Reviewer’ s report
Title: Prevalence of somatic and urogenital symptoms as well as psychological health in women
age 45 to 55 attending Primary Health Care: a cross-sectional study.
Version: 0Date: 03 Jun 2016
Reviewer: Sara Nowakowski
Reviewer's report:
Manuscript Title: Prevalence of somatic and urogenital menopause symptoms as well as
psychological health in women age 45 to 55 attending Primary Health Care: a cross-sectionalstudy.Submitted to: BMC Women's HealthManuscript ID: BMWH-D-00166Summary: The studydescribed the prevalence of menopausal symptoms in women who were within the primaryhealthcare setting, and the factors that are associated with the severity of symptoms. One hundredand thirty-one women were recruited and data was collected using the Menopause Rating Scaleand the Montgomery-Asbery Depression Scale. Results indicated that exhaustion, depressivemood, muscle, joint problems, sleep, and sexual problems were the most prevalent symptomsreported by participants in the study. It was concluded that cardiovascular risk factors,musculoskeletal symptoms, sexual and sleep problems, and mental health should be assessed inwomen between the ages of 45 to 55. Strengths:*The topic is one that needs to beaddressed.General Limitations: *The lack of control group is a fatal flaw in the study.*The lack ofassessment of menopausal stage is another fatal flaw. There is no way to confirm or deny ifparticipants were peri- or post-menopausal. Given the age of this sample compared to the meanage of menopause in Sweden (m=51 years), it is likely some women are still menstruating (ie.,premenopausal). Therefore, the study is simply measuring symptoms. Not necessarily
"menopausal symptoms" despite questionnaires used.*This descriptive study of prevalence rates
does not substantially add to the literature. *The lack of assessment of comorbidities is alimitation. Additional Points:Title: *Consider removing the term "menopause" as the authors didnot confirm menopausal status in study participants. Abstract:*Page 4, line 4: Please be morespecific on specific "ill-health conditions." *Page 4, line 12: Please clarify, is the aim of the studyto evaluate symptoms using symptoms?*Page 4, line 14: Delineate which "menopausalsymptoms" are being referred to. *Page 4, line 23: Consider changing the term "self-administrated" to "self-reported."*Page 4, line 39: This statement is a recommendation and not aconclusion from what the study findings implicated. Please consider revising. Background:*Page5, line 15: Clarify if it has already been shown that the cardiovascular system, skeletal system,joint/muscles, and urogenital systems are affected how this would be novel and how would thisadd to the literature. *Please add a section on what primary care is and background on it. *Pleaseaddress if menopausal symptoms are under reported and/or under treated. *Consider reviewingstudies such as SWAN and WHI as this have added information to the literature regarding theprevalence in general of menopausal symptoms (or similar epidemiological studies in Sweden).*Provide justification as to the need to assess prevalence specifically in this population.Methods*Please delineate that this was a convenience sample as this is important to document.*Please provide clarification on how this sample was known to be either peri or post-menopausal,
and if it was by patient-report or confirmed by their physician. *Please clarify if STRAW staging
criteria was used. *Please also include information on the sample inclusion and exclusion criteria
as they relate to current medications, use of hormones, and use of anti-depressants. *Please clarifyhow the authors assessed the relationship between age and symptoms if limiting the inclusioncriteria to one decade. Data Collection:*Clarify if the versions of these instruments were translatedinto Swedish and then validated. How were the instruments translated?Statistical Analysis:*Pleaseclarify why a continuous regression was not utilized. *Clarify why the MADRS variables weredichotomized and not left as continuous. *Page 9, line 8: Clarify why the forward stepwiseregression was done versus a multiple linear regression or hierarchical regression. The stepwisemethod excludes based on statistical significance and is not the best approach. Results:*Please
clarify if the MADRS score was compared to the MRS score. Both of these questionnaires
measure psychological symptoms. Collinearity makes it inappropriate to compare these twomeasures. Discussion:* Page 10, line 27: Please clarify this statement as it is very confusing.*Page 10, line 30: The lack of assessment or obtaining information (through chart review) aboutmedical and psychiatric co-morbidities and medication use is concerning. *Page 10, line 44:Consider removing the line regarding stress as this was not assessed in this study. *Please discussthe association between depression, age, and menopausal symptoms. *Did authors analyze item-by-item? Was the questionnaire designed and validated to do so? *Page 12, line 41: This sectionis far reaching as the authors did not analyze cardiac effects/symptoms. Please omit.*Page 13, line51: The change in life, crisis, and illness was not addressed on the questionnaires therefore itemssuch as this one should not be discussed.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
NoAre the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
NoAre 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 am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
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