Title: The quality of life and work productivity are affected by the presence of nausea/vomiting
in patients taking iron preparations for heavy menstrual bleeding or anemia: A population-based
cross-sectional survey in Japan
Version: 1 Date: 09 Nov 2023
Reviewer's report:
This study addresses the important issues regarding the impact of nausea and vomiting on
the quality of life (QoL) and work productivity in patients taking iron preparations for heavy
menstrual bleeding (HMB) or anemia. It is known that gastrointestinal adverse effects, such as
nausea and vomiting, appear in up to 30% of patients taking iron preparations, which decreases
patients’ adherence to appropriate treatment. The adverse effects of iron preparations may
affect the QoL and work productivity of patients with the symptoms of iron-deficiency anemia.
Evaluation of patient-reported outcomes (PROs) reflective of QoL and work productivity has
been increasingly recognized and is worthy to reflect the therapeutic effect. Thus, this study
aimed to understand the relationship between nausea/vomiting and QoL and work productivity
in patients taking iron preparations for HMB or anemia is of interest and importance to the
readers of the journal.
Overall, this is a clear, concise, and well-written manuscript. The introduction is relevant and
quite sufficient for readers to follow the present study rationale and procedures. However, there
is one important concern. In the title it stated that the study aims to the impact of nausea and
vomiting on QoL and work productivity in patients taking iron preparations. However, the
design of this study is cross-sectional and only comparisons between groups with and without
nausea/vomiting were made. It is not enough to characterize the impact of nausea/vomiting on
QoL and work productivity. The results obtained clearly state that QoL and work productivity
are affected by the presence of nausea/vomiting in patients with taking iron preparations for
HMB or anemia.
The methods are in general appropriate. One comment - the comparative analysis was not
matched in terms of age, terms of nausea/vomiting etc.
Overall, the results and discussion are clear and compelling. The tables and graphs are
appropriate and they are appropriately labeled.
The study has several limitations. They are definitely described in the Discussion. One of the
serious limitations of the study (it is mentioned in the discussion) is the lack of a longitudinal
study to explore the impact of nausea/vomiting on  QoL and work productivity. Another
limitations is that the evaluation of the impact of nausea/vomiting on  QoL and work productivity
should be conducted in a comprehensive way, using different approaches.
Thus, there is one major comment.
- The title, the study aim and conclusions should be more concise and reflect the methods and
results obtained. It is unlikely to state that the impact of nausea/vomiting on  QoL and work
productivity was studied. The results obtained are not comprehensive enough to make such
conclusions.
To sum up, the manuscript is of good quality and provides demonstration that  nausea/vomiting
are associated with impaired  QoL and work productivity in patients with taking iron preparations
for HMB or anemia.