Title: Gastrointestinal Functioning and Menstrual Cycle Phase in Emerging Young Adult
Women: A Cross-Sectional Study
Version: 3 Date: 16 Sep 2023
Reviewer's report:
I appreciate the authors' efforts to improve this manuscript.  While most previous comments
have been addressed, some comments have yet to be addressed adequately. Here are my further
suggestions.
1. Please specify how you adapted the pain pictogram. How is it different from any existing
tool?  Did you pilot test this tool for its validity, reliability, and readability?  If not, you may
add it as a limitation.
2. In introduction,  citation(s) need to be added for average length of the follicular phase. Can
you also add the range of the length for follicular phase? Citation #9 does not address  vaginal
inflammation. Please correct.
3. It is still unclear to me how you classify people based on their menstrual cycle and what you
did with participants with shorter cycle (e.g., 22-25 days).   It may be helpful to use a figure to
show how you classify people into different menstrual cycle stages.
4. While the authors stated in their responses that they did not study women with visceral
pain related to the uterus. Most participants likely had dysmenorrhea given high prevalence of
dysmenorrhea in this age group (prevalence ~50%-90%).  Dysmenorrhea is a type of visceral
pain. For some people, such pain can be poorly localized.  Please discuss why the menses group
only reported more pain in hypogastric region, but not other regions.  Also, many people with
dysmenorrhea experience GI symptoms.  See citations a previous reviewer mentioned. Please
discuss why you did not find more GI symptoms among those in menses group compared to
other groups.
4. The authors stated that they originally included items concerning DGBI treatment, but the sole
purpose was to establish the sensitivity of the PROMIS-GI scales.  I am not clear on whether
the authors excluded people with DGBI who were not receiving medical treatments.
5. The within- and between- person differences have not been addressed in discussion.  It's
possible that the differences (or lack of differences) you found between menstrual cycle stage
were actually due to differences/lack of differences between individuals.
6. Given PROMIS-GI scales have a 7-day recall, what you measured at a given stage may not
capture symptoms at that stage.  Please discuss this as a limitation. This may contribute to a lack
of differences in PROMIS-GI scores between groups.
Title: Gastrointestinal Functioning and Menstrual Cycle Phase in Emerging Young Adult
Women: A Cross-Sectional Study
Version: 3 Date: 16 Sep 2023
Reviewer's report:
I appreciate the authors' efforts to improve this manuscript.  While most previous comments
have been addressed, some comments have yet to be addressed adequately. Here are my further
suggestions.
1. Please specify how you adapted the pain pictogram. How is it different from any existing
tool?  Did you pilot test this tool for its validity, reliability, and readability?  If not, you may
add it as a limitation.
2. In introduction,  citation(s) need to be added for average length of the follicular phase. Can
you also add the range of the length for follicular phase? Citation #9 does not address  vaginal
inflammation. Please correct.
3. It is still unclear to me how you classify people based on their menstrual cycle and what you
did with participants with shorter cycle (e.g., 22-25 days).   It may be helpful to use a figure to
show how you classify people into different menstrual cycle stages.
4. While the authors stated in their responses that they did not study women with visceral
pain related to the uterus. Most participants likely had dysmenorrhea given high prevalence of
dysmenorrhea in this age group (prevalence ~50%-90%).  Dysmenorrhea is a type of visceral
pain. For some people, such pain can be poorly localized.  Please discuss why the menses group
only reported more pain in hypogastric region, but not other regions.  Also, many people with
dysmenorrhea experience GI symptoms.  See citations a previous reviewer mentioned. Please
discuss why you did not find more GI symptoms among those in menses group compared to
other groups.
4. The authors stated that they originally included items concerning DGBI treatment, but the sole
purpose was to establish the sensitivity of the PROMIS-GI scales.  I am not clear on whether
the authors excluded people with DGBI who were not receiving medical treatments.
5. The within- and between- person differences have not been addressed in discussion.  It's
possible that the differences (or lack of differences) you found between menstrual cycle stage
were actually due to differences/lack of differences between individuals.
6. Given PROMIS-GI scales have a 7-day recall, what you measured at a given stage may not
capture symptoms at that stage.  Please discuss this as a limitation. This may contribute to a lack
of differences in PROMIS-GI scores between groups.
Please review this paper.
user
Title: Gastrointestinal Functioning and Menstrual Cycle Phase in Emerging Young Adult
Women: A Cross-Sectional Study
Version: 3 Date: 16 Sep 2023
Reviewer's report:
I appreciate the authors' efforts to improve this manuscript.  While most previous comments
have been addressed, some comments have yet to be addressed adequately. Here are my further
suggestions.
1. Please specify how you adapted the pain pictogram. How is it different from any existing
tool?  Did you pilot test this tool for its validity, reliability, and readability?  If not, you may
add it as a limitation.
2. In introduction,  citation(s) need to be added for average length of the follicular phase. Can
you also add the range of the length for follicular phase? Citation #9 does not address  vaginal
inflammation. Please correct.
3. It is still unclear to me how you classify people based on their menstrual cycle and what you
did with participants with shorter cycle (e.g., 22-25 days).   It may be helpful to use a figure to
show how you classify people into different menstrual cycle stages.
4. While the authors stated in their responses that they did not study women with visceral
pain related to the uterus. Most participants likely had dysmenorrhea given high prevalence of
dysmenorrhea in this age group (prevalence ~50%-90%).  Dysmenorrhea is a type of visceral
pain. For some people, such pain can be poorly localized.  Please discuss why the menses group
only reported more pain in hypogastric region, but not other regions.  Also, many people with
dysmenorrhea experience GI symptoms.  See citations a previous reviewer mentioned. Please
discuss why you did not find more GI symptoms among those in menses group compared to
other groups.
4. The authors stated that they originally included items concerning DGBI treatment, but the sole
purpose was to establish the sensitivity of the PROMIS-GI scales.  I am not clear on whether
the authors excluded people with DGBI who were not receiving medical treatments.
5. The within- and between- person differences have not been addressed in discussion.  It's
possible that the differences (or lack of differences) you found between menstrual cycle stage
were actually due to differences/lack of differences between individuals.
6. Given PROMIS-GI scales have a 7-day recall, what you measured at a given stage may not
capture symptoms at that stage.  Please discuss this as a limitation. This may contribute to a lack
of differences in PROMIS-GI scores between groups.
assistant