“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING POST

MENOPAUSAL BLEEDING AND ITS MANAGEMENT AMONG

MENOPAUSAL WOMEN ATTENDING AT HSK HOSPITAL AND RESEARCH

CENTRE, BAGALKOT”.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

MS.EVANGELINE MARY

SHRI. B.V.V.SANGHA’S

SAJJALASHREE INSTITUTE OF NURSING SCIENCES,

NAVANAGAR, BAGALKOT, KARNATAKA.

2012

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address

(in block letters)

MS.EVANGELINE MARY

I YEAR M. Sc. NURSING

SAJJALASHREE INSTITUTE OF

NURSING SCIENCES, BAGALKOT.

2. Name of the Institution SAJJALASHREE INSTITUTE OF

NURSING SCIENCES, BAGALKOT.

3. Course of Study and Subject M. Sc. NURSING

OBSTETRICS AND

GYNAECOLOGICAL NURSING.

4. Date of Admission to the course 15/05/2012

5. Title of the Topic

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING POST

MENOPAUSAL BLEEDING AND ITS MANAGEMENT AMONG

MENOPAUSAL WOMEN ATTENDING AT HSK HOSPITAL AND RESEARCH

CENTRE, BAGALKOT”.

2

6.Brief Resume of the Intended Work

“Charm is deceptive, beauty is fleeting; but a

woman who fears

the lord is to

be praised.”

Proverbs: 31:30.

Introduction

Every living thing in nature is susceptible to change. The

flower that blooms today will wilt tomorrow the leaf that looks green today will fall off.

This is the case with human too, Human beings experience various turning points in

their life. Aging is a fact of life and it is a normal process. A transitional change of a girl

starts when she attains menarche. Thus a girl transformed to a women, At last the

women will reach to the stage of menopause in which various physiological as well as

psychological changes will takes place.1

Women are the vital set up of the heart of the family when

women have been tired altered women facing lot of problem through their life one of the

most common problem they are facing is menopause.2Menopause is derived from Greek

word Men (Month) and Pauos (to stop or cessation) who has defined menopause as the

permanent cessation of menstruation resulting from the loss of ovarian follicular

activity.3

Menopause is the time in a women’s life when her periods

(menstruation) eventually stop and the body goes through changes that no longer allow

3

her to get pregnant. It is her natural even that normally occur in women in the age group

between 45 to 55 years. Thus it is an important phase for dramatic hormone and other

changes in life span of a woman.4

Life expectancy during this era, hence, many will experience

post menopausal bleeding is a common complaint from women seen in general practice.

Post menopausal bleeding (PMB) is defined as bleeding that occurs after one year of

Amenorrhea in a woman of a age where the menopause can be expected on the average

of 50 year.It is a frequent and alarming sign and exclusion of genital tract malignancy.5

The significance of post menopausal bleeding what ever slight

it may be , should not be under estimated. As many as one third of the cases are

due to malignancy. The some importance is also given to those cases where normal

menstruation continues even beyond the age of 55 years.6

Approximately one in 10 women experience this problem

usually, this occurs in early years of menopause and is less frequent after 3 or more

years of menopause. Increasing time internal bleeding is highly indicative of

malignancy. In developed countries more than 60% cases are due to benign lesions like

atrophic vaginitis, uterine or cervical polyp endometrial hyperplasia and atrophic

endometritis.The average age of menopause is 51 years any woman who is still

menstruating after 55 years should be viewed with suspicion and post menopausal

bleeding must be evaluated for endometrial carcinoma.1

The assessment includes evaluation of risk factors like obesity,

parity, family history of endometrial / breast carcinoma, personal history of carcinoma

and drug history as the hormone replacement therapy Tamoxifen and anticoagulants.

4

Perhaps the most common cause of post menopausal bleeding is the decline of estrogen

levels. For the majority there is an innocent cause for the bleeding the common

precisiting symptoms.7

Post menopausal includes:-

P – Polyp (cervical) is about 12 %

O – Ovarian cancer is about 10 %

S - senile vaginitis, endometritis

T- Trauma

M – Myoma

E – Endometrial hyperplasia 80 %

N- Not removed pessary leading to ulceration

O – Oestrogen (intermittent)

A – after radiation ulceration

U – Urethral carbuncle

S – Sarcoma Uterus

E – Erosion in cervix.8

The main aim of investigations for PMB post menopausal

bleeding is to exclude endometrial cancer which presents with post menopausal bleeding

in over 95% case, The probability of endometrial cancer in women presenting with post

menopausal bleeding is approximately 5 – 10 %. It is clear therefore, that 90 – 95 % of

cases of PMB /post menopause bleeding results from benign. In these circumstances

treatment of the underlying problem will usually resolve the symptoms.9

5

Managing women presenting with PMB will have to assess their practice

in the light of this evidence and their own facilities and experience. The aim of

the management of post menopausal bleeding / PMB is to establish a reliable

diagnosis patient due to fear of a potential uterine malignancy do present early

responding to vaginal bleeding during this period.9

Post menopausal bleeding in women regardless of initial USS endometrial

thickness measurements. There is a continued risk of serious endometrial disease with

post menopausal bleeding. “It may be more prudent to offer these women testing with all

available modalities.” In most health care system, women with PMB/post menopause

bleeding will present to a primary care physician with general expertise, who then refers

them to a specialists in Gynaecology for further quantitative reviews of diagnostic

accuracy and subsequent cost effectiveness analysis.10

However, more research is required to evaluate the impact of improvements in

ultrasound technology or diagnostic accuracy, the true value of testing when the whole

clinical process is accounted for and the preferences of patients and clinicians with

regard of diagnosing both malignant and benign disease. The problems of how to

manage recurrent post menopausal bleeding and the effectiveness of community

delivered ‘ ambulatory’ service also requires further evaluation to keep guide best

practices.11

6

6.1.Need for the study

“Post menopausal women stand at a cross road,

facing the possibility of living the remainder of their

lives.”

Post menopausal is a common clinical problem post menopausal bleeding

is a problem in both general and hospital setting postmenopausal bleeding must be

considered as indicative of malignant disease until proven otherwise” still holds true in

our circumstances. The incidence of spontaneously occurring post menopausal

bleeding in the general population can be as high as 10% immediately after menopause.

It is common gynaecological problem seen in about 5 to 10 % of gynaecological patient

is likely to increase further. About 25 million women pass through menopause each

year. By 2030 the world population of menopausal and postmenopausal women is

projected to increase to 1.2 billion with 47 million new entrances each year.12

The pathology as the cause is often over seen specific interrogation to such

cause is of almost importance. One of these causes is the use of “ natural Hormones” as

patient do not consider these as active medication further more practioniers still

prescribe un opposed oestrogen therapy with an intact uterus, this is still a common

cause of endometrial malignancies.13

A handy diagnostic tool in the management of postmenopausal bleeding is

intra uterine saline infusion with ultra sound imaging. Infusion is done with the help of a

baby feeding tube markedly enhances the visibility of uterine polyps use of saline

infusion sonography as a second step in the evaluation of postmenopausal bleeding. The

7

study shows that all patients with typical history of postmenopa usal bleeding were

evaluated it tells total 50 patients of postmenopausal bleeding were included. Benign

lesion was found in 24 (48%) cases, followed by malignant pathology is 15 (30%) pre

malignant lesion was responsible for postmenopausal bleeding in 7 (14%) cases, while

pathology remained undetermined in 4 (18%) patients.14

The earlier studies conducted in different parts of the world showed a

prevalence of malignancy in postmenopausal bleeding of around 35% while the more

recent prevalence is quoted to be around 9.9% - 11 %. This drop in prevalence

of malignancy reflects the awareness of women and availability of screening facilities.14

In Pakistan malignancy of the genital tract is the existing pathology in a

large number of cases Pamelaetal from India showed prevalence of 63.6% woderossen-

from Ethiopia 60.8%, Liaguatest at 53.7%, Asifet at 44% and Ghazi et at 20%. The

frequency found in study is (30%) occupies a middle position when compared with local

studies. Evaluation of post menopausal bleeding needs an exclusion of corpus cancer

which is fourth common cancer in women and most common gynaecological

malignancy in USA. This situation reflects a long life span of women more than 70

years, required for development of endometrial carcinoma.5

The present study was carried out to ascertain various causes of

postmenopausal bleeding and to determine its prevalence. Prognosis is excellent as

postmenopausal bleeding is an early warning sign lead women to seek medical advice.

Post menopausal bleeding is a very big concern among many patient, this topic was

required by doctors and patients who was diagnosed and treated post menopausal

bleeding that occurs in a menopausal woman. It is usually accompanied by hot flashes

mood changes and insomnia. Women with recurrent post menopausal bleeding should

be re-investigated but are not likely to have endometrial cancer.17

8

Many women experiences some post menopausal bleeding how ever, post

menopausal bleeding is not normal because it can be a symptom of serious medical

condition, any episodes of post menopausal bleeding should be brought to the

attention of a women’s doctor. Post menopausal bleeding is not a printable disorder.

However a healthy weight will decreases the change of its occurring. Post menopausal

bleeding is a symptom not to be underestimated. The result showed that atrophic

endometrium was the most common cause of the post menopausal bleeding. Among

the malignant causes, cervical carcinoma accounts for 44.4% of malignant pathologies

responsible for postmenopausal bleeding. This high incidence may point to the need for

more public awareness to integrate routine screening definitive diagnosis of

postmenopausal bleeding is to be made.16

From the above mentioned facts it is clear that post menopausal bleeding is

very important condition it affects the health of the women leading to cancer. So that

women should be aware of the bleeding after the menopause. Hence the investigator has

made an attempt to improve the knowledge regarding post menopausal bleeding and its

management.

6.2.Review of literature

Review of Literature is a key step in research process refers to the activities

involved in searching for information on a topic and developing a comprehensive picture

of the state of knowledge on that topic. This provides a background for understanding

what has already been learned on a topic and illuminates significant of new study.

  A cross-sectional study was conducted in Chandigarh, India. The objective

of the study was to ascertain the knowledge about menopause and postmenopausal

bleeding in women of urban and slum area of Chandigarh, Systematic random sampling

9

was used. The study population comprised of women above 40 years and resident of

study area.  Out of total 528 women interviewed, 302 (56.1) were residing in urban

area and rest were the residents of slums. 78.8%, urban and 60.2% from slums have

attained menopause. Majority (70.3%) of urban residents have heard about menopause

as compared to 30.9% in slums. Thus the study concluded that there is lack of

awareness regarding menopause and related aspects especially PMB in both

urban and slum population.17

A cross-sectional study was done in the department of obstetrics and

gynecology patient in J.N.M medical college and Dr.B.R Ambedkar memorial hospital,

Raipur. the participants were 146 women who came with the complaints of

postmenopausal bleeding, by interviewing these women information was collected about

different demographic factors like age, socio-economic status, parity etc. The data

collected was put in the master chart and analyzed .The result included the proportion of

post menopausal bleeding causes was 3.5% maximum causes(50%) with

postmenopausal bleeding were found in the age group of 45-54yr 60% of patients were

from rural areas and 62% were illiterate.65% of the patient were grand multipara. Most

of the patient belonged to lower socio-economic status. The study concluded post

menopausal bleeding is high, requiring immediate investigation lack of awareness led to

presentation of most of the patient so education is required.18

A retrospective study carried out in post menopausal bleeding clinic

department of Obstetrics and Gynecology, Southern General Hospital, Glasgow, UK.

The objective of the study was to determine the prevalence of endometrial cancer in

patients presenting with recurrent postmenopausal bleeding. A total of 1536 women with

PMB were seen over a period of 56 months. 66 required definitive treatment after their

first visit.126 re-presented with recurrent bleeding. The prevalence of endometrial

10

cancer in women presenting for the first time with PMB was 3.04% whereas that in

women presenting with recurrent PMB after initial negative investigations was 4%.One

woman had an endometrial cancer even though the endometrial thickness was less than 3

mm. The study concluded that women with recurrent PMB after initial negative

investigations are no more likely to have endometrial cancer than those presenting for

the first time but re-investigation is indicated if six months has elapsed.19

A cross sectional study was conducted by the department of obstetrics and

Gynaecology, Shaikh Zayed post graduated medical institute and hospital, Lahore. The

objective of the study was to find out the causes of postmenopausal bleeding and its

correlation with medical illness. A total 50 patient were included in the study maximum

number of patients with postmenopausal bleeding were between 56-60 years (32%),

most of the patients were having parity between 4 – 6 (48 %) majority of patients (32%)

had symptom about 10 years after menopause 70% patients were having benign cause

while 30% patients had malignant cause for postmenopausal bleeding, The study

concluded that carcinoma of genital tract is one of the most important cause of post

menopausal bleeding so early detection of the cause can be life saving.20

A retrospective study was conducted to investigate the clinical significancy

endometrial pathology in patient with postmenopausal bleeding in term of etiology risk

factor incidence of malignancy and histopathological evaluation. 304 cases of

postmenopausal bleeding admitted to Babylon Teaching Hospital for Gynaecology, the

age range of the patient was from (45 – 77 years) with a mean of (49 years),result

showed that benign pathology was found in (167 / 304) cases. This includes senile

atrophic endometrium, endometrial hyperplasia endometritis, and cervical polyps.

Malignant pathology was found in (27) cases including (12) cases of cervical cancer and

(15) case of adenocarcinoma of the endometrium. It is concluded that postmenopausal

11

bleeding is an important symptom and requires careful and promote evaluation to

eliminate the possibility of malignancy as quickly as possible.1

A prospective observational study was carried out in the department of

Obstetrics Gynaecology Fauji foundation Hospital Rawalipindi, Pakistan. The objective

of the study includes to as certain various causes and prevalence of genital organ

malignancy in patient presenting with postmenopausal bleeding. A study comprising of

167 consecutive cases presenting with postmenopausal bleeding one year after

menopause. Results showed that the commonest cause of PMB was atrophic

endometritis and vaginitis 33 (21.2%). Overall incidence of various genital tract

malignancies was 25 (16.0%).The study concluded that overall incidence of genital tract

malignancies in patients presenting with PMB is high (16.0%),therefore, it needs to be

taken seriously and requires prompt and thorough investigations.21

A cross-sectional study was conducted in Gynaecological oncology centre

in united Kingdom. The population included all postmenopausal women referred with

vaginal bleeding .The objective of the study is to determine the risk of endometrial

cancer. All women were investigated using Gray-scale transvaginal

ultrasonography. Main outcome measures, were endometrial cancer diagnosis. The study

was over a 50-month period, 4454 women were investigated for postmenopausal vaginal

bleeding. A total of 259 (6%) of women were diagnosed with endometrial carcinoma.

The odds of endometrial cancer in women where the endometrial thickness was not

visualized were found to be significantly higher than the odds of cancer for women with

an endometrial thickness of 5–9.9mm The study concluded that for women presenting

with postmenopausal bleeding ultrasonography, hysteroscopic evaluation is

recommended.22

 An observational cross section study was conducted in the department

12

of obstetrics and gynecology at peoples medical college and hospital Nawabshah,

sindh. All patient with a typical history of postmenopausal bleeding were evaluated

under anesthesia and diagnostic dilatation and curettage was done for

histopathological assessment of endometrial lining. Cervical biopsy was taken in

selected patients. Total 50 patients were included, Benign lesion was found in 24(48%)

cases, followed by malignant pathology in 15(30%), premalignant lesion was

responsible for postmenopausal bleeding in 7(14%) cases, while pathology remain

undetermined in 4(8%) patients, The study concluded that malignancy has an important

role in the etiology of postmenopausal bleeding which needs a careful evaluation. This

study showed a high prevalence of malignant disorders (30%) with carcinoma of cervix

and endometrium having an equal contribution. Multiparity was the most significant

factor for carcinoma of endometrium.7

A r etrospective study was conducted on 163 consecutive patients who

presented with postmenopausal bleeding in kandang kerbau Hospital, Singapore. The

objective of the study was to study the etiology and pattern of postmenopausal bleeding

in the local population. Results of the study included that malignant causes were found

in 42(25.7%) patient .Cervical carcinoma was the most common malignancy (12.9% of

the patients)followed by endometrial carcinoma (11%).Important benign causes are

cervicitis (12.9%),atrophic vaginitis( 12.3% ) and cervical polyp (6.7%).Other benign

causes include endometrial hyperplasia (3.1%),urethral car uncle (2.5%) and estrogen

replacement therapy(1.8%).The study concluded that postmenopausal bleeding is a

varied aetiologies. The associated incidence of malignancy is high and a thorough

diagnostic evaluation is mandatory.23

A retrospective analysis has been made of 160 cases of postmenopausal

bleeding, the women were at least 45 years old and the time lapse from the last

13

menstruation was at least 2 years, the cause was a malignant neoplasm in 23·75%. The

incidence of malignancy showed a definite rise with advancing age and with increasing

duration of bleeding. It was nearly twice as high in women who stopped menstruation

after the age of 55 years. Malignancy also seemed to be more frequent in patients with

profuse bleeding and in those who had amenorrhea lasting for 20 years or more. The

most usual malignant lesions were endometrial and cervical carcinoma, the ratio of these

two conditions being 1·6: 1. Estrogen administration was the most common cause in the

non-malignant group: 12·5%. No cause for bleeding could be demonstrated in 8·8%.The

study concluded that the etiology of postmenopausal bleeding is to be discussed.24

6.3 .Statement of the problem:

“A Study To Assess The Effectiveness Of Structured Teaching Programme On

Knowledge Regarding Post Menopausal Bleeding And Its Management Among

Menopausal Women Attending HSK Hospital And Research Centre Bagalkot.”

6.4. Objectives of the study :-

1) To assess the knowledge about Post Menopausal bleeding and its management

among Menopausal women.

2) To determine the effectiveness of Structure teaching programme about post

menopausal bleeding and its management among menopausal women.

3) To find out the association between the knowledge about post menopausal bleeding

and its management among menopausal women with their selected socio-

demographic variable.

6.5.Operational definitions:

1. ASSESSMENT: In this study assessment refers to an evaluation of condition of

knowledge of menopausal women about post menopausal bleeding.

2. EFFECTIVENESS: In this study effectiveness refers to which extent the Structure

14

teaching programme prepared by investigator was successful in manipulating the

knowledge of menopausal women.

3. STRUCTURE TEACHING PROGRAMME: structured teaching programme

refers to lecture given by the investigator to menopausal women about post menopausal

bleeding and its management.

4. KNOWLEDGE: In this study knowledge refers to the range of information

awareness or all that has been perceived by menopausal women.

5. POST MENOPAUSAL BLEEDING :- In this study post menopausal bleeding

refers to any bleeding that occurs from genital tract more than 12 months after last

menstrual period.

6. MENOPAUSAL WOMEN:- Menopausal women refers to women of the age

group of 45 – 55 years.

7. SOCIO – DEMOGRAPHIC VARIABLES: Socio – Demographic variables

refers to variables like age, educational status, religion, income, marital status et

6.6 Assumptions:

1. Menopausal women will have some knowledge regarding post menopausal

bleeding and its management.

2. Menopausal women will willingly participate and give reliable information

needed for the study.

3. Menopausal women will have knowledge related to post menopausal bleeding

and its managements, but not practicing properly.

4. Knowledge many vary according to the demographic variables.

6.7 Hypothesis:

15

H1: There will be statistically significant difference between the pre and post

Knowledge scores of menopausal women regarding post menopausal bleeding

and its management.

H2:There will be a significant association between level of knowledge of

women on post menopausal bleeding and their selected socio – demographic

variables.

8 6.8. Delimitation:

The study is delimited to the women who are visiting to HSK Hospital and

Research centre Bagalkot.

7. Materials and Methods:

The study is designed to determine the effectiveness of structured teaching

programme on knowledge regarding post menopausal bleeding and its management

among menopausal women attending HSK Hospital.

7.1 Source of Data:

The data will be collected from women who are visiting to HSK Hospital &

research centre Bagalkot.

7.1.1Research Design:

A quasi experimental design will be adopted for conducting the present study

(one group pre test, post test design).

7.1.2 Setting:

This study will be conducted in HSK Hospital and research centre Bagalkot.

7.1.3 Population:

In this study the population includes menopausal women’s attending HSK

Hospital and research centre Bagalkot.

7.1.4.Sample

16

In the present study sample consists of women attending HSK Hospital and

research centre Bagalkot.

7.2 Methods of Data Collection :-

7.2.1 Sample Size:

The sample size of the study is 50 women.

7.2.2 Sampling technique:

Convenient sampling technique is used to select subjects.

7.2.3. Duration of study

The present study will be conducted for 6 weeks

7.2.4. Criteria for Sampling

1. Inclusion Criteria for Sampling

The study includes the women

Who are attending the HSK Hospital and research

centre Bagalkot.

Who are willing to participate in the study

Who are available at the time of data collection

The study include women’s in the age group of 45 – 55 years.

2. Exclusion criteria

The study excludes the women

Who are attending other hospitals.

Who are not able to co-operative throughout the period of study.

The women who are professionals of medical and nursing fields.

Who are having complications.

7.2.5 Selected variables:

Variables selected in the present study are

17

Independent Variable: Structured Teaching programme on knowledge

regarding postmenopausal bleeding and its management among menopausal women.

Dependent Variable: Knowledge of women regarding post menopausal bleeding and

its management.

Socio Demographic Variables: Socio demographic variable includes socio

demographic characteristic of women like age, education, occupation, family income,

marital status, religion.

7.2.6.Data collection instruments:

The investigator has planned to assess the knowledge of women

with the help of structured closed ended questionnaire.

It consist of 2 sections namely section 1,section 2

Section 1- deals with socio demographic data related to sample.

Section 2- deals with the items related to assessment of knowledge regarding

post menopausal bleeding and its management.

7.2.7. Data collection method

The investigator uses self administered structured closed ended questionnaire for data

collection.

7.2.8.Data analysis method:

Numerical data obtained from the sample will be organized and summarized with

help of descriptive statistics like percentage, mean, median, and standard deviation.

Testing the level of significance of hypotheses and identifying relationship between

socio demographic variables and knowledge regarding post menopausal bleeding and its

management among women’s will be done with the help of inferential statistics, tests

like Chi- square test, co efficient correlation and paired t-test will be used.

7.2.9. Projected outcome:

18

The structured teaching programme will help the menopausal

women to improve their knowledge regarding post menopausal bleeding and its

management.

7.3. Does the study require any investigations or interventions to be conducted on

patients or other humans or animals? if so please describe briefly.

Yes,

In present study investigation is done on human beings ie, assessment of

knowledge of women regarding post menopausal bleeding and its management.

Intervention is given ie, Structured Teaching Programme will be conducted as an

intervention to menopausal women regarding post menopausal bleeding and its

management.

7.4 .Has ethical clearance been obtained from your institution in case of 7.3?

Yes,

a) Permission will be obtained from the principal of Sajjalashree Institute of

Nursing Sciences, Navanagar, Bagalkot.

b) Permission will be obtained from the institutional ethical and research

committee of Sajjalashree Institute of Nursing Sciences, Navanagar.

Bagalkot.

c) Permission will be obtained from the Medical superintendent of HSK

Hospital Bagalkot.

d) Written consent will be obtained from participants.

8.LIST OF REFERENCES

19

1. http://www.sandiego therapist.com/three stage.htim/.

2. http://pre.menopause.fate back.com/.

3. Research on the menopause in the 1990’s report of a WHO scientific group,

WHO tech report series 1996:8861-107.

4. http://www/womens fitness health.com/pre-menopause.htm/

5. Ali Hassan at-Timim MBC HBm MS , PhD. Professor of pathology post

menopausal bleeding clinic pathological study in Babel. Journal of Babylon

University.18(3)-2010.

6. D.C.Datta Gynaecology ; Post menopausal bleeding page no 512.

7. Kauser Jillani ,Razia Bahadur Khero; Prevalence of malignant disorder of post

Menopausal bleeding .JMPA 60: 540 : 2010.

8. Panda JK; One-stop clinic for the post menopausal bleeding .J Reprod med.2002.

Sep : 47(9) : 761-6.

9. J.James A. Meril MD .Management of post menopausal bleeding .Clinical obset

gynaec 1981; 24(1) :285-99.

10. Evaluation of one stop clinic for the rapid assessment of PMB journal of

obstetrics and gynaecology volume 18,number 2,March 1998.

11. Decherney, Alan H, a martinc ,pernoll; “complication of menstruation” in

current obstetric and gynaecological diagnosis and treatment Norwalk. CT

Applitim and Lange 1994.

12. T1 Cope – Some aspects of post menopausal bleeding.Clinical obset and gynaec

1956;7(2).

13. Dreisler E, Stampe Soresen S, Ibsen PH, Cose G.Prevalance of endometrial

polyps and abnormal uterine bleeding in danis population aged 20-74 years.

Ultra sound obset gynecol 2009 ;33(1);102-8.

20

14. Kauser Jillani, Razia Bahadur Kheroj prevalence opf malignant disorders of

Post menopausal bleeding .JPMA 60:540:2010.

15. Article for the January 4th edition of today’s Health empowered women 2009.

16 . T.J.Clark P.M, Barton, A. Coomarasamy, J.K.Gupta and K.S.Khan,

Investigation post menopausal bleeding for endometrial cancer; BJ04,vol-113

No.5 PP 502-510-2006.

17. S.Puri, V.BhMangat; perception of menopausal and post menopausal

bleeding in women of Chandigarh India.The internet journal family practise

2008 vol.600.2-DOI: 10.55 .80/20BC.

18. Sonia A1 ,Bhyp index A2 ,marwaha, singh vol 24 No 2, April 2012 page no.158.

19. Rashmi Ronghe* and macro Gaudoin women with recurrent post menopausal

Bleeding should be reinvestigsated .Menopause international 2010,16-9-11.

20. Dr.Sadia ZALFIQAR CHEEMA, Dr.Muhammad Iklam, Shaikh Zayed

medical complex, Lahore post menopausal bleeding 328.

21. Department of obstetrics gynaecology fauji foundation hospital, Rawalpindi.

Prevalance of genital organ malignancy.

22 Barbos N, Crocker SG, Morr’s EP, Nieto JJ.DUN Can. Management of post

menopausal women with vaginal bleeding when the endometrial cannot be

visualized.Act-9 obstet gyneco scaned 2012 :91:D01:10/111/16

23. Lee WH,Tan KH, Lee YW; The aetiology of post menopausal bleeding …

a study of 163 consecuive case in Singapore.Deparment of maternal foetal

medcine, Kandang Kerbal Hospital ,Singapore Med J.1995 Apr.36(2):164-8.

24. Clinical Review ,Aetiology of post menopausal bleeding, M.J.N.C, Keirse M.D

Department of obstetrics and gynaecology , sin t- michielskliniek Brussels .

21

Belgium postgraduate medical journal 49,344-348.

22

9 Signature of Candidate

10 Remarks of the Guide The proposed study is ethically acceptable and socially

beneficent. It is feasible for the student researcher to be

carried out.

11 Name and Designation of

(In Block letters )

11.1 Guide

MRS. KAMALA .K.N

ASSISTANT PROFESSOR AND HOD OF OBG

NURSING,

SHRI. B.V.V.SANGHA’S SAJJALASHREE

INSTITUTE OF NURSING SCIENCES,

NAVANAGAR, BAGALKOT, KARNATAKA.

11.2 Signature

11.3 Co- Guide (if any) MRS. JAYASHREE.AWARSANG

ASSISTANT PROFESSOR

SHRI. B.V.V.SANGHA’S SAJJALASHREE

INSTITUTE OF NURSING SCIENCES,

NAVANAGAR, BAGALKOT, KARNATAKA.11.4 Signature

11.5 Head of Department MRS. KAMALA.K.N

HOD OF OBG NURSING

SHRI. B.V.V.SANGHA’S SAJJALASHREE

INSTITUTE OF NURSING SCIENCES,

NAVANAGAR, BAGALKOT, KARNATAKA.11.6 Signature

12 12.1 Remarks of the principal

The study selected by the candidate is suitable for the present situation. This topic is

also approved by the research and ethical committee of the institute.

12.2 Signature

23