RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.

1. NAME OF THE CANDIDATE

AND ADDRESS

Mrs. SHASHIKALAVATHI

GOUTHAM COLLEGE OF NURSING

MANJUNATHA NAGAR,

WEST OF CHORD ROAD RAJAJINAGAR,

BANGALORE-10.

2. NAME OF THE INSTITUTION GOUTHAM COLLEGE OF NURSING

MANJUNATHA NAGAR,

WEST OF CHORD ROAD

RAJAJINAGAR, BANGALORE-10.

3. COURSE OF STUDY AND

SUBJECT

I YEAR M.Sc. NURSING

OBSTETRICS AND GYNAECOLOGICAL

NURSING.

4. DATE OF ADMISSION TO

COURSE

16.10.2007.

5. TITLE OF THE TOPIC A STUDY TO ASSESS THE

EFFECTIVENESS OF SELF

INSTRUCTIONAL MODULE ON

POLYCYSTIC OVARY SYNDROME

AMONG THE ADOLESCENT GIRLS IN A

SELECTED COLLEGE OF BANGALORE.

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6. BRIEF RESUME OF THE INTENEDED WORK

6.1 NEED FOR THE STUDY:

Pcos (Polycystic Ovary syndrome) an endocrine disorder, which means

normal hormone cycles are interrupted. The syndrome was originally reported by

Stein and Leventhal in 1935 when they described a group of women with

Amenorrhea, Infertility, Hirsuitism and enlarged poly cystic ovaries. Polycystic

are two to five times larger than normal ovaries. Women are usually diagnosed

when in their 20’s or 30’s. This can contribute to infertility. Possible

complications are, Sterility, Obesity, Related conditions like high blood pressure

and diabetes, Increased risk of Endometrial Cancer, Possible increased risk of

Breast Cancer.1

Pcos is reported to be growing problem with Adolescent girls .It can be

very difficult to diagnose pcos in teenage girls as they often experience irregular

or absent menses and acne. The underlying cause of pcos may or may not be

detectable in Adolescents during the onset of pcos symptoms. As a result

researchers report that pcos is often missed in this age group. This causes great

concern among clinicians due to the potentially serious complications associated

with these conditions.2

Pcos occurs in 5% to 10% of women, making it one of the most common

endocrine disorder.3 Pcos is a heterogeneous endocrine disorder that affects about

1 in15 women worldwide.4 The prevalence of pco in Indian sub continent Asian

women was 52%.5Polycystic morphology seen in ultrasound is approximately

22% of women.6 Hirsutism is a common problem in India as elsewhere in the

world. Idiopathic hirsutism 38.7%, pcos 37.3%.. In India nearly 40% of women

are affected by pcos. But among them only 60% come to hospitals for treatment,

when they recognize that they have got infertility21.

Pcos also known by the name Stein Leventhal syndrome is a variety of

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symptoms. The symptoms of pcos includes, irregular or no menstrual periods,

Acne, obesity, excess hair growth, oily skin, dandruff., Infertility, skin

discolorations, High cholesterol levels, Elevated blood pressure and Abnormal

hair growth and distribution. Any of the above symptoms and signs may be

absent in pcos, with the exception of irregular or no menstrual periods. All

women with pcos will have irregular or no menstrual periods.8

A report released in the British journal of obstetrics and gynecology in

2000 indicated that up to 40% of women with pcos have either impaired glucose

tolerance or type 2 diabetes by age 40. In addition, with pcos, high levels of

insulin stimulate the ovaries to produce large amounts of testosterone (A male

hormone), which can possibly prevent ovaries from releasing an egg each month

thus causing infertility. High testosterone levels can also cause excessive hair

growth male pattern boldness and acne. In patients with pcos insulin resistance

encourages the storage of fat and the production of excessive amounts of

testosterone.9

Pcos are readily identified by pelvic ultrasound because, they are

larger than normal size (overage volume three times that in normal women).10

The diagnosis of pcos is based on ultrasound scan of the ovaries using a vaginal

probe and a hormone profile including measurement of FSH /LH, testosterone

and androstenedione .11

Lifestyle modification with increased physical activity and weight

reduction remains first line of therapy.12 Treatment of Pcos includes weight loss

of more than 5% of previous weight is important and will help in restoring the

hormonal milieu to some extent. Cigarette smoking raises DHEA

(Dehydroepiandrostenedione, Which produces androgens) it should be avoided.

Estrogen suppresses androgen and adrenal production. It is in oral contraceptives.

Dexomethosone 0.5Mg or Prednisolone 5Mg at bed time also reduces androgen

production. Hirsutism is treated with cyproteron acetate (Prevents recurrence of

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hirsutism) Infertility is treated With clomiphene 80% ovulate and 40% conceive.

Surgery is reserved for those in who medical therapy fails hyper stimulation

occurs. Surgery comprises laparoscopic multiple punctures of the cysts with

electrocautery or laser.13

The symptoms of pcos are major source psychological morbidity and can

negatively affect quality of life of adolescents. One of the symptoms acne is the

area least reported upon in terms of its impact upon health related quality of life.14

A few small studies have also suggested an increased risk of depression in

women with pcos.15

As pcos is among the most common during adolescence, there is always a

need to investigate all new relevant data. Early recognition and prompt treatment

of Pcos in adolescents is important to prevent long term sequel. More research is

necessary in order to find answers to many clinical and the theoretical aspects of

the syndrome.16

The onset of pcos occurs during adolescence since it is known that

incidence of pcos is more among adolescents. They are suffering from physical

and psychological morbidity. There is an increasing number of adolescents are

presenting with signs of pcos and also there is an increased risk of cardiovascular,

metabolic and depressive disorders. Mainly they will face problems like

disturbance in their body image because of certain pcos related problems. It

causes a psychological disturbances and also if untreated it may lead to

complication of pcos. The pcos is a source of psychological morbidity and also

can negatively affect the quality life of adolescents. So, early recognition,

prevention and treatment is important to prevent long term sequel and to develop

a positive attitude and follow healthy life style. From the above studies the

investigator found adolescent girls have lack of knowledge regarding pcos and

they are neglecting taking care of the disease. Hence, the researcher is interested

to educate the adolescent girls regarding pcos by giving them self instructional

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module and assess the effectiveness of Self instructional module.

6.2 REVIEW OF LITERATURE:

Review of literature for this study has been organized under the

following headings.

6.2.1. Studies related to polycystic ovary syndrome.

6.2.2 Studies related to prevalence of polycystic ovary syndrome.

6.2.3 Studies related to etiology of polycystic ovary syndrome.

6.2.4 Studies related to diagnosis and treatment of polycystic ovary

Syndrome.

6.2.5 Studies related to complications of polycystic ovary syndrome.

6.2.6 Studies related to quality of life of adolescents with polycystic ovary

syndrome.

6.2.1. Studies related to polycystic ovary syndrome.

A study conducted on Pcos is a heterogeneous endocrine disorder that

affects about 1 in 15 women worldwide. The major endocrine disruption is

excessive androgen secretion or activity, and a large proportion of women also

have abnormal insulin activity. Many body systems are affected in Pcos, resulting

in several health complications including menstrual malfunction, infertility,

hirsutism, acne, obesity, and metabolic syndrome. Women with this disorder have

an established increased risk of developing type 2 Diabetes and still debated

increased risk of cardiovascular disease. The diagnostic traits Pcos

hyperandrogenism, chronic and anovulation, and polycystic ovaries, after

exclusion of other conditions that cause these same features.4

A study conducted on “pcos and adolescents” by US scientists that is

pcos is the most common form of chronic anovulation associated with androgen

excess perhaps occurring in 5% to 10% of reproductive age women. Infertility is

caused by failure of ovulation although hyper secretion of LH (leutinizing

hormone) is also and important in this regard, obesity often associated with an

increase in the ratio of waist to hip circumference is the 3 rd classical feature. The

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classical profile is the hyper secretion of LH androgens with normal circulating

FSH, prolactin and thyroxin concentration. In-fact spectrum of endocrine findings

occurs, reflecting the phenotype heterogeneity of the Pcos. In a study of more

than 1500 cases 44% had and elevated serum LH and 22% an elevated serum

total testosterone concentration. Levels of LH were raised most commonly in the

women complaining of infertility and of testosterone in those complaining of

hirsutism.10

6.2.2 Studies related to prevalence of polycystic ovary syndrome.

A study conducted on “Prevalence of pcos in Women of Reproductive

Age”. 189 healthy women aged between 20-45 years were included in the study.

The women were divided into 2 groups, those 35 years of age and younger and

those 36 years age and older, on cycle days 1-6 trans vaginal ultrasound was

performed and blood samples were collected. There was 14.2% prevalence of

pcos in entire group (27/189). The prevalence was 21.6% in women 35years and

younger and 7.8% in the women 36years and older. Significantly more irregular

cycles were seen in women with pcos than in those with normal (44%v/s 19%).

In healthy women, the prevalence of pcos varies with age. The binding are more

common in women younger than 35 years.17

A study conducted on Prevalence of ultrasonography proved polycystic

ovaries in North Indian women with type 2 diabetes mellitus. Polycystic ovary

syndrome as well as type 2 diabetes mellitus is common medical conditions

linked through insulin resistance. 105 reproductive age group women with diet

and /or oral hypoglycemic treated T2DM were the subjects of the study. 60 non-

diabetic women served as controls. Trans abdominal ultrasonographic assessment

of the ovaries was used to diagnose pcos. Clinical, biochemical and hormonal

parameters were also noted. Ultrasonographic prevalence of pco was higher in

women with diabetes than in non-diabetic subjects, whereas that of pcos was

37.1% in diabetic subjects and 25% in non-diabetic controls. Diabetic women

with pco had diabetes of significantly longer duration than those without pco.

Among both diabetic and non-diabetic women, those with pco had significantly

6

higher plasma LH, LH/FSH ratio, and total testosterone and androstenedione

levels. This study demonstrates a higher prevalence of pco in women with T2DM

as compared to non-diabetic subjects 18.

6.2.3 Studies related to etiology of polycystic ovary syndrome.

The cause of pcos is unknown, but studies suggest a strong genetic

component that is affected by gestational environment, life style factors, or both.4

A study conducted on Epidemiologic and etiologic aspects of hirsutism in

Kashmiri women in the Indian subcontinent. To assess the prevalence of

hirsutism and study its etiology in the Kashmir Valley of the Indian subcontinent.

5000 women attending various hospitals for reasons unrelated to hirsutism and

150 consecutive women referred for hirsutism were in study. The etiology of

hirsutism revealed idiopathic hirsutism in 38.7%, pcos in 37.3%, postmenopausal

state in 9.2%, adrenal tumors in 2.1%, congenital adrenal hyperplasia in 1.4%,

and drug-induced hirsutism in 0.7%. The cause remained undetermined in 10.6%

of patients. Hirsutism is as common a problem in the Kashmir Valley (India) as

elsewhere in the world. Idiopathic hirsutism (38.7%), pcos (37.3%), and

postmenopausal state (9.2%) are common causes of hirsutism. Late-onset

congenital adrenal hyperplasia is a relatively uncommon cause of hirsutism in the

Kashmir Valley.7

6.2.4 Studies related to diagnosis and treatment of polycystic ovary

Syndrome.

A study conducted on “Diagnosis Management of Pcos-A Practical

Guide”, Pcos is a syndrome, which can be defined as a group of recognizable

patterns of symptoms or abnormalities that indicate a particular medical situation.

The current definition of Pcos requires the presence of two of the following three

conditions: (i) Oligo and /or anovalation, (ii) Clinical and/or biochemical signs of

hyper androgenism, and (iii) Polycystic ovaries-and the exclusion of other

etiologies. An approach to a patient with possible Pcos should be directed

towards making a diagnosis and screening for associated endocrine abnormalities.

Therapeutic interventions are directed towards addressing the need of the patient

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at present and towards preventing long term complications of the syndrome.

Body Mass Index (BMI), which is a primary mediator in the relationship between

Pcos and HRQL in obese Pcos adolescents. Any intervention directed at reducing

central obesity will not only improve quality of life but also correct

hyperinsulinism and improve fertility and lipid and androgen profile19.

A study conducted on “Current Approaches to the Diagnosis and

Treatment of Polycystic Ovarian Syndrome in Youth”. Pcos often presents during

late adolescence but in some cases certain features are evident even before

menarche. The diagnosis is based on a typical physical exam and laboratory

evidence of hyper androgenism, such as elevated free testosterone,

androstenedione and dehydroepiandrosterone sulfate (DHEAS), decreased sex

hormone-binding globulin (SHBG) and increased luteinizing hormone (LH). An

ovarian ultrasound may detect the multiple cysts. Oral contraceptive therapy is

used to reduce androgen and LH levels with resultant improvement in acne and

hirsutism, and the induction of regular menses. Anti androgens are usually

required for a substantial improvement in hirsutism score. Insulin sensitizers such

as metformin are a new class of drugs utilized in treatment of pcos. Despite all

the available medications, life-style changes are the mainstay of therapy as

weight loss and exercise improve all parameters of Pcos without the potential side

effects of medication.20

A study conducted on Benefits of Kayakalpa Yoga over pcos patients,

The aim of the study is to evaluate the benefits Kayakalpa yoga in pcos patients.

“Natural forces within us are the best healers of diseases.” Pituitary glands

control the endocrine metabolism of our body. By giving treatment to pituitary

gland the pcos could be cured. Kayakalpa yoga is an intrinsic factor, done to

regulate the endocrine metabolism of our body. Pcos is one of the endocrinal

disorders; this yogasana is applicable to patients suffering from pcos. Obesity is

one of the causative factors for pcos patients .Due to this yogasana our body will

be reduced. So in the study, a new approach is analyzed to control the obesity

factor in pcos patients. Kayakalpa yoga is a rejuvenating technique , which

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maintains the potency of our body and extends life span.21

6.2.7 Studies related to complications of polycystic ovary syndrome.

A study conducted on increase risk of the depressive disorders in women

with pcos, is associated with several metabolic complications. A few small

studies have also suggested an increased risk of depression in women with Pcos.

The goals of this study were to estimate the prevalence of depressive disorders in

women with Pcos compared with controls and to evaluate the correlation between

depression, hyperandrogenism, and other metabolic markers. Women with pcos.

Women without pcos seen during the same time. Period for an annual exam were

used as control subjects. Depressive disorders, Women with pcos were at an

increased risk for depressive disorders compared with controls. The report was a

significantly increased risk of depressive disorders in women with Pcos and

recommend routine screening in this population.15

6.2.8 Studies related to quality of life of adolescents with polycystic ovary

syndrome.

A study conducted on “Quality of life in adolescent girls with Pcos”, A

Cross-sectional study of female adolescents conducted at an urban hospital with

97 adolescents girls with Pcos and 186 healthy women. HRQL (health related

quality life) scores as determine by the child health questionnaire-child self report

form. It says Adolescents with Pcos experience lower HRQL compared with

healthy adolescents.3

6.3 STATEMENT OF THE PROBLEM:

A study to assess the Effectiveness of self instructional module on

polycystic ovary syndrome among the adolescent girls in a selected college of

Bangalore.

6.4 OBJECTIVES OF THE STUDY:

1. Assess the knowledge regarding poly cystic ovary syndrome among

adolescent girls.

2. Assess the effectiveness of self instructional module on polycystic ovary

9

syndrome among adolescent girls.

3. Determine the association between the selected demographic variables

with the knowledge of adolescent girls regarding polycystic syndrome.

6.5 OPERATIONAL DEFINITIONS:

1. KNOWLEDGE

Refers to the responses of subjects on self administered questionnaire on Pcos.

2. EFFECTIVENESS.

. Refers to the gain in knowledge as determined by significant difference in

pre test and post test scores.

3. SELF INSTRUCTIONAL MODULE.

Refers to a booklet of contents prepared by the investigator and validated by

experts. It contains the meaning, signs and symptoms, management and

prevention of pcos, which will be provided to the subjects for self reading and

gaining information.

4. POLY CYSTIC OVARY SYNDROME.

Polycystic ovary syndrome is a complex condition affecting many organ

sites in reproductive age women including the hypothalamus, pituitary, ovary,

pancreas, peripheral glucose sensitive tissues, and skin in different individuals.

5. ADOLESCENT GIRLS

Refers to the first and second year PUC students.

6.6 HYPOTHESES

H1 - There will be significant difference between pre test and post test level of

knowledge among of adolescent girls regarding Pcos.

6.7 ASSUMPTIONS

Its is a assumed that

1. Adolescent girls will be willing to express their knowledge regarding

polycystic ovary syndrome.

2. Self instructional module increases the knowledge of adolescent girls

regarding polycystic ovary syndrome.

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6.8 DELIMITATIONS:

1. The study is delimited to adolescent girls only

2. Adolescent girls who are available at the period of study.

3. Measurement of knowledge scores of Adolescent girls once before and

after effectiveness of self instructional module.

6.9 PROJECTED OUTCOME

1. The study will enhance the knowledge of Adolescent girls on Pcos and

help in increasing autonomy and operate in a desirable manner to

achieve positive health.

2. The study will generate new knowledge on attitudes of Pcos among

Adolescent girls.

7 MATERIALS AND METHODS

7.1 SOURCE OF DATA Adolescent girls in a selected college of

Bangalore.

7.2 METHODS OF COLLECTION OF DATA.

7.2.1 SAMPLE CRITERIA

Inclusion criteria of the

study

Exclusion criteria of the

1. Adolescent girls in a selected college

2. Adolescent girls available during data

collection.

3. Who are willing to participate.

4. Who understand the language

Kannada, English and Hindi.

1. Not willing to participate in the study.

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study 2. Adolescent girls not attending college.

7.2.2 RESEARCH DESIGN Pre Experimental design. One group pre test

and post test design.

7.2.3 VARIABLES UNDER

STUDY

INDEPENDENT VARIABLE

DEPENDENT VARIABLES.

ATTRIBUTE VARIABLE

Self instructional module.

Knowledge of adolescent girls regarding polycystic ovary syndrome..

Age, socioeconomic status, Education.

7.2.4 SETTING OF THE STUDY Study will be conducted in a selected

college of Bangalore.

7.7.5 SAMPLE TECHNIQUE The researcher will use convenience sampling

technique.

7.2.6 SAMPLE SIZE The sample size consists of 30 Adolescent girls

7.2.7 TOOLS OF RESEARCH Level of knowledge of Adolescent girls about

Pcos can be assessed by questionnaire on

knowledge of Adolescent girls about Pcos.

7.2.8 COLLECTION OF DATA An informed consent will be obtained from the

subjects The process of the study will be

explained to the subjects. Structured

questionnaire will be administered to the

subject to assess the knowledge level.

Subsequently to the pre test, a self instructional

module on poly cystic ovary syndrome will be

given to the adolescent girls. Following this on

4th day the investigator will assess the

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knowledge score by post test using structured

questionnaire. Study duration is of 30 days.

7.2.9 METHOD OF DATA

ANALYSIS AND

PRESENTATION

By using descriptive and inferential statistics.

The plan of data analysis will be as follows

1. Organize the data in a master sheet /

computer

2. Frequencies and percentages for the

analysis of background data

3. Mean , median, SD and ‘F’ values to

determine the significance

4. Chi-square test to determine the

association

7.3 Does the study require any investigation or intervention to be conducted on

patients or other human or animals? If so, please describe briefly?

The study requires administration of questionnaire

7.4 Has the ethical clearance been obtained from the institutional authorities of

the particular institution and students

Yes. Ethical clearance and informed consent will be obtained from the

institutional authorities and students. Privacy, confidentiality and anonymity will

be guarded. Scientific objectivity of the study will be maintained with honesty

and impartiality.

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