PONE-D-23-32106Vitamin C and E antioxidant supplementation may significantly reduce pain symptoms in endometriosis: A systematic review and meta-analysis of randomized controlled trialsPLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: I would like to extend my congratulations to all of you for the completion of your intriguing work. The manuscript demonstrates significant potential; however, I have a few concerns and suggestions that I believe could enhance the quality of your work.

1. Justification for the Choice of Antioxidant Vitamins: It is imperative that the authors provide a clear justification for their choice of combining vitamin C and E in their SRMA. While the manuscript highlights the efficacy of these specific vitamins, it is essential to address the presence of other antioxidant vitamins, such as vitamin A, zink and etc. A comprehensive rationale for this selection would strengthen the research.

2. I would like to bring to your attention that this is not the first SRMA regarding the use of antioxidant vitamins in reducing endometriosis-related pain. I recommend that the authors refer to PMC10464024.

3. Enhancement of the Discussion Section: The discussion section appears to be an area where further expansion is needed to align with the high standards of this journal. A more comprehensive and nuanced discussion would not only contribute to the scholarly value of the manuscript but also make it more engaging and thought-provoking for readers.

Reviewer #2: Thank you for giving me the opportunity to review this study.

Despite the good overall merit, I have some comments:

- include some details on the type of endometriosis (e.g. superficial/deep/ovarian) and any co-existing adenomyosis (e.g. doi 10.1002/jum.15237) of the selected studies, if available;

- pain is a very complex symptom (doi 10.1016/j.jmig.2022.10.007), it depends on several factors including localization of the disease (e.g. parametrial, sacral plexus), previous surgical interventions, coexisting conditions (e.g. interstitial cystitis), peripheral and central sensitization. Please include these issues in the Limitations section.

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Reviewer #1: No

Reviewer #2: No

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Vitamin C and E antioxidant supplementation may significantly reduce pain symptoms in endometriosis: A systematic review and meta-analysis of randomized controlled trials

PONE-D-23-32106R1

Dear Dr. Bayu,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Diego Raimondo

Academic Editor

PLOS ONE

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