STATEMENT OF THE PROBLEM

A study to evaluate the effectiveness of Self Instructional Module on knowledge regarding Polycystic Ovarian syndrome among college students in a selected colleges, Tirupati. INTRODUCTION:
The word Adolescence derived from the Latin word adolescence which means to grow. Its a traditional stage of physical and mental human development. This transition involves biological (ie, pubertal), social and psychological changes. The period of adolescence is filled with intellectual and emotional changes in addition to other biological and physical changes. It is a time of discovery of self and ones relationship to the world around him / her. Adolescence young people between the ages of 10 to 19- are often thought of as a healthy group. This age group includes Early Adolescence, Middle Adolescence and Late Adolescence. In this late adolescence (16-19), body takes adult form has distinct identity and more settled ideas and opinions. Adolescent phase starts from the onset of puberty and extends from till sexual maturation is complete. During this period the individual becomes capable of reproduction. The age at the onset of puberty and sexual maturation vary within a wide range. The adolescent are prone to suffer from medical and health problems peculiar to this age period. As a growing adolescent, problem related puberty is the main stress for both girls and boys. In adolescent girls, the problem related to menstruation is getting prevalent nowadays. Menstrual problems are not corrected due to lack of knowledge.ie, fails to understand normal menstruation and menstrual problem. www.wikipedia.com Hormones help regulate the normal development of eggs in the ovaries during each menstrual cycle. Polycystic ovary syndrome is related to an imbalance in these female sex hormones. Too much androgen hormone is made, along with changes in other hormone levels. Polycystic ovarian syndrome (PCOS) was originally described in 1935 by American gynecologists Irving F. Stein, Sr. and Michael L. Leventhal, from whom its original name of Stein-Leventhal syndrome is taken. Stein & Leventhal defined as a syndrome manifested by amenorrhea(80%), hirsutism(50-70%) & obesity(50%) associated with enlarged poly cystic ovaries. D.C.Dutta (Text book of gynecology) Other names are polycystic ovaries; Polycystic ovary disease; Stein-Leventhal syndrome; Polyfollicular ovarian disease. -http://www.rbej.com

Polycystic ovarian syndrome is a complex, heterogeneous disorder of uncertain etiology, it can to a large degree be classified as a genetic disease which occurs amongst all races and nationalities, is the most common hormonal disorder among women of reproductive age and is a leading cause of infertility. www.wikipedia.com Follicles are sacs within the ovaries that contain eggs. Normally, one or more eggs are released during each menstrual cycle. This is called ovulation. In polycystic ovary syndrome, the eggs in these follicles do not mature and are not released from the ovaries. Instead, they can form very small cysts in the ovary appears like string of pearls near its surface. -http://www.rbej.com PCOS is a multifactorial & polygenic condition.Incidence varies between 0.5- 4 % more common among infertile women. It is prevalent (20-30%) in young reproductive age group. www.wikipedia.com Adolescent girls are often associated with Oligomenorrhea, amenorrhea irregular, few, or absent menstrual periods, Hirsutism excessive and increased body hair, typically in a male pattern affecting face, chest and legs. Hair loss appearing as thinning hair on the top of the head Acne, oily skin, seborrhea , acanthosis nigricans. Obesity or weight gain: one in two women with polycystic ovarian syndrome are obese, depression and deepening of voice. All these are due to immaturity of the hypothalamic pituitary ovarian axis during the first years following menarche. D.C.Dutta (Text book of gynecology) Hyperinsulinemia and insulin resistance are present in the majority of women with polycystic ovary syndrome (PCOS). Both metformin and rosiglitazone can improve the ovulation and endocrine disorders of the patients.acanthosis nigricans is characterized by specific skin changes due to insulin resistance. The skin is thickened & pigmented. Commonly affected sites are nape of the neck, inner thighs & axilla. -depaolol@mail.nih.gov During Adolescent period general interventions like weight reduction, regular exercise &maintaining a healthy weight can reduce hormonal imbalance, restore ovulation and fertility, and improve acne and hirsutism. -http://www.ebmoline.org

NEED FOR THE STUDY:Adolescence is an important period because they are necessary for future national health, demographic and economic force. The adolescence are facing some common health problems such as malnutrition, general health problem, menstrual problem, mental health problems, early and unprotected sex, addictive behaviors, accidents and violence, sexual abuse, depression, suicide and eating disorder. www.wikipedia.com Adolescent grow both rapidly and mature dramatically during this period. In a family in which an adolescent is expected to begin working full time or to marry at an age, one should need to include factors such as effects of job, family, financial stress and readiness for early child

bearing also. Reproductive disorders in children range from mild infections to serious anatomic malformations. All of these require prompt and careful treatment so that we have to make them aware of normal reproductive health and its abnormalities. Then only they can identify abnormalities & treat promptly. Reproductive health outlook (2002) The polycystic ovarian syndrome is a frustrating experience for an increasing number of women. PCOS is a common endocrinopathy, affecting 5-10% of women of reproductive age. Worldwide statistics shown that polycystic ovarian syndrome affects 1 in 15 women. While is not known to be hereditary, it is true that women in the same family will have a higher incidence of the disorder. Recent studies are shown that it is possibly a genetic abnormality that causes the insulin resistance, over production of androgen and lack of ovulation. Sisters of PCOS have about 50% chance of having PCOS. -http://www.managingpcos.org/prevalence. In India, the prevalence of pcos in adolescence is 9.13 %. India has witnessed about 30% rise in pcos cases in the last couple of years. This draws attention to the issue of early diagnosis in adolescent girls. Lack of awareness & lifestyle changes are considered to be the major factor leading to this phenomenon. So, there is need to increase awareness among women so as to avoid major cases of fertility problem in future. The PCOS has now become a common health problem that affects teenage girls & young women. It seems to be related to an imbalance in a girls hormones. About 40% of women affected with PCOS belongs to the most reproductive age group. If PCOS is not treated properly, it can put a girl at risk for lots of problems like infertility, excessive hair growth, acne, obesity, diabetes, heart disease, high blood pressure , abnormal bleeding from the uterus, & cancer etc; though there is no cure for PCOS since it is a hormonal disorder, it can be controlled & treated.(Dr. Punjabi- sonologist & family planning expert) Incidences of PCOD have increased from 5% to20% among adolescent girls over the last five to eight years. Incidence of pcos is increasing may be because of our food habits, lifestyle changes, or rising environmental pollution. Its the frequent cause of infertility. Some pcos symptoms may be of concern, especially in adolescent girls. Education and support are important in helping young women with the physical and psychological aspects of pcos. - ( suja Nair shirodhkar,2009) Patients with PCOS are at high risk for developing insulin glucose tolerance, the early identification of affected patients and institution of life style changes or pharmacological treatments may help delay the progression to type 2 DM. 45% of PCOS women more likely to have diabetes than normal women. 50% - 70% of PCOS women more likely to have obesity. - (salley.et.al-2007) In a population of 400, unselected, consecutive premenopausal women the prevalence of PCOS was 6.6% and that the prevalence of overweight & obesity was 24 & 32% respectively, with a higher proportion of black women with respect to white women. Infertility affects at least 12% of couples worldwide (Reproductive health outlook, 2002).

Majority of PCOS women have poor sleep quality, related to insulin resistant. Sleep apnea may occur up to 50% women with PCOS. Aproximately 50% of PCOS women have increased depression scores. Prevalence of metabolic syndrome in PCOS women is 25 to 30%. -depaolol@mail.nih.gov Dr.Punjabi informs that women with PCOS have to maintain base lifestyle and control date diet per keeping PCOS under control.Women with PCOS should try to opt for low glycemic index food, as they will cause slower rise in blood sugar. Avoid those carbohydrate that trigger more hunger or cravings. Management should focus on support, education and addressing psychological factors and should have a strong emphasis on healthy life style. Life style management aiming for weight loss and/ or prevention of weight gain should be first line, with targeted medical therapy as required. Along with managing reproductive complication, monitoring first and managing longer term metabolic complications (including glucose intolerance, diabetes, cardiovascular risk factors and hyperlipidemia) are important. Jaean hailel et.al (2011) Fahimeh R Tehrani, Masoumeh Simbar(2011) was conducted study on the prevalence of polycystic ovary syndrome in a community sample of Iranian population Using the stratified, multistage probability cluster sampling method, 1126 women were randomly selected from among reproductive aged women of different geographic regions of Iran. PCOS were diagnosed using universal assessment of ultrasonographic parameters, hormonal profiles and clinical histories. Results shown that the mean +/- SD of age of study population was 34.4 +/- 7.6 years. Estimated prevalence of idiopathic hirsutism was 10.9% (95% CI: 8.9-12.9%); 8.3% of women had only oligo/anovulation and 8.0% had only polycystic ovaries. The prevalence of PCOS was 7.1% (95% CI: 5.4-8.8%) using the NIH definition, 11.7% (95% CI: 9.5-13.7%) by AES criteria and 14.6% (95% CI: 12.3-16.9%) using the Rott definition. For Adolescent no surgical management is possible, before marriage, so that by giving information regarding Polycystic ovarian syndrome is very useful. As PCOS leads to a lot of problem, it needs urgent attention, since the incidence rate is increasing at higher rate. Education, awareness and self control is the only way to control it from rising further and affecting more women.Therefore I taken this study to assess the knowledge regarding polycystic ovary and complications among adolescents within 16-20 years including nature, meaning, dietary practice, exercise, complications and administer the self instructional module and to investigate its effect in terms of gain in knowledge among adolescent girls. REVIEW OF LITERATURE:Awartani KA, Cheung AP et.al(2002), This study identified 23 prospective studies addressing the effects of metformin on PCOS. Because of the heterogeneity of the published reports, only a qualitative assessment of the data was possible. Review of this literature confirms a beneficial role of metformin in reducing insulin resistance in some women with PCOS. Other favorable biochemical effects include reduced free testosterone levels and increased sex hormone-

binding globulin (SHBG). Metformin may improve menstrual regularity, leading to spontaneous ovulation, and improve ovarian response to conventional ovulation-induction therapies. There is, however, little evidence supporting the use of metformin to facilitate weight reduction, or improve serum lipids or hirsutism. Further evaluation is required to define the long-term effectiveness of metformin, who will benefit from metformin treatment, and the optimal duration of metformin therapy. J.A. Barry1,A.R. Kuczmierczyk et.al(2011)conducted study to assess differences in anxiety and depression between women with and without (controls) polycystic ovary syndrome (PCOS). They was conducted a systematic review and meta-analysis of published literature comparing women with PCOS to control groups on anxiety and depression. Electronic databases were searched up to 17 December 2010. The inverse variance method based, as appropriate, on a random- or fixed-effects model in Review Manager, Version 5 was used to analyse the data. Results shown that Twelve comparative studies were included; all studies assessed depression (910 women with PCOS and 1347 controls) and six also assessed anxiety (208 women with PCOS and 169 controls). Analysis revealed higher depression (Z = 17.92, P < 0.00001; Hedges g = 0.82; 95% CI 0.730.92) and anxiety (Z = 5.03, P < 0.00001; Hedges g = 0.54; 95% CI 0.33 0.75) scores in the participants with, than without, PCOS. Studies controlling for BMI showed a smaller difference between women with PCOS and controls on anxiety and depression scores than studies not controlling for BMI. They concluded that Women with PCOS on average tend to experience mildly elevated anxiety and depression, significantly more than women without PCOS. Women with PCOS with lower BMI tended to have slightly lower anxiety and depression scores, suggesting that having a lower BMI reduces anxiety and depression. Future studies might consider (i) controlling for BMI, (ii) stratifying by medication use in order to control for any anti-androgenic effects of medication and (iii) excluding women with polycystic ovaries from control groups. Fahimeh R Tehrani, Masoumeh Simbar(2011) was conducted study on the prevalence of polycystic ovary syndrome in a community sample of Iranian population Using the stratified, multistage probability cluster sampling method, 1126 women were randomly selected from among reproductive aged women of different geographic regions of Iran. PCOS were diagnosed using universal assessment of ultrasonographic parameters, hormonal profiles and clinical histories. Results shown that the mean +/- SD of age of study population was 34.4 +/- 7.6 years. Estimated prevalence of idiopathic hirsutism was 10.9% (95% CI: 8.9-12.9%); 8.3% of women had only oligo/anovulation and 8.0% had only polycystic ovaries. The prevalence of PCOS was 7.1% (95% CI: 5.4-8.8%) using the NIH definition, 11.7% (95% CI: 9.5-13.7%) by AES criteria and 14.6% (95% CI: 12.3-16.9%) using the Rott definition.. Suzette C. Bishop, BM et.al (2009) to assess the prevalence of depression and psychologic disorders and their effect on the quality of life in women with polycystic ovary syndrome. Results shown that In patients with polycystic ovary syndrome, the presence of depression and allied disorders was frequently noted to diminish mental well-being, affect, and self-worth. The symptoms often associated with this syndrome, such as hirsutism, obesity, irregular menses, and subfertility, were a major source of psychologic morbidity. Obesity was the most prevalent

cause of mental distress, whereas other features such as hirsutism and infertility were less well defined as major factors. Although the findings in some studies have been inconclusive, the presence of clinically significant eating disorders and a 7-fold increase in the suicide rate have been reported in women with polycystic ovary syndrome. E Carmina, N Napoli, et.al, conducted study on prevalence of metabolic syndrome in polycystic ovary syndrome. Assessment of the prevalence of MBS in 282 women with PCOS, aged 1840 years, living in western Sicily. Eighty-five age- and weight-matched normal women served as controls. Patients were divided into those with chronic anovulation and hyperandrogenism (classic PCOS; n 225) and others with hyperandrogenism and polycystic ovaries but who were ovulatory (ovulatory PCOS; n 57). A 75 g oral glucose tolerance test was carried out, as were lipid determinations; insulin resistance was assessed by the Quantitative Insulin-Sensitivity Check Index (QUICKI). They used ATP-III and WHO criteria to diagnose MBS. Results shown that Using ATP-III criteria, the prevalence of MBS was 8.2% and using WHO criteria it was 16% in Italian women with PCOS. In controls, the prevalence was 2.4% using both methods. In classic PCOS patients, MBS was higher (8.9% by ATP-III, 17.3% by WHO) than in ovulatory PCOS (5% and 10.6% respectively). Harrison CL, Lombard CB, (2011) et.al, conducted study on exercise therapy in PCOS Studies were included if exercise therapy (aerobic and/or resistance) could be evaluated as an independent treatment against a comparison group. Outcomes measured included cardiovascular risk factors [insulin resistance (IR), lipid profiles, blood pressure and weight] and reproductive measures (ovulation, menstrual regularity and fertility outcomes). Quality analysis was performed based on the Cochrane Handbook of Systematic Reviews and the Quality of Reporting of Meta-Analyses checklist. Results shown that randomized controlled trials and three cohort studies, all studies involved moderate intensity physical activity and most were of either 12 or 24 weeks duration with frequency and duration of exercise sessions ranging between studies. The most consistent improvements included improved ovulation, reduced IR (9-30%) and weight loss (4.5-10%). Improvements were not dependant on the type of exercise, frequency or length of exercise sessions. OBJECTIVES OF THE STUDY To assess the existing knowledge on polycystic ovary syndrome among adolescent girls in terms of pretest score. To develop a Self Instructional Module regarding Polycystic Ovarian syndrome. To evaluate the effectiveness of self instructional module on knowledge of college students regarding Polycystic Ovarian syndrome.

 To determine the association between post test knowledge score and socio demographic variables such as age, age of menarche, obesity, menstrual history, education, religion, type of family, socioeconomic status, source of information. OPERATIONAL DEFINITION Effectiveness: It refers to the desired change brought about by the self instructional module which will be measured in terms of significant knowledge gain in the post test scores. Self instructional module: It refers to a well planned informational strategy for the higher secondary school children regarding meaning, signs and symptoms, management and prevention of Polycystic Ovarian syndrome, which will be provided to the subjects for self reading and gaining information. Knowledge: It refers to the awareness and correct responses of the adolescents regarding polycystic ovary syndrome. Polycystic Ovarian syndrome: it refers to knowledge of adolescent girls College students: The children studying at 11th and 12th standards only. RESEARCH APPROACH: - An Evaluative approach RESEARCH DESIGN: - Pre test -post test research design. STUDY SETTING:Study will be conducted in selected colleges at Tirupati SAMPLE:The population of the present study comprises of the adolescent girls aged between 16-20yrs. SAMPLE SIZE:Sample consists of 100 adolescent girls aged between 16-20yrs in selected colleges of Tirupati SAMPLING TECHNIQUE:Non probability purposive sampling.