Title: Clustering Iranian Women according to their Menopausal Severity Symptoms and
Exploring the Factors Associated with Severe Categories, using Baseline Category Logit Model
Version: 3 Date: 12 Apr 2024
Reviewer's report:
Thanks for giving me the opportunity to review this manuscript. My comments are as follows:
General comment: The manuscript needs serious native and technical editing.
Abstract:
1. Please write Aged 42-60.
2. Which clustering algorithm?
3. "with placement into the severe clusters ", is not clear to me, could you explain it more?
4. the fall into  replace by maybe belonging to?
Introduction:
The introduction is long, there are paragraphs which is trying to explain K-means algorithm,
it sounds unnecessary. The authors could explain this in analysis section. Also nothing was
mentioned about how these classes can be affected by other factors? The introduction needs
a major modification. It is not clear to me the importance of the research question in the
introduction. Also I would not mention the research questions by numbers, and instead I would
try to add few lines at the end of introduction by a sentence like the purpose of the current study
is ….
Materials and Methods :
1. That would be nicer to have a sub-section for data and sample size determination.
2. again aged 42-60.
3. What is d and p? is there any references for these numbers?
4. It would be better to start with this paragraph, from there sample size calculation, then the
rest …. "The sampling in this study is multi-stage with stratified, cluster, and simple random
sampling [35-36]. Initially, the five major health centers of Mashhad were treated as strata. The
sub-centers of each stratum were considered as clusters. The number of sampling clusters at
each stratum to participated in the study was determined using the sampling fraction. Finally,
simple random sampling was performed to select the participants in each cluster. "
5. There are spaces between paragraphs which sounds unnecessary.
Statistical analysis:
1. How the optimal number of cluster has been determined?
2. The first time in the text, you would need to mention the full name like Analysis of variance
(ANOVA), same for all similar cases.
3. "According to the clustering results the target variable has three nominal categories, so the
baseline category logit model was employed "should be in the results.
Results:
1. In the result section, I could not find any reports regarding the cluster analysis?
2. The caption of figures should be below the figures.
3. From which table/figure are you concluding "The findings show  that the most commonly
reported symptoms of menopause were pain in muscles and joints (45.2%), followed by anxiety
(34.1%) and vasomotor symptoms (41.0%). "?
4. And not &?
5. Based on table2, are the groups are significantly different in terms of anxiety, depression,
etc…? Please report p-value?
6. What are cluster1, cluster2, and cluster3 are called? Are they the same as three groups of
Pre-menopausal, Peri- menopausal, and Post- menopausal? It is confusing.
7. The results of table 5, could be better explained, and interpreted.
8. Cluster not in capital letter? Same for number?
Discussion:
1. I would suggest to start with the general findings of the current study, and discuss and compare
the results to previous studies. Also try to justify the differences. Moreover, in the current
framework, the paragraphs are not well connected.
2. Is there any similar study which is conducted in Iran or middle east?
Limitations and Strengths of Study
How using this questionnaire can be the strength? Are there other questionnaires which measure
is used for menopausal symptoms ? If so, what is the advantage of MSSI38?
Conclusion:
"Moreover, there is a need for more causality analysis and interventional studies to investigate
the causes of this high prevalence and to prevent and control these symptoms. ", This has already
been mentioned. You could instead mention how it helps with health policy.