study
Version: 3 Date: 05 Jun 2025
Reviewer:  Tongku Liu
Reviewer's report:
The title of the revised manuscript is “Early Menopause as an Independent Risk Factor for
Postoperative Atrial Fibrillation in Women Undergoing Coronary Artery Bypass Grafting: A
Retrospective Cohort Study”.
The author has made meticulous modifications to this article as per the reviewers' comments
and suggestions, and the quality of the revised manuscript has been significantly improved
especially the change of the title from "The Correlation Between Early Menopause in
Women and the Incidence of Postoperative Atrial Fibrillation After Coronary Artery Bypass
Grafting: A Retrospective Cohort Study" to "Early Menopause as an Independent Risk Factor
for Postoperative Atrial Fibrillation in Undergoing Coronary Artery Bypass Grafting: A
Retrospective Cohort Study", which makes the title better reflect the main content and research
purpose significance. I have no new comments or suggestions on the content of the revised
manuscript after reading the revised manuscript.
Title: Early Menopause as an Independent Risk Factor for Postoperative Atrial Fibrillation in
Women Undergoing Coronary Artery Bypass Grafting: A Retrospective Cohort Study
Version: 3 Date: 16 Jun 2025
Reviewer's report:
The authors have adequately addressed our concerns and made appropriate revisions. However,
there is one additional point I would like the authors to address. In their response, they stated:
"Reply: Thank you very much for your review. The covariates included in the multivariable
regression analysis were chosen based on their established association with adverse outcomes
after cardiac surgery."
I recommend that the authors cite relevant references to support this statement.
Title: Early Menopause as an Independent Risk Factor for Postoperative Atrial Fibrillation in
Women Undergoing Coronary Artery Bypass Grafting: A Retrospective Cohort Study
Version: 5 Date: 24 Jul 2025
Reviewer:  Tongku Liu
Reviewer's report:
The authors have made significant revisions to the manuscript based on the reviewers'
suggestions, substantially improving its quality.
Title: Perspectives on fertility preservation among women living with breast cancer in Ghana
Version: 4 Date: 24 May 2025
Reviewer's report:
This is a very important study for young, premenopausal women who are diagnosed with breast
cancer.  It would have been a stronger study if the cohort included younger women, particulary
those who are nullipasous or with a desire to have additional children. Those already in their late
40's most likely do not have a strong interest in having additional children and skew the results
of this study.  Women in their 40's who have completed their families may not be interested in
further discussing FP.
While this is a qualititave report, statements such as "some" and "most" are relative terms. If
only two women commented, then that should be stated clearly (ie 2 of 15 report....).  Also with
so few participants, critical data such as patient age, educational level and number of children
should have been actively sought and reported. One grammatical error (Section 3.2.1 - who
should be whom).
Recall may not be accurate and a physician may have asked about interest in FP or at least
skirted the issue.  The issue may not have been addressed in the women in thier 40's or those who
have comleted their families. The shock of a diagnosis of breast cancer may be overwhelming
and overshadow any other conversation. I strongly caution against overly bold statements  such
as "the results indicate a significant gap in FP awareness and FP counselling for women with
a diagnosis of breast cancer in Ghana".  The opening statement in the discussion should have
clarified that only 15 women were interviewed and some (! - how many???) may not have an
interest in FP. Study design is not ideal to make strong statements about FP and premenopausal
women diangosed swith breast cancer.
Title: Perspectives on fertility preservation among women living with breast cancer in Ghana
Version: 4 Date: 27 May 2025
Reviewer:  Vivian F. Saria
Reviewer's report:
Congratulations for the Good work.
The introduction is well elaborated, and the Methodology part is well done. A few comments,
at least briefly, can be seen in the following areas.
1. Participants' Recruitment and sampling are not being described
2. The pilot was not seen
3. The trustworthiness of the study was not mentioned
4. How did the saturation reach?
Thanks
Title: Influencing factors on bone mass abnormalities in Tibetan adult females from a
socioeconomic perspective
Version: 4 Date: 08 Jul 2025
Reviewer:  Peter Bernstein
Reviewer's report:
This is overall a very important study and I strongly encourage the team for further research in
order to influence the right policy.
However, in Table 1 - the reporting of relative numbers leads to a counter-intuitive impression.
E.g. 75% of normal bone mass women had not been to school but only 24% of the women in the
abnormal bone mass group ??? This does not allow for your conclusion that educational status
plays a critical role. In order to display patterns, you should sum up to 100% within each group.
Beside this major issue, I only had some minor comments (language), which I included in the
commented manuscript.
Title: Association Between Osteoporosis and Severe Depressive Symptoms Among
Postmenopausal Women attending Tertiary Outpatient Clinics in Nigeria: A Cross-Sectional
Study
Version: 0 Date: 18 Jun 2025
Reviewer's report:
Comments
1. From line 70 on page 3 to line 81 on page 4, “The findings reveal…” Should be moved
to the discussion section of the manuscript, and does not need to be stated under background/
introduction. They are the findings from your study, which should be mentioned in the discussion
section of the manuscript.
2. On page 4, lines 81 to 85, “The present study…” These are the objectives of your studies that
have been highlighted under the abstract section. YOU DO NOT NEED TO REPEAT THEM
HERE. KINDLY REMOVE THEM APPROPRIATELY.
3. On page 4, the sentences starting from lines 85 to 95, “This study contributes to the…” should
be REMOVED and put under the subheading RECOMMENDATIONS AND CONCLUSION
AFTER THE DISCUSSION SECTION.
4. Line 100 on page 4, check the correct spelling for “Purposively”
5. Line 110 on Page 5 should be reframed as, “The postmenopausal women who did not meet
the inclusion criteria were excluded from the study.”
Title: Association Between Osteoporosis and Severe Depressive Symptoms Among
Postmenopausal Women attending Tertiary Outpatient Clinics in Nigeria: A Cross-Sectional
Study
Version: 0 Date: 07 Jul 2025
Reviewer's report:
The study fills a gap in LMIC literature on comorbid osteoporosis and depression, aligning with
WHO priorities for integrated NCD care. However, the following points are noted:
1)  The study mentions recruitment across six geopolitical zones - what tertiary hospitals and in
what states? They need to be mentioned for transparency.
2) A graphical illustration (figure) of how the randomization and  clusters were selected will
prove invaluable and provide clarification.
3) Has the tool ODAQ been validated for use in Nigeria? Please state and provide reference.
4) In the result section: Report effect sizes (e.g., odds ratios) alongside p-values to quantify
associations.
5) Discussion: Please explain the higher depression in non-smokers  rather than stating it without
interpretation.
6) Ensure all citations follow journal formatting guidelines (e.g., consistent use of "[1]" vs. "1.").
Title: Attitudes of Women Towards Uterus Transplantation in Turkey: A Cross-sectional Study
Version: 2 Date: 06 Mar 2025
Reviewer's report:
1. Nicely written manuscript
2. In the abstract it is mentioned  that survey was face to face and online whereas in the
methodology its written only online. so kindly mention the mode of survey.
3. The conclusion in abstract and main text is not matching.
Title: Environmental heavy metal exposure and altering anti-Mullerian hormone levels in
women
Version: 2 Date: 23 Apr 2025
Reviewer's report:
1. Study Design and Causality
The cross-sectional design limits the ability to establish causality. While the analysis adjusted
for age, BMI, and lifestyle factors, the observed inverse association between Cu and AMH may
reflect correlation rather than a direct biological effect. Longitudinal studies are needed to assess
temporal relationships and confirm whether Cu exposure accelerates ovarian aging.
2. Confounding Factors
Hormonal Contraceptives: Hormonal contraceptives, particularly combined oral contraceptives,
are known to suppress AMH levels. If contraceptive use differed across Cu quartiles and was
not adequately adjusted for, this could bias results.
PCOS Status: Elevated Cu levels are linked to polycystic ovary syndrome (PCOS), which is
associated with higher AMH. The study did not specify whether PCOS was excluded or adjusted
for, potentially confounding the results.
3. Inconsistent Findings with Other Metals
The lack of significant associations with cadmium (Cd) or lead (Pb) contrasts with prior research
linking these metals to lower AMH. This discrepancy may arise from differences in exposure
levels, population characteristics, or biomarker selection (serum vs. urinary measurements).
4. Clinical Relevance
The reported reductions in AMH (0.34–0.43 ng/ml) with higher Cu quartiles are modest. AMH
naturally declines with age (e.g., a 30-year-old woman has a median AMH of ~2.1 ng/ml, falling
to ~0.5 ng/ml by age 45). The clinical impact of Cu-associated declines on fertility or time to
menopause remains unclear.
5. Mechanistic Uncertainty
The study does not explore biological mechanisms. Copper’s role in oxidative stress
or interactions with hormonal pathways (e.g., hypothalamic-pituitary-gonadal axis) could
theoretically affect ovarian reserve, but this requires experimental validation.
6. Measurement and Exposure Assessment
Serum Cu levels may not fully reflect long-term exposure compared to urinary biomarkers.
Heavy metals often co-occur in the environment; the analysis did not address potential
interactions or multicollinearity between metals.
Title: Environmental heavy metal exposure and altering anti-Mullerian hormone levels in
women
Version: 2 Date: 25 Apr 2025
Reviewer:  Yigit Cakiroglu
Reviewer's report:
General comments:
This interesting and important study has aimed to investigate the association between serum
concentrations of heavy metals with AMH. They have reported decreased AMH levels with
increased serum levels of Cu. The main concern about the methodology is the attribution of
decrease in AMH levels solely on metal levels.
Abstract:
The abstract section reflects the summary of the whole MS.
Introduction:
Information about AMH, ovarian reserve, heavy metals have been given in the introduction
section.
Methods
Study design, type of the study and statistical analysis have been defined in this section. The
analysis has been performed in a long follow-up period with multiple measurements.
Results
The results have been reported in regards of the analysis.
Discussion
The discussion section states the significance of the findings.
References:
The reference section contains appropriate and number of references.
Tables:
Tables are well-designed.
Figures:
Figures are demonstrable.
Title: Environmental heavy metal exposure and altering anti-Mullerian hormone levels in
women
Version: 3 Date: 17 May 2025
Reviewer's report:
1. Causality vs. Association:
The conclusion implies a potential causative link between copper levels and reduced AMH, yet
the cross-sectional nature (use of stored samples from observational study) only supports an
association. The language should be more cautious to avoid implying causality.
2. Adjustment for Confounders:
While multiple confounders were adjusted for, dietary intake (especially copper-rich foods or
supplements), occupational exposure, and environmental sources of heavy metals are important
missing variables that could significantly bias the association.
3. Biological Plausibility Not Addressed:
The study fails to discuss why or how copper specifically may affect ovarian reserve or AMH
biologically. Without a hypothesized mechanism, the association remains speculative.
4. Statistical Significance Without Clinical Context:
Although the reduction in AMH is statistically significant, it is unclear whether a decrease of
0.34 to 0.43 ng/ml is clinically meaningful in terms of fertility or ovarian function.
5. No Longitudinal Analysis:
Despite access to repeated samples (second and fifth follow-ups), the analysis appears cross-
sectional. A longitudinal approach could better assess temporal relationships between heavy
metal exposure and AMH decline.
6. Quartile Analysis Without Dose-Response Clarity:
The third and fourth quartiles of Cu show association, but lack of consistent dose-response
weakens confidence in the association. The second quartile data is not mentioned, and the
absence of a trend test is a limitation.
7. AMH Variability and Measurement:
There is no mention of AMH assay methods, inter-assay variability, or sample degradation over
time, which can critically affect hormone level interpretation from stored samples.
8. Sample Selection and Generalizability:
The study population is limited to TLGS participants, potentially limiting external validity.
Cultural, environmental, or genetic factors unique to this cohort may not apply to broader
populations.
9. Null Findings for Other Metals Under-Explored:
The lack of association with Pb, Cd, Al, and Cr is not discussed. This could reflect limited
exposure, measurement error, or low statistical power, which warrants mention.
10. Potential Residual Confounding:
Even with multivariate adjustment, residual confounding from unmeasured variables (e.g.,
endocrine disruptors, other pollutants) cannot be ruled out and should be acknowledged.
Title: The Effect of Exercise On Menstrual Symptoms: A Randomized Controlled Trial
Version: 2 Date: 27 Jul 2024
Reviewer's report:
Dear editor
Thank you for the opportunity to review this manuscript, entitled: "THE EFFECT OF
EXERCISE ON MENSTRUAL SYMPTOMS: A RANDOMISED CONTROLLED TRIAL".
This manuscript has some issues. Here is some feedback.
- Line 3; The word of “impact” should be replaced with “effect”.
- The method of random allocation must be clarified in the abstract section.
- The results in the abstract section should be reported with effect sizes and other statistical
values.
- Please explain more the rationale of study.
- Please define completely primary and secondary outcome measures in the Methods section,
including how and when they were assessed.
- Please specify that who generated the random allocation sequence, who enrolled participants,
and who assigned participants to interventions.
- Lines 15-16; Please revised the sentence of “Randomization was carried out using the sealed
envelope method.”  Sealed envelope is used for allocation concealment not randomization.
- Please clarify that one-sided # has been used in the determination of sample size or two-sided #.
- Why the Kolmogorov-Smirnov test has not been used to determine normality.
- Please clarify in the Data Analysis subsection that which variables had non-normal distribution.
- Please specify whether the analysis was done based on intention-to-treat or not?
- The numbers in the tables must be written correctly.
- The statistical tests used for comparison of study group in terms of demographic characteristics
must be specified in the Table 1.
- Please use ANCOVA test for variables with normal distribution.
- The discussion is not in-depth. Please revise it.
-  Please discuss about potential biases and generalizability (external validity, applicability) of
the study findings in the Discussion section.
- Please report the implications of the study findings in the Discussion section.
- The manuscript should be revised by a native speaker.
- The references style is incorrect. Please follow the author guidelines carefully.
- The reasons for exclusion and lost to follow-up must be reported in the consort flow diagram
(Figure 1).
Thanks
Title: The Effect of Exercise On Menstrual Symptoms: A Randomized Controlled Trial
Version: 2 Date: 28 Jul 2024
Reviewer's report:
The authors aimed to explore the impact of exercise on menstrual symptoms, focusing on sleep
quality, fatigue, and physical activity levels. They did a randomized controlled trial and provided
some interesting data. However, the authors did not conduct the study in a well-designed way.
Therefore, it could not be accepted for publication as the current manuscript shown.
The following points are examples of the major disadvantages:
1. The authors did not explain well how to recruit the participants, especially only the menstrual
patterns were documented. Did they aware of the purpose of the study during the evaluation
process?
2. It seemed that the placebo effect in the excise group could not be ruled out as the control
group did not receive any intervention in this study.
3. The authors did not provide the definition of menstrual symptoms in this study. Furthermore,
sleep quality and fatigue were also included in women with menstrual symptoms in this study. It
seemed to contribute more confounding factors in the analysis of  the specific impact of exercise
on symptoms during menstruation.
Overall, the authors did not provide evidence-based data to conclude that exercise programs
may be effective in relieving menstrual symptoms.
Title: The Effect of Exercise On Menstrual Symptoms: A Randomized Controlled Trial
Version: 2 Date: 03 Aug 2024
Reviewer:  Ghada E. El Refaye
Reviewer's report:
-Thank you for your effort, the point of research is very essential
1- The full paper is already published on line since
4 days and this is the link: https://www.researchgate.net/
publication/382621877_The_Effect_of_Exercise_On_Menstrual_Symptoms_A_Randomised_Controlled_Trial
with DOI:10.21203/rs.3.rs-4669670/v1,   how this come before the revision and acceptance of
the journal?
2- The study wasn’t registered on clinical trials as they said in the paper, I referred to the clinical
trials site there was no registrations with this number.
Trial registration: The protocol is registered with http://clinicaltrials.gov/ (17/August/2023,
Clinical Trial, NCT06006507), Please revise the registrations.
3- The research is traditional, Lack of novelty in the research.
4- Although the introduction is covered all the research variables. Instead it's poorly organized
with no flow.
- rearrange the introduction,
5- The introduction doesn't show the knowledge gap.
6- In the abstract section you write the study included 54 women aged 19 to 45 years, then you
write in the inclusion criteria were as follows: signing the voluntary consent form, being between
the ages of 18 and 50, please unify the ages.
7-  The female ages range is very large and above 45 years almost having irregular menstruations
because the starting of premenopausal period.
8- There are some language mistakes in the manuscript, so it needs language editing.
9- The discussion needs rewriting, is so short, please add more paragraph.
10- Please, clarify the mechanism of how exercise can improve the menstrual symptoms??
11- Please, check the plagiarism percentage of this paper.
Title: The Effect of Exercise On Menstrual Symptoms: A Randomized Controlled Trial
Version: 2 Date: 05 Aug 2024
Reviewer's report:
Dear Authors
The new article mentions the symptoms of menstruation, while the introduction deals with the
symptoms of premenstrual syndrome. In my opinion, it is better to refer to the symptoms of
premenstrual syndrome or PMS.
In the method, given that the participants were aware of the type of intervention that is being
done for them, how is it said that the study is single blind?
Line 22 of page 4 is similar to line 14 of page 5. In order to avoid repeating the content, it referred
to the Consort checklist and wrote articles based on it.
It is necessary to explain more about the random allocation of people in two groups and the
method of concealment.
Regarding the number of people participating in the study, in the method and results, different
amounts have been reported in the control and intervention groups, which is confusing.
What was the analysis model of the present study based on? Analysis with intention to treat or
per protocol?
In the exclusion criteria, it is said that the people who were included in the study should not have
been included in the study, so how in the variables of Table 1, people with a history of sports
were included in the study? Does the habit of exercise mean the current practice of exercise?
In my opinion, treatment is not the right way to exercise, but exercising is a type of intervention,
not treatment.
I did not understand exactly how many weeks or months the intervention was done? Does the
applied intervention have a standard protocol? If there is, it should be referenced.
Well written discussion
Title: The Effect of Exercise On Menstrual Symptoms: A Randomized Controlled Trial
Version: 3 Date: 12 Oct 2024
Reviewer:  Ghada E. El Refaye
Reviewer's report:
-Thank you for your effort,
1- The point of research is lack of novelty.
2 *introduction:
Although the introduction is covered all the research variables. Instead it's poorly organized
with no flow.
- rearrange the introduction,
3- There are some language mistakes in the manuscript, so it needs language editing.
4- The introduction doesn't show the knowledge gap.
5- The discussion needs rewriting, is so short, please add more paragraph