Reviewer’s report
Title: Associations between the menstrual cycle, lifestyle factors and clinical assessment of the
ocular surface: a prospective observational study
Version: 0 Date: 07 Jun 2019
Reviewer: Salvatore Caruso
Reviewer's report:
I was pleased to review the Manuscript "Associations between the menstrual cycle, lifestyle factors and
clinical assessment of the ocular surface: a prospective observational study" (BMWH-D-19-00253).
This manuscript requires major revisions as suggested below:
The Authors did not mention the sample size calculation for their study. It is essential to specify this
data in order to guarantee an adequate significance of the results obtained by the Authors.
The Authors performed only a Pearson's correlation in order to investigate the relationship between
correlation between lifestyle factors, menstrual cycle phases and sign/symptoms of dry eye. However,
it is not clear whether the authors, based on the results of this correlation analysis, have also performed
a regression analysis in order to better establish the association between these variables. Therefore, I
strongly recommend to better clarify this methodological and statistical issue, also presenting the
results of a regression model that would certainly make the evidence of this study stronger.
It would be interesting to discuss the influence of hormonal changes also on other sensory systems such
as  auditory or  olfactory ones.  Some  interesting  studies  about  this  topic  are  the  following:  Int  J
Otolaryngol.  2018  Aug  19;2018:7276359.  doi:  10.1155/2018/7276359;  Gynecol  Endocrinol.  2017
Dec;33(12):980-984. doi: 10.1080/09513590.2017.1334200; Eur J Contracept Reprod Health Care.
2006 Dec;11(4):250-7.
I also suggest mentioning women's sexuality changes over the menstrual cycle and their relationship
with stress and mood. In this regard, the Authors can refer to the following studies: J Sex Med. 2014
Jan;11(1):211-21. doi: 10.1111/jsm.12348; Arch Sex Behav. 1997 Aug;26(4):359-82.
References  should  be  better  formatted  according  to  the  Journal's  guidelines.  Please  follow  this
example: Rohrmann S, Overvad K, Bueno-de-Mesquita HB, Jakobsen MU, Egeberg R, Tjønneland A,
et al. Meat consumption and mortality - results from the European Prospective Investigation into
Cancer and Nutrition. BMC Medicine. 2013;11:63. 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this
manuscript, either now or in the future?
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financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below.
If your reply is yes to any, please give details below.
I declare that I have no competing interests
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