Reviewer's report
Title:Menstrual bleeding patterns: a community-based cross-sectional study
among women aged 18-45 years in Southern Brazil
Version: 1Date:16 August 2010
Reviewer: cyrille huchon
Reviewer's report:
The authors conduct a cross-sectional study to investigate the distribution of
self-perceived menstrual bleeding and seek to identify association with
socio-demographic and anthropometric women’s characteristic. This is an
interesting work, however, I have some comments, listed below.
There are a few questions on the paper:
Major Compulsory Revisions
1. The standard in this study to estimate menstrual blood loss was not validated.
It could have sense to compare the method used by the authors with the
reference used by Hallberg et al. (alkaline hematine method; Hallberg L.,
Hogdahl A.M., Nilsson L., Rybo G. Menstrual blood loss-a population study.
Variation at different ages and attempts to define normality Acta Obstet Gynecol
Scand 1966 ; 45 (3) : 320-351 ) as stated in the discussion. PBC assessment
score has been validated and could have been used in this study (Janssen C.A.,
Scholten P.C., Heintz A.P. A simple visual assessment technique to discriminate
between menorrhagia and normal menstrual blood loss Obstet Gynecol 1995 ;
85 (6) : 977-982 ; Higham J.M., O’Brien P.M., Shaw R.W. Assessment of
menstrual blood loss using a pictorial chart Br J Obstet Gynaecol 1990 ; 97 (8) :
734-739 ). The heaviest menstruation day may not represent the overall
menstruation flow.
2. Results: a chart flow seems necessary and this section has to be shortened.
Please avoid redundancy between text and tables.
3. I am concerned that you try to find association with extra-menstrual bleeding
but organic reasons of bleeding are not advocated in the paper, even as a cause
of menorrhagia.
4. I am not convinced that woman self-perception is a reliable estimate of blood
loss to be employed in epidemiological studies as 21% to 63% have an
overestimation of their menstrual blood loss (Hallberg L., Hogdahl A.M., Nilsson
L., Rybo G. Menstrual blood loss-a population study. Variation at different ages
and attempts to define normality Acta Obstet Gynecol Scand 1966 ; 45 (3) :
320-351 ; Chimbira T.H., Anderson A.B., Turnbull A. Relation between measured
menstrual blood loss and patient’s subjective assessment of loss, duration of
bleeding, number of sanitary towels used, uterine weight and endometrial surface
area Br J Obstet Gynaecol 1980 ; 87 (7) : 603-609 ; Janssen C.A., Scholten P.C.,
Heintz A.P. A simple visual assessment technique to discriminate between
menorrhagia and normal menstrual blood loss Obstet Gynecol 1995 ; 85 (6) :
977-982 ; Warner P.E., Critchley H.O., Lumsden M.A., Campbell-Brown M.,
Douglas A., Murray G.D. Menorrhagia I: measured blood loss, clinical features,
and outcome in women with heavy periods: a survey with follow-up data Am J
Obstet Gynecol 2004 ; 190 (5) : 1216-1223 ; Reid P.C. Assessment of
menorrhagia by total menstrual fluid loss J Obstet Gynaecol 2006 ; 26 (5) :
438-441 ).
Minor Essential Revisions
1. First para in the background should be removed as it does not support
information for readers of a Woman’s Health Journal.
2. Heavy blood loss is not equivalent to menorrhagia line 7, page 1.
3. Power of the study has to be in the results section, as the sample size
calculation was not performed for this study.
4. Bias is discussed in terms of Selection Bias. However, recall bias, both from
patients, and interviewers helping with the questionnaire should be addressed.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests