Reviewer ’s report  
 
Title: Preval ence and severity of menopause symptoms among perimenopausal and 
postmenopausal women aged 30 -49 years in Gulele sub -city of Addis Ababa, Ethiopia  
 
Version: 0 Date: 06 Jul 2016  
 
Reviewer: Nese Yuksel  
 
Reviewer's report:  
 
Thank you for the opportunity to review the manuscript "Prevalence and severity of menopause 
symptoms among pe rimenopausal and postmenopausal women aged 30 -49 years in Gulele sub -
city of Addis Ababa, Ethiopia".  In this manuscript the authors describe a cross -sectional survey 
to assess the prevalence and severity of menopausal symptoms in peri and postmenopausal 
women in Ethiopia.  The authors indicate that this is the first study on the experiences of 
menopausal women in Ethiopia.  
Overall the manuscript is well written.  I have several suggestions that may assist the authors 
with further revisions.  
 
Major Compuls ory Revisions  
Background:  
P4, line 13 -14 - Definitions of perimenopause and premenopause in the background are not 
consistent with current definitions (ie premenopause is defined as prior the change in menstrual 
cycle, not the "one or two years preceding menopause", perimenopause refers to the time where 
irregularities in menstrual cycle are seen with symptoms).  Suggest following the STRAW 
definitions for consistency. Harlow et al. Menopause 2012;19(4):119.  
 
Methods:  
Study selection and subjects: More det ails on subject recruitment would be helpful. For example 
how was the information about the study population obtained (ie how were ages available, how 
were the women identified)?  How were the women contacted?  
Was there any other exclusion criteria?  For  example did you exclude women with certain 
medical conditions (for example breast cancer, chronic diseases such as renal/hepatic failure 
etc)?  If not, was this information collected from the women (should be presented as part of the 
demographics).  
Data collection instruments: Was use of hormone therapy or CHC asked as well? Was different 
medical conditions captured - especially ones that may add to symptoms (for example thyroid)?  
Was BMI/weight collected?  Smoking status? This background data is importa nt in interpreting 
the prevalence/severity of menopausal symptoms.  
 
Results:  
P9, Lines 7 - 15, Table 1:  The following information would be helpful in this section: number of 
women with hysterectomy, breakdown of the iatrogenic causes as mentioned in methods (BSO, 
chemotherapy/radiation induced), smoking status, BMI if available, m edical conditions that may 
have overlapping symptoms with menopause.  All of this information is important in interpreting 
the presence and severity of menopausal symptoms.   
Other information needed for postmenopausal women - age at menopause (ie LMP) an d duration 
in menopause (for example number of years since LMP).  
How was monthly income (wealth quintiles) decided?  Should include how this was classified in 
methods.  
 
Discussion:  
P12, lines 15 -16: Where was the "age of 49 years" obtained - reference?  Does the age of 49 
years refer to both peri and postmenopausal women?  Does it refer to the start of menopausal 
symptoms?  It is difficult to compare the mean age in your study with this reference range 
without some idea of timeline since last LMP for pos tmenopausal women.  The age of 40 years - 
is the mean age in your sample but may not represent the same thing as the reference range of 
"49 years".  
P12 - 13 - It may be helpful to have information on HT use or other treatment options for 
menopausal sympto ms.  This will provide some context when interpreting the symptoms and 
severity reported.   As well it would be helpful to have demographic information such as 
smoking status and other medical conditions to be able to interpret the findings.  
 
Conclusion:  
P14, Line 1 - "age of menopause was 40.1 years".  Be cautious in indicating this as the age of 
menopause.  This is the age of your sample, not the age of menopause.  
 
Discretionary revisions:  
Table 2: Much of the information in Table 2 is already in Table 3.  Not sure if Table 2 is also 
needed.  It could be removed.   
Table 5 - why did you choose to present the data in this format versus the mean scores on the 
MRS scale?  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does 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.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional s tatistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain o r lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the futur e? 
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of t he manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is ac cepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommo ns.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal