Title: A survey assessing the impact of symptoms related to the menstrual cycle and perceptions
of workplace productivity: considerations for employer-sponsored menstrual health programs
Version: 2 Date: 08 Oct 2024
Reviewer's report:
Thank you for the opportunity to review this article.  Overall, the article and research is very
good.  Please find the following comments to help with the clarity of this article:
INTRO:
Line 76-79.  "Developing..."  A strong statement here.
Line 77: "...lacking..." is slang --> limited?
METHODS:
Under study design, include  the 20 minute self-report survey  and in an appendix, list the
questions for transparency.  Perhaps naming this survey  (The One-Time Self-Report Survey or
something along those lines) would be beneficial for the readers so that they understand that this
survey is different from the one listed.  After the initial survey, then list the EFPQ
LIne 120.  A sentence is needed here to say about using the questionnaire in the current study
for clarity.
**I appreciated that the study included women who had natural and/or hormone-induced
menstrual cycles.  Also, women were included who were/were not using contraception.
**The authors addressed the first reviewers questions and included their suggestions in the
paper.
** A strong addition was including menstrual stage in the questionnaire.
Line 201.  " Akaike Information Criteria (AIC)..."
RESULTS.  The results were displayed in easy-to-understand Tables and the writing of the
results was clear.
Line 231.  "All symptoms remained prevalent throughout the entire cycle."  This statement is
confusing because it implies cramping and bleeding during the late follicular and luteal phases.
From what I read, most of the symptoms were reported from women in each phase, and the
impact was on a scale in terms of severity (increased/decreased).
Line 238.    "Comparisons across the three phases revealed..." is a stronger sentence.
Line 299.  "Participants were more likely to report more positive perceptions of energy and
more negative perceptions of relationships with their co-workers in Phase 4 compared to Phase
1."  This result is very curious and part of it (work-related productivity) was addressed in the
discussion.  Any thoughts about the negative perceptions of relationships?
DISCUSSION:
Line 335.  The inclusion of symptom clusters is important here as well as the "real world
experience" of symptom clusters.  Nicely phrased.
Line 338.  "Sixteen bleed-related disturbances...were reported... (See Table 3).
Line 339.  "This could..." --> These disturbances... (A noun is needed after "this").
Line 342.  What did the PMS education checklist include that reduced the MDQ scores?  More
detail is needed here.
Line 367-377.  Please consider addressing the negative perceptions of relationships with
coworkers in addition to increased productivity.
Line 387.  "Like our findings" --> Similar to this study's findings...
Line 393.  "This is ..."  --> This interest or desire is... (A noun is needed after "This").
Line 396.  Ending a sentence with a preposition ("in").   --> ... might be something in which
they participate.
Line 412.  "Other considerations... demographic stratifiers, for example, ...  More detail is needed
here.
Line 413.  "...programming against the presence of specific symptoms..."  This sentence is
ambiguous.  For example, ... ?  More detail is needed here.
Line 418 "lacking" is slang.  "...limited.."?
Line 423.  "...lack of..."  Using limited or diminished is suggested.