Authors have used red flag symptoms e.g. abdominal distension, weight loss, post-menopausal bleeding etc for exclusion criteria at the time of recruitment. Development of these symptoms in follow-up were taken as outcome variable as well. Author should also have done a bi-manual examination, an ultrasound and estimation of CA-125 for exclusion of ovarian cancer at recruitment and its development in the follow-up for estimating the validity and measurement of risk factors (along with red flag symptoms). Very surprisingly authors have not used ultrasound and bi-manual examination in the study, which would have been handy and valid.

Competing interests: None declared