Strengths and limitations
This is the first large RCT evaluating an individual or group educational intervention concerning issues relevant to middle-aged women with symptoms commonly associated with stress. The two-factor design with a high follow-up rate is the main strengths of this RCT. The contents of PCS and GE does not have its main focus on hormones and medication, but rather focus on normal aging and common psycho-social aspects of life specifically related to middle-aged women. Most of patient education recommended in PHC only have evidence for short-term follow-up, often less than 6-months. It was a strength that this study also had a long-term 12 months follow-up since it was evident that the result at 12 months was quite different from that at 6 months.This study calculated many p-values which might be considered a weakness since some of them may reach statistical significance purely by chance. However, all inferential statistics in Table Menopause status was not registered at the first assessment, only at the 12-month follow-up, which is a limitation. In this study, participants were recruited by advertisement, which might be considered either a limitation or strength. However, reaching motivated women early through advertising aligns with PHC´s mission of preventive health work.