Reviewer's report 
 What aspects of periods are most bothersome for women reporting heavy menstrual bleeding? Title: 
Community survey and qualitative study 
 1  1 November 2006 Version: Date: 
 Mark Shapley Reviewer: 
Reviewer's report: 
General 
This interesting paper consists of a further analysis of information gained from a previously published cross-sectional survey in combination with a new study using qualitative methodology. This is a significant strength as the combination of approaches improves the validity of the qualitative research as well as 
providing quantative data not previously published. 
I do however have a number of concerns, which I will put in the format you require. 
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Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
1. Originality 
The qualitative study replicates the work of others performed in primary and secondary care as the authors 
acknowledge. They claim originality, as the participants in the survey are a community population. They do 
not in the paper state whether or not they have excluded women who have consulted with primary or 
secondary care from their analysis of the community survey or excluded such women from the qualitative study. It is therefore not know if the participants are truly different from those in previously published studies. If they are then the study provides new and important information. If they are not then the work 
largely confirms the findings of previous studies. 
2. Conclusions 
As the premise for the originality of the study is that the population has not consulted primary or secondary 
care then any inferences drawn from the data should not be related to the consultation. The authors 
acknowledge that women who consult with heavy menstrual bleeding and those that do not consult are different but they give recommendations as to what to do in a consultation despite the study being based on 
data from a different population (women who have not consulted). I would suggest a greater emphasis is put 
on self-help leaflets, posters, websites and community education programs including the media and all 
reference as to what to do in a consultation removed. 
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Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
Page 4 background (Coulter et al) should be (3) 
Typo page 5 first line final paragraph should not contain a ?. 
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Discretionary Revisions (which the author can choose to ignore) 
1. Abstract 
I found the results section unclear and would suggest structuring it into cross-sectional survey and 
qualitative study. 
2. Background 
Very good but why reference the Third National Morbidity Survey in preference to the more recent Fourth 
National Morbidity Survey? 
3. Methods 
The process of randomisation is not given. Any validation of the process for the classification of the free-text 
responses into the categories used? Who classified them and could this be a source of bias? 
How were the 32 women selected for the qualitative study out of all the women with the particular 
characteristics? There does seem to be a large proportion of nurses. 
4. Results 
No information is given about differences between responders and non-responders although this is present 
in the previously published paper on the cross-sectional survey. Perhaps reference should be made to this? 
Overall I enjoyed reading the paper and it gave me insight into the problems women have. I do need to be 
convinced that I could not have gained this from reading previous research although it has value in 
confirming the conclusions of previous studies. 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests.