Reviewer’ s report
Title: Changes in six domains of cognitive function with reproductive and chronological ageing
and sex hormones: a longitudinal study in 2411 UK mid-life women
Version: 1Date: 18 Jan 2020
Reviewer: Nancy F. Woods
Reviewer's report:
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Please overwrite this text when adding your comments to the authors.BMC review 011820Understanding the influence of reproductive and chronological aging on cognitive function is
important given the prevalence of cognitive problems and dementia among women. This paperhas provided data that can contribute to understanding the associations of the menopausaltransition (being premenopausal vs postmenopausal) and endocrine function (FSH, LH, AMH)with cognitive function. Some comments related to refinement of the presentation of the datafollow.
1.Inconsistency between definitions within this paper should be corrected. For example, the
introduction states that the STRAW criteria for reproductive aging were used, yet the tables use
different stages, leaving the reader curious about what these stages truly indicate. For example,Table 2 refers to pre-menopause, perimenopause, and postmenopause, as do Table 3 and 4. Pleaseclarify what pre-menopause and perimenopause mean in this context. Also how did youdetermine whether women were in the menopausal transition? Did you use a menstrual calendar?Interview? What were the criteria you used to differentiate late reproductive from the menopausaltransition stages?2.Please include a PRISMA flow diagram to clarify the inclusion/exclusion from the samples usedin the analyses as part of the manuscript, not the appendices.3.Please clarify which women were included in Tables 2, 3, and 4. Which segment/s of the samplewere included for each occasion? Are all women included? Only those with three occasions ofmeasurement?4.Please include the p values and effect measures for the analyses that you report under mainresults in the narrative. It is not possible to understand the magnitude and direction of the effects,as well as their statistical significance as that data are currently presented. In some instances youclarify that results were not significant, but not in all of your results, thus making it difficult todiscern their meaning.5.In the first paragraph of the Discussion, you refer to the modest effects of menopause on the
verbal episodic memory tests. How do these results compare to those from other studies, e.g. the
SWAN results? And how might these results be explained by effects of endogenous estrogen
levels? FSH is usually inversely related to estradiol levels. Is it likely that this might explain theeffect of FSH? Also what interpretation may be made of effects of LH and AMH? Why shouldthese levels be associated with cognitive functioning measures?6.On p. 16 you refer to years since entering the menopause. Do you really mean the yearspostmenopause? E.g. the years FOLLOWING menopause?7.There is recent evidence that would suggest that AMH is a better predictor of the final menstrualperiod/entry to post-menopause than other markers. You may want to update the citations toreflect this.
8.There have been several recent publications related to effects of menopausal transition to
postmenopause on cognitive function, including some that compare women using hormonetherapy to those without the influence of HT. These would be good to consider in your discussion.9.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
YesAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I recommend additional statistical reviewQuality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration of competing interests
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