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: 27 Feb 2017
Reviewer: Myra Hunter
Reviewer's report:
This is a cross-sectional study of 131 Swedish primary care attendees aged 45-55 years, with the
Menopause Rating Scale (MRS) and the Montgomery-Asberg Depression Rating Scale (MADRS)assessed as outcome measures; the aims of the study are to estimate the prevalence of menopausalsymptoms in women within Primary Health Care (PHC) and evaluate factors associated withsevere symptoms. While the study has quite specific aims these have clinical relevance to informprofessionals working in primary care settings and the aims of informing preventative strategiesare worthy. Introduction: Page 5: 'The most frequently occurring symptoms during menopause arepain, sleep disorders, physical and mental fatigue, depression and sexual problems [5, 7-10].' Werehot flushes and night sweats not the main symptoms of the menopause in the sample? Pages 5-6While the authors acknowledge that many symptoms reported during mid-life are not associatedwith lowered oestrogen levels and are associated for example with age and stress, the items on theMRS tend to be considered as 'menopausal symptoms' ie attributable to menopause. Theseinclude a range of psychological and somatic items that may have other causes. For example,(page 9) 'The most frequently reported menopausal symptoms were: physical and mentalexhaustion, depressive mood, sleep problems, hot flushes, muscle and joint problems and sexualproblems'. I suggest referring to these items as 'MRS symptoms' and then discussion in the
discussion whether they are attributable to menopause. This is also the case in relation to Fig 1.
where severe menopausal symptoms are considered.Results: P. 10 and Fig 1. 'Depression and agewere associated with more severe menopausal symptoms' - depression is included here as anindependent variable and also items of depressed mood are contained within the dependentvariable - MRS (psychological symptoms) which would increase the association between thesevariables. Menopausal status was not identified in the study so it might be expected that aproportion of the women aged 45-55 would be pre-menopausal. The implication of this should bementioned and discussed in the discussion section as a limitation. If women are not going throughthe menopause transition and complete the MRS how should their scores be considered?Dis-cussion:P 13 'This study confirms previous findings of a high prevalence of mental illness andpsychiatric symptoms during menopause.' It would be helpful to compare the MADRS scores withnorms for the population. On Table 1 no women report severe depression and only 6% reportmoderate depression - the majority having no or mild depression. This does not support theconclusion as stated. 'Furthermore, it seems that the prevalence of depression and menopausalsymptoms increase with age.' Please discuss this finding in the context of the age range included inthis study (45-55) which will include pre and peri as well as post menopausal women. P 14 'It ispossible that early information about menopausal health issues is equally relevant for womenbefore their menopause occurs.' Please refer to relevant literature here as there are studies of health
education interventions for menopause.
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.
Unable to assess
Are 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.
Not relevant to this manuscriptQuality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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