The Duration of Menstrual Blood Loss: Historical to Current Understanding

Round 1

Reviewer 1 Report

A very interesting study. Authors made great effort in order to gather all the literature. However there are some points need improvement. 

1. Line 58: the aim of thei study is not very clear. Authors just mention that they just reviewed the literature. But what made them do it

2. It would be better if they make a table with the studies and the main findings. In the present form it is difficult for readers to understand the key points

Author Response

A very interesting study. Authors made great effort in order to gather all the literature.

Many thanks. We are pleased that the manuscript was of interest and agree that this is a rarely considered aspect of everyday practice.

However, there are some points that need improvement. 

1. Line 58: the aim of their study is not very clear. Authors just mention that they just reviewed the literature. But what made them do it

We have clarified this point as follows: Women often raise the question with clinicians as to the reasons why they bleed for shorter or longer days, but in contrast with the question of the amount of blood loss, the issue seems largely set aside and rarely, if ever, considered in literature or clinical guidelines. 

In this article we undertook a literature review of literature relevant to understanding the clinical features that are considered and the cut-off points that delimit normal duration of bleeding and the factors that determine the duration of blood loss in spontaneous cycles. The review also addresses factors that determine the onset of flow and its cessation and thus contribute to the control of the duration of blood loss at menstruation.

2. It would be better if they make a table with the studies and the main findings. In the present form it is difficult for readers to understand the key points

Many thanks for the helpful suggestion, we have produced a tabulation of the studies that identified factors relevant to the duration of blood loss.

Author Response File: Author Response.docx

Reviewer 2 Report

The work from Dr. Habiba reviewed the duration of menstrual blood flow and discuss the mechanisms that make the differences among individuals. I feel that the topic is interesting because this kind of simple physiologic issue is rarely discussed scientifically. I think this work may be worth to be published after minor revision.

Minor comments
1.      Page 3, line 136. The authors should describe how did they perform a literature search (e.g. search engine, duration, and key words, etc.).
2.      Page 5, line 208. Table 1 was not found in the manuscript. The table summarizing the results from the literature search should be presented as a Table.
3.      The references were not cited correctly through the manuscript. The authors should check again vigorously the references are cited correctly.

Author Response

Referee 2

The work from Dr. Habiba reviewed the duration of menstrual blood flow and discuss the mechanisms that make the differences among individuals. I feel that the topic is interesting because this kind of simple physiologic issue is rarely discussed scientifically. I think this work may be worth to be published after minor revision.

Thank you for your comment; we value the opportunity to raise awareness of this largely neglected topic.

Minor comments

1. Page 3, line 136. The authors should describe how did they perform a literature search (e.g., search engine, duration, and key words, etc.).

We undertook literature search using Medline (December 2022, and repeated May 2023) using the broad terms: Menstruation, or menstrual blood loss, or menstrual cycle combined with duration or duration of bleeding. This identified 2226 references that were reviewed manually (title and abstract) to identify all articles that either specifically focussed on the duration of bleeding (n=0) or that contained a reference to the duration of bleeding in the context of the study of menstrual patterns in natural cycles (n=51). Identified articles were read in detail to determine those that are relevant to the review (n=24). Other references were identified through search of reference lists in identified articles.

2. Page 5, line 208. Table 1 was not found in the manuscript. The table summarizing the results from the literature search should be presented as a Table.

We have added the missing table and added a table with the main summaries.

3. The references were not cited correctly through the manuscript. The authors should check again vigorously to ensure that the references are cited correctly.

Our apologies. We have corrected the numbering which was produced during the creation of the PDF document.

Author Response File: Author Response.docx