Reviewer's report
Title:Informing women about hormone replacement therapy: the Consensus
conference statement
Version: 2Date:1 March 2009
Reviewer: Pratima Gupta
Reviewer's report:
The paper addresses an important issue of providing women with correct and
balanced information about the risks and benefits of HRT. This paper is not
providing any new information but has produced a summary of the available
information about benefits and risks of HRT, which can be used by the
professionals and lay public to help them making an informed decision.
Major compulsory revision
In the Methods - Very little information has been given about the population
survey for example- How women were selected, any potential for bias, what was
the response rate and exactly what information was collected.
Results of the population survey are missing in the results section.
Minor essential revisions
Background
Line 10 – It is ‘The Million Women Study’, not ‘One Million Women Study’
The information given about the jury process is too long and can be summarised
in fewer words
Results
On page 12 under section Clinical issues- the statement that other medical
conditions such as depression, weight gain would need medical attention when
they become serious is misleading because these conditions may not be the
symptoms of menopause but they require medical attention as soon as they
develop and should not be left unattended until these become serious.
Discussion –
Some statements need references
e.g. page 15 last paragraph, line 22 – It has been demonstrated that women’s
attitude ----affects women’s use of HRT and Clinicians have a strong influence
and on Page 16, line 3- Some studies have found that women ---- need
references.
In the supplementary document
Page 6, line 10 should read DVT and not DVP
In the same paragraph – A previous history of DVT is not an absolute
contraindication for HRT. Again the reason for DVT should be investigated and a
benefit risk analysis should be performed. A non-oral form of HRT may be
justifiable in some cases after careful analysis of the case.
On page 7 There is no clear evidence for the benefit of Soya products and due to
lack of long-term safety data, these products can not be recommended for
general use at present. Just because vasomotor symptoms are less prevalent in
some Far East countries is not a good enough reason to recommend prescription
of these dietary supplements.
Discretionary revisions
In Methods, Page 7- Grading of the scientific evidence is unconventional
Generally meta-analysis and RCTs are considered as level 1 evidence, well
designed controlled studies as level 2 evidence, other studies as level 3 evidence
and experts opinion as level 4.
Using guidelines from public institutions as the topmost level of evidence
contradicts authors own statement in the background (line 14 - The subsequent
guidelines and recommendations from Italian Medical societies and other health
care institutions disagreed)
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.