Reviewer’s report
Title:  The relationship between menopausal symptoms and burnout. A cross-sectional study among
nurses.
Version: 2 Date: 30 Jul 2019
Reviewer: Research Square
Reviewer's report:
"STATISTICAL REVIEWER ASSESSMENT: 
Is the study design appropriate for the research question (considering whether the analyzed population
accurately reflects the design and whether you see any problems with control/comparison groups, e.g.,
likely confounders)?
No - there are minor issues
Are methodologies adequate and well implemented (considering whether assumptions are addressed
and whether analyses are robust)?
No - there are minor issues
Are the analyses adequately communicated (considering whether reporting details are adequate and
whether figures and tables are well labeled and described)?
No - there are major issues
Does the interpretation accurately reflect the analyses without overstatement (considering whether
limitations/bias are acknowledged and whether accurate descriptors, e.g., 'significant', are used?
No - there are major issues
Could an appropriately REVISED version of this work represent a statistically sound contribution? 
Maybe - with major revisions
STATISTICAL REVIEWER COMMENTS:
Thank you for the opportunity to review the paper. I have provided my revisions for each section of the
paper.
Abstract
Please remove the software used to conduct the analysis from the abstract.
Introduction
The word extant is overused in the section. Please consider revising.
The link between menopause, burnout and the workplace is clearly stated. The need for workplace
mental health studies is vital and this should be explored further, which this study aims to achieve.
Methods
Page 9, line 1-7, please add a citation for this sentence/paragraph.
The response rate should be reported in the result section of the paper. Please revise.
The translation of the MENQOL to Italian should be listed as a limitation of the study. Could the
authors find another measure that was available in Italian?
What  they  of  post-hoc  analysis  did  the  authors  conduct?  I  did  not  find  this  information  in  the
manuscript. If this analysis was not done, please provide a rationale.
Results
The analysis appears appropriate, however, the authors should include the post-hoc analysis. 
Discussion
The results should be integrated and compared to the existing literature. The authors should expand on
their explanation of the relationship between menopause and emotional exhaustion. 
The limitation section should be clarified. Where the author state the following: ""Another limitation is
the cross-sectional design. Future research should employ multiple
waves to ascertain that it is menopausal symptoms that lead to increase burnout, not vice versa. "",
what do they mean by multiple waves? Do you mean that a longitudinal design should be used to
validate the cross-sectional findings ?
Why have you not considered the limitation of translating a questionnaire that was not available in
Italian?
REQUESTED REVISIONS: 
The study is well designed, however, there are some concerns regarding the interpretation of the study
findings given that one of the key measures of the study was not available in Italian. There should also
be additional analyzes done to ensure to prevent multiple testing problems."
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
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:
Acceptable
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?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
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.
This reviewer has been recruited by a partner organization, Research Square. Reviewers with declared
or  apparent  competing  interests  are  not  utilized  for  these  reviews.  This  reviewer  has  agreed  to
publication of their comments online under a Creative Commons Attribution License attributed to
Research Square and was paid a small honorarium for completing the review  within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer recommendation.
I agree to the open peer review policy of the journal. I understand that my name will be included on my
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. I agree for my 
report to be made available under an Open Access Creative Commons CC-BY license 
(http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not
be published.
I agree to the open peer review policy of the journal