Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore s11

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 NAME OF THE MRS. JESMI M JOSEPH CANDIDATE AND KOSHYS COLLEGE OF NURSING ADDRESS SY NO.31/11, HENNUR BAGALUR ROAD, KADUSONNAPPANAHALLI,KANNUR POST BANGALORE – 562149.

2 NAME OF THE KOSHYS COLLEGE OF NURSING INSTITUTION

3 COURSE OF STUDY AND 1ST YEAR M. Sc. NURSING SUBJECT OBSTETRIC AND GYNAECOLOGICAL NURSING

4 DATE OF ADMISSION TO 09/06/2010 COURSE

A STUDY TO EVALUATE THE 5 TITLE OF THE TOPIC EFFETCIVENESS OF PLANNED TEACHING PROGRAMME REGARDING KNOWLEDGE ON PRE MENSTRUAL SYNDROME AMONG PRE UNIVERSITY STUDENTS IN SELECTED COLLEGES, BANGALORE.

1 6. BRIEF RESUME OF THE INTENTED WORK

INTRODUCTION: What we ought to see in the agonies of puberty is the result of the conditioning that maims the female personality in creating the feminine.

- Germaine Greer

The word puberty is derived from the Latin pubertas, which means adulthood.

Puberty is the period during which the onset of sexual maturity occurs. The pituitary gland secretes hormones that stimulate enlargement and development of the sex organs, which thus become capable of reproduction. In females the reproductive cycle of ovulation and menstruation begins, pubic hair appears, and development of the breasts and other body contours takes place.1

Menstruation (a period) is a major stage of puberty in girls; it's one of the many physical signs that a girl is turning into a woman. The start of periods is known as menarche.Menstruation is also called menstrual bleeding, menses, catamenia or a period.

Although every woman has an individual cycle of menstruation. The length of a woman's menstrual cycle will typically vary, with some shorter cycles and some longer cycles. A woman who experiences variations of less than eight days between her longest cycles and shortest cycles is considered to have regular menstrual cycles2.

Most women experience some form of premenstrual syndromes whether mild or severe at some time in their life. Premenstrual (pree-MEN-struhl) syndrome

(PMS) is a group of symptoms linked to the menstrual cycle. Pre Menstrual Syndrome symptoms occur 1 to 2 weeks before the ‘period’ (menstruation or monthly bleeding)

2 starts. The symptoms usually go away after you start bleeding. Pre Menstrual Syndrome can affect menstruating women of any age and the effect is different for each woman3.

The exact cause of Premenstrual Syndrome is not known. It is believed that the changes in the hormones level before the menstrual cycle begins may be the cause of

Premenstrual Syndrome. Females have a natural balance of both the male and female hormones in their body. An increase in the level of prolactin (responsible for producing breast milk) and male hormones in the body of women can decrease the level of progesterone and delay ovulation. This could also be a possible reason of Premenstrual

Syndrome. Premenstrual Syndrome could also be due to imbalance in magnesium and calcium levels in the body4.

PMS symptoms can range from mild to severe. Symptoms may include: Breast swelling and tenderness, dizziness, headache, cramps, nausea and vomiting, food cravings, abdominal bloating , weight gain from water retention, stomach upset, swelling of the face, hands, ankles, depressed mood, crying spells, anxiety, irritability, anger, trouble falling asleep (insomnia), appetite changes or food cravings and fatigue.5

The diagnosis of Premenstrual Syndrome can be difficult because many medical and psychological conditions can mimic or worsen symptoms of Premenstrual Syndrome.

There are no laboratory tests to determine if a woman has Premenstrual Syndrome. When laboratory tests are performed, they are used to exclude other conditions that can mimic

Premenstrual Syndrome. The most helpful diagnostic tool is the menstrual diary, which documents physical and emotional symptoms over months.6

The treatment of Premenstrual Syndrome can sometimes be challenging. Many things have been tried to ease the symptoms of Premenstrual Syndrome. Various treatments and approaches have been used to treat this condition. General management includes a healthy lifestyle including exercise. Family and friends can provide emotional

3 support during the time of a woman's cycle. Avoid salt before the menstrual period and reduce caffeine intake; Quit/reduce alcohol intake and reduce intake of refined sugars6.

All of the above have been recommended and may help symptoms in some women. Furthermore, some studies suggest that vitamin B6, vitamin E, calcium, and magnesium supplements may have some benefit. A variety of medications are also used to treat the different symptoms of Premenstrual syndrome. Medications include diuretics, pain killers, oral contraceptive pills, drugs that suppress ovarian function, and antidepressants7.

Some natural home remedies also exist that may help ease pre- menstruation discomfort. They're easy, contain items typically found in the home, and some probably work as well as, or better than, the medical treatments available7.

A study to assess the prevalence and the effect of menstrual disorders on daily routine was conducted among unmarried undergraduate medical students in Delhi

Medical college. Premenstrual syndrome (67%) and Dysmenorrhea (33%) were perceived by the study subjects as the most distressing problems associated with menstruation. The result showed that the effect of menstrual problems on daily routine reported by the study subjects was in the form of prolonged resting hours (54%) followed by inability to study (50%). More than half (52%) of the subjects discussed their problems with their mother, and 60% of the study subjects were opted for allopathic treatment for their menstrual problems8.

PMS can be a monthly inconvenience, but with some small precautions and simple home remedies, its negative effects can be greatly lessened, and, in some cases, even eliminated altogether.

6.1 NEED FOR THE STUDY

4 Menstruation does not stop just because there is an emergency. While

80% of menstruating women have experienced at least one symptom that could be attributed to PMS, estimates of prevalence range from as low as 3% to as high as 30%.

The topic holds a paramount importance in the life cycle of a woman, the time of acquiring the age of adolescence. The knowledge level of a young girl at the age of 8 to

10 years is very meager to accept the myths and facts of the menstrual cycle and its associated problems. There needs to be awareness in the mind of all the girls regarding the process and complications on the topic9.

Although premenstrual syndrome is an issue that every girl and woman has to deal with in her life. There is lack of information on the process of menstruation and the physical and psychological changes associated with this and proper requirements for managing premenstrual syndrome. The taboo surrounding this issue in the society prevents girls and women from articulating their needs and the problems and the management have been ignored or misunderstood10.

Approximately 75 percent of women are affected by PMS. For about half of these women, the condition is severe enough to interfere with daily tasks, and for about ten percent of women, it's severe enough to be disabling. Women who seem to be most affected include those between their late 20s and early 40s3.

The reported prevalence of about 20–40% shows that a significant group of women may be affected by PMS. In studies conducted in New York, reports of PMS among adolescents in indicate a prevalence ranging from 14 to 30% 2.

Some of the PMS symptoms may create serious negative consequences for the adolescents, their families and their social relatiosnships including low self-esteem, low tolerance to stress and feelings of inadequacy. The consequences necessitate the development of effective educational programs and their implementation to facilitate the

5 adolescents learning to control their PMS symptoms, rather than letting the symptoms control them. In Hong Kong, about 10% of the secondary schools were found to have no sex education on the topic of menstruation. Less than half of the secondary schools in

Hong Kong who responded to a survey indicated that the schools had formulated an overall policy in the implementation of sex education. Thus when these adolescent girls approach puberty, those with lack of support or education may not be well prepared to handle all the associated changes accompanying their menstruation6.

In studies that examined the effects of educational programmes, the findings reflected a significant improvement in the outcome measures. Gaining knowledge has been regarded as an important goal towards improving an individual's health status. It also helps to gain a means of controlling feelings of powerlessness 6.

Many women suffer from varying degrees of premenstrual syndrome, or

PMS. For many, acute symptoms of PMS have been a lifelong struggle. Whether the symptoms are disruptive to daily living or just monthly annoyances, women are looking for answers in dealing with PMS4.

Nowadays, there is more effort in evaluating education programs in terms of improvement in individuals' health status including physical and psychological well-being. A major goal in health education is also to promote better health. Some scholars argue that when PMS in adolescents is ignored; it can cause an impact on the adolescent’s health and quality of life.

A study was conducted to investigate the frequency of premenstrual syndrome (PMS) associated symptoms and effects of nutrition on PMS in adolescent girls. One hundred and five adolescent girls out of 171 (61.4%) met DSM-IV criteria for

PMS. There was an association between Dysmenorrhea and PMS in 60 (57.1%). Half of the girls, i.e. 52 (49.5%).) had mild, 39 (37.1%) had moderate and 14 (13.4%) had severe

6 PMS. The most common symptom of PMS was negative affect particularly in the form of stress (87.6%) and nervousness (87.6%)1.

The researcher, I find this study very much effective and hold paramount importance in the life of every girl, who comes across the phenomenon of Pre menstrual syndrome. The researcher has felt that the problems faced by the adolescent girls during the time of their periods, in which many of them even thought of not attending the classes for days together due to lack of self confidence, shame, and depression, Due to these multifarious reasons The researcher strongly felt that the study will be very much effective to improve the knowledge regarding Premenstrual Syndrome among pre university students11.

6.2 REVIEW OF LITERATURE Review of literature is the key step in research process. Literature review of present study will be collected and presented under the following headings, studies and literature related to:

 General information and symptoms of premenstrual syndrome.

 Incidence and prevalence associated with premenstrual syndrome

 Management of premenstrual syndrome

 Effectiveness of teaching/SIM on premenstrual syndrome

 General information and symptoms of premenstrual syndrome:

Prospective study was conducted to determine the age at menarche and the most common symptoms of premenstrual syndrome (PMS) in adolescent girls with intellectual disability. The main method of data collection was through the use of a survey and an interview with the girls. The sample consisted of 31 adolescent girls with intellectual disability and 31 adolescent girls without intellectual disability serving as a control

7 group. Both groups were between the ages of 14 and 18 years. The results of this study revealed higher variability of age at menarche in girls with intellectual disability compared to girls without intellectual disability. The symptoms of PMS were almost equally distributed in both groups of girls. Many girls with intellectual disability do not have enough knowledge about menstruation. The research recommended that more attention needs to be given to treating the symptoms of PMS and educating the girls in a school setting12.

In Journal of Pediatrics and Adolescent Gynecology, identify the presence of patients with premenstrual syndrome (PMS) in an adolescent gynecology practice, and evaluate the reported severity impairment and timing of the symptoms in the menstrual cycle. Adolescents ages 13–18 years completed a symptom questionnaire, functional impairment ratings, and a brief medical history questionnaire during an office visit. Teens who responded that they had PMS and reported premenstrual symptom score at least 50% greater than the postmenstrual score and rated moderate to severe impairment in one or more domains comprised the “PMS” group. Teens who responded that they had PMS but did not meet the symptom and impairment criteria were termed “PMS not supported.”

Teens who responded that they did not have PMS and did not meet the PMS symptom and impairment criteria were termed “No PMS.” Study participants (n = 94) had a mean age of 16.years, 31% met the criteria for the PMS group, 54% said they had PMS but did not meet criteria, and15% clearly had no PMS. In the PMS group, the most severe symptoms were mood swings, anxiety and irritability, with the greatest impairment in the home/family domain13.

A comparative study was conducted to assess the menstrual characteristics among the adolescents of rural and urban West Bengal, India. The sample of the study constituted 715 adolescent girls from rural (325) and urban (390) areas of West Bengal, a

8 State of India. Data on socio-economic variables and menstrual characteristics were collected using pretested questionnaires. The result showed that the rural and urban adolescents differed significantly (p < or = 0.05) with respect to age at menarche, skipped and irregular cycles, premenstrual syndrome, duration of menstrual discharge, mean number of days of peak discharge and problems related to menstrual discharge. Place of residence was found to be a significant predictor of age at menarche (beta = 0.27, p <

0.01). Significant association was observed between some of the socio-economic variables and various menstrual characteristics among the study participants. Menstrual characteristics differ significantly between rural and urban adolescents. Moreover, various socio-economic variables pertaining to place of residence significantly affect the menstrual characteristics among adolescents13.

A study was conducted to compare premenstrual symptoms among asthmatic women according to whether they have premenstrual asthma or not. A questionnaire on respiratory symptoms during a single menstrual cycle was developed for asthmatics of fertile age, together with another on symptoms related to premenstrual syndrome. These included dysphoric-psychiatric symptoms (anxiety, depression, fatigue, irritability, and mood swings), edematous symptoms (abdominal and mammary tension, swelling, acne, and migraine), and other symptoms (leg pains, nausea, sweating, vomiting, and tiredness). Morning and evening peak flow scores were collected to evaluate lung function. The study examined 103 patients of fertile age, 46 of whom (44.7%) presented with premenstrual asthma. Practically all of the monitored symptoms increased in the premenstrual phase with respect to the preovulatory phase. This increase was greater in women with premenstrual asthma. A clear link was found between premenstrual asthma and the premenstrual exacerbation of dysphoric symptoms14.

9 Incidence and prevalence associated with premenstrual syndrome

In Indian Journal of Pediatrics (2008), to study the types and frequency of problems related to menstruation in adolescent girls and the effect of these problems on daily routine. Girls in the age group 13–19 years who had had menarche for at least one year at the time of study. 198 adolescent girls have been studied. Data was collected by personal interviews on a pre-tested, semi-structured questionnaire. The questions covered menstrual problems. . Dysmenorrhea (67.2%) was the commonest problem and (63.1%) had one or the other symptoms of Pre-menstrual syndrome (PMS). Other related problems were present in 55.1% of study subjects. Daily routine of 60% girls was affected due to prolonged bed rest, missed social activities/commitments, disturbed sleep and decreased appetite. 17.24% had to miss a class and 25% had to abstain from work.

Mothers and friends were the most common source of information on the issue.14

A descriptive study was conducted to investigate the prevalence and impact of premenstrual symptoms in Japanese women; they developed the PSQ “The Premenstrual

Symptoms Questionnaire” for the screening of premenstrual symptoms. One thousand one hundred and eighty-seven Japanese women between the ages of 20 and 49 yrs were assessed regarding their premenstrual symptoms using the PSQ. As many as 95% of these women were found to suffer from premenstrual symptoms. The rates of prevalence of moderate to severe PMS and PMDD in Japanese women were 5.3 and 1.2%, respectively, which are lower than those in Western women. Only 5.3% of women with moderate to severe PMS and PMDD were treated. The results of this study suggest that race and ethnicity influence the expression of premenstrual symptoms and that the current state of medical care for Japanese women with moderate to severe PMS and PMDD is not satisfactory15.

10 A descriptive study was conducted to determine the prevalence of

Dysmenorrhea, its impact, and the treatment-seeking behavior of adolescent Asian girls.

A cross-sectional study with 1092 girls from 15 public secondary schools and 3 ethnic groups in the Federal Territory of Kuala Lumpur and Malaysia. Overall, 74.5% of the girls who had reached menarche had Dysmenorrhea; 51.7% of these girls reported that it affected their concentration in class; 50.2% that it restricted their social activities; 21.5% that it caused them to miss school; and 12.0% that it caused poor school performance.

Ethnicity and form at school were significantly associated with the poor concentration, absenteeism, and restriction of social and recreational activities attributed to

Dysmenorrhea. Only 12.0% had consulted a physician, and 53.3% did nothing about their conditions. There were ethnic differences in the prevalence, impact, and management of

Dysmenorrhea16.

A descriptive study was conducted to determine the frequency and severity of Premenstrual Syndrome (PMS) in medical college students evaluate the impact of the condition on the quality of life and find out the associated risk factors.

Unmarried medical students aged 18-25 years with regular menstrual period for the last

06 months were recruited by convenience sampling. PMS-related data was collected on daily record of severity of problems (DRSP) for two prospective cycles. Descriptive and inferential analysis was done by two-tailed t-test and multivariate logistic regression analysis. Study participants (n=172) had mean age of 21.2 + 1.9 years. Eighty-nine (51%) girls met the criteria for PMS recording to ICD - 10, among them, 53 (59.5%) had mild

PMS, 26 (29.2%) had moderate and 10 (11.2%) had severe PMS. Ten (5.8%) girls were found to have Premenstrual Dysphoric Disorder (PMDD) according to DSM - IV criteria.

The order of frequency of symptoms were anger, irritability, anxiety, tiredness, difficult

11 concentration, mood swings and physical symptoms like breast tenderness and general body discomfort with great impairment in social life / activities and work efficiency/productivity. Dysmenorrhea (p=0.003) and family history of premenstrual syndrome (p < 0.001) were significantly associated with premenstrual syndrome on univariate and multivariate analysis. Sf - 36 score on Mental Component Summary

(MCS) and Physical Component Summary (PCS) were significantly lower in the affected group17.

A descriptive study was conducted to investigate the frequency of premenstrual symptoms and prevalence of PMS among young Iranian women. A cross- sectional study was carried out among female students of Zahedan University (Iran), aged

18-27 years. Overall 300 participants were asked to complete an anonymous questionnaire assessing premenstrual symptoms. : Of the 300 participants, 98.2% reported at least one mild to severe premenstrual symptom and 16% met the criteria of

DSM-IV for PMS. Most common symptoms were feeling of tiredness or lethargy (84%), depressed mood (72.3%), sudden feeling of sadness or tearfulness (70.3%), anxiety

(70%), backache (69%) and sleep problems (66%). There was no significant difference in severity of symptoms based on marital status and living conditions (living with parents or away from parents), but severity of symptoms were significantly higher for the younger women (18-20 years) compared to the older women (21-24 and 25-27 years). : High frequency of premenstrual symptoms and significant prevalence of PMS was found in our study sample. Preventive and treatment strategies for PMS are highly recommended18.

According to studies menstrual problems are common among young girls.

These deserve careful evaluation as uncorrected menstrual problems may adversely affect the daily routine and quality of life. The aim of this article is to study the prevalence and the effect of menstrual disorders on daily routine among unmarried undergraduate

12 medical students and their treatment-seeking behavior. Of 276 undergraduate girl students, 112 were sampled by stratified random sampling. . The data collected were analyzed. Premenstrual syndrome (67%) and Dysmenorrhea (33%) were perceived by the study subjects as the most distressing problems associated with menstruation. The most common effect of menstrual problems on daily routine reported by the study subjects was in the form of prolonged resting hours (54%) followed by inability to study (50%). More than half (52%) of the subjects discussed their problems with their mother, and 60% of the study subjects were opted for allopathic treatment for their menstrual problems.19

Management of premenstrual syndrome:

Although the etiology of PMS is uncertain, a major emphasis in the treatment, apart from pharmaceutical management, is educating woman to practice self-care measures to reduce the severity of symptoms. Equipping adolescent girls with adequate information regarding premenstrual syndrome and its management is seen as empowering them with knowledge which enhances their self-esteem and academic performance20.

A descriptive study was conducted to investigate the effectiveness of

Hypericum perforatum on symptoms of PMS.The randomized; double-blind, placebo- controlled, crossover study was conducted among 36 women aged 18-45 years with regular menstrual cycles (25-35 days), who were prospectively diagnosed with mild

PMS. Symptoms were rated daily throughout the trial using the Daily Symptom Report.

Secondary outcome measures were the State Anxiety Inventory, Beck Depression

Inventory, Aggression Questionnaire and Barratt Impulsiveness Scale. Plasma hormone

(follicle-stimulating hormone [FSH], luteinizing hormone [LH], estradiol, progesterone, prolactin and testosterone) and cytokine (interleukin [IL]-1beta, IL-6, IL-8, interferon

13 [IFN]-gamma and tumor necrosis factor [TNF]-alpha) levels were measured in the follicular and luteal phases during Hypericum perforatum and placebo treatment21.

In result Hypericum perforatum was statistically superior to placebo in improving physical and behavioral symptoms of PMS (p < 0.05). There were no significant effects of Hypericum perforatum compared with placebo treatment for mood- and pain-related PMS symptoms (p > 0.05). Plasma hormone (FSH, LH, estradiol, progesterone, prolactin and testosterone) and cytokine (IL-1beta, IL-6, IL-8, IFNgamma and TNFalpha) levels, and weekly reports of anxiety, depression, aggression and impulsivity, also did not differ significantly during the Hypericum perforatum and placebo cycles (p > 0.05).So concluded that daily treatment with Hypericum perforatum was more effective than placebo treatment for the most common physical and behavioral symptoms associated with PMS22.

A descriptive study was conducted to assess the effectiveness and adverse effects of acupuncture for the symptomatic treatment of PMS from randomized controlled trials RCTs comparing acupuncture with control investigating acupuncture for

PMS were considered for this study. Study collection and quality assessment were performed by two reviewers using the criteria described in the Cochrane Handbook. Nine studies were systematically reviewed. Only two of the nine trials reported details regarding sequence generation and allocation concealment. Four studies reported a significant difference in reduction of PMS symptoms for acupuncture treatment compared with pharmacological treatment. Two studies reported the improvements in primary symptoms within the acupuncture and herbal medications groups compared with baseline. Only two RCTs reported information regarding acupuncture-related adverse events, which included one case of a small subcutaneous haematoma. Although the included trials showed that acupuncture may be beneficial to patients with PMS23.

14 A descriptive study was conducted to evaluate the effectiveness and safety of traditional Chinese herbal medicines in the treatment of women with premenstrual syndrome. They searched MEDLINE (January 1950 to December, 2007),

EMBASE (January 1980 to December, 2007), Chinese Biomedical Database (CBM)

(January 1975 to December, 2007), China National Knowledge Infrastructure (CNKI)

(January 1994 to December, 2007), and the VIP Database (January 1989 to December,

2007). Randomized controlled trials (RCTs) studying the efficacy of traditional Chinese herbal medicine(s) for treatment of the premenstrual syndrome were included. Two review authors telephoned the original authors of the RCTs to confirm the randomization procedure, extracted and analyzed data from the trials that met the inclusion criteria. Two

RCT considering 549 women were included. One trial which was identified to be of higher methodological quality demonstrated the therapeutic effectiveness of Jing qianping granule. The other study was considered of lower quality due to the inherent risk of various biases in it. Two studies showed statistically significant differences in elimination of symptoms in proliferative phase and premenstrual phase by taking Jing qianping granule than taking Xiaoyaowan (RR 3.50, 95% CI1.74 to 7.06). Women treated by Cipher decoction had a higher rate of recovery than those taking Co-vitamin

B6 capsules (RR 48.99, 95% CI 3.06 to 783.99).However, currently there is insufficient evidence to support the use of Chinese herbal medicine for PMS and further, well controlled, trials are needed before any final conclusions could be drawn24.

Effectiveness of teaching/SIM on premenstrual syndrome:

A descriptive study was conducted to assess the Knowledge,

Attitudes, and Consequences of Menstrual Health in Urban Adolescent Females. The purpose of this research was to determine: (1) The prevalence of Dysmenorrhea, premenstrual symptoms and other menstrual disorders among adolescents who receive

15 their health care at an urban adolescent health center; (2) The attitudes and expectations adolescents have relating to their menstrual period; and (3) The relationship between teens' attitudes and expectations regarding menses and actual menstrual-related morbidities such as school absenteeism. A 35-item, survey was administered to post menarcheal adolescents ages 12–21 years. .Result shows Premenstrual syndrome (PMS) was the most prevalent reported menstrual disorder (84.3%) followed by Dysmenorrhea

(65%), abnormal cycle lengths (13.2%), and excessive uterine bleeding (8.6%). Only 2% of teens report receiving information about menstruation from their health care provider.

Negative expectations regarding menstruation were associated with higher rates of school absenteeism and missed activities25.

A descriptive study was conducted to assess therapeutic effect of an extract of

Vitex agnus castus (VAC, BNO 1095) in premenstrual syndrome (PMS) in Chinese women. It was a prospective, randomized, double-blind, placebo-controlled study carried out in China. Eligible patients were treated with VAC extract or placebo for three cycles.

Symptoms were documented with PMS diary (PMSD), a daily rating scale with 17 items.

Main efficacy variable was the reduction percentage of 17 symptom score documented in

PMSD during the luteal phase of the third treatment cycle. A total of 67 patients were enrolled and randomly assigned to VAC group or placebo group. Of these, 64 patients completed the study (31 vs. 33). All the 17 symptoms showed a significantly greater improvement with VAC than placebo (P < 0.05) except lower abdominal cramping (P >

0.05).Concluded as Vitex agnus castus is more effective than placebo in the treatment of moderate-to-severe PMS in Chinese women, especially in symptoms of negative effect and insomnia26.

16 According to studies, menstruation has important implications on the physical and emotional well-being of adolescents' reproductive health. This study aimed to investigate the perception towards menstruation and premenstrual syndrome (PMS), to provide insight into menstrual-related education information in order to help adolescent girls manage the physical and psychological changes associated with menstruation. This cross-sectional study included 1,092 adolescent females from 94 schools in the Federal

Territory of Kuala Lumpur, Malaysia. A self-administered semi-structured questionnaire was used in the data collection. The result showed a total of 80.7% and 83.6% of the participants experienced one or more affective and somatic symptoms respectively in the premenstrual phase. Irritability, mood swing and tension were the three most frequently reported affective symptoms, while fatigue and menstrual cramps were highly prevalent somatic symptoms in both the premenstrual and menstrual phases. The effects on functional impairment and quality of life include poor class concentration, restriction of social and recreational activities, difficulty to mingle with friends, and poor class performance. Despite the evident impact, only 10.3% of adolescent girls consulted doctors for PMS symptoms, while one-third did nothing about their condition. There were ethnic differences in the seeking of treatment for PMS. The study calls for an education program related to PMS and menstrual-related disorders to provide information and support to adolescents. This will help them to cope better with menstrual-related problems, and encourage positive attitudes to menstruation26.

6.3 STATEMENT OF THE PROBLEM: A study to evaluate the effectiveness of planned teaching programme regarding knowledge on pre menstrual syndrome among pre university students in selected colleges, Bangalore.

17 6.4 OBJECTIVES OF THE STUDY 1. To assess the knowledge of the adolescent girls regarding premenstrual

syndrome.

2. To evaluate the effectiveness of a planned teaching programme on

knowledge regarding premenstrual syndrome.

3. To find association between the post score with the selected demographic

variables.

6.5 HYPOTHESES:

H0: There is no significant association between pre-test and post-test knowledge

scores of students regarding premenstrual syndrome.

H1 There is significant association between level of knowledge of students and

their selected socio-demographic variables

6.6 OPERATIONAL DEFINITIONS: Effectiveness: It refers to gain in knowledge by adolescent girls regarding

premenstrual syndrome as determined by significant improvement in post- test

scores measured by a structured knowledge questionnaire

Planned teaching Programme: It refers to systematically organized learning

module prepared by investigator and validated by experts on premenstrual

syndrome. The areas covered are general information, incidence, signs and

symptoms management and home remedies for treating menstrual syndrome.

Knowledge : It refers to the ability of adolescent girls to give correct responses

to questions on premenstrual syndrome measured by structured knowledge

questionnaire.

18 Premenstrual syndrome: It refers to a combination of emotional, physical,

psychological, and mood disturbances that occur after a woman's ovulation

and typically ending with the onset of her menstrual flow.

Pre University Students: It refers to female students who are in the age group of

16-19 years.

6.7 ASSUMPTION:  Students may have adequate knowledge about Pre menstrual Syndrome.

 Planned teaching programme may increase the knowledge level of the

students regarding Pre menstrual Syndrome.

6.8 DELIMITATION: Study is delimited to -

 Pre university students who are in the age group of 16-19.

 60 Pre university students.

7. MATERIALS AND METHODS: 7.1 Sources of Data:

Pre university school female students with ages ranging from 16 to 19.

7.2 METHODS OF DATA COLLECTION: Research Method : Quasi experimental method.

Research Design : One group pretest, post test design

Sampling Techniques : Convenient sampling.

Sample Size : 60 female Pre University students.

Setting of the study : Selected Colleges at Bangalore,

19 7.2.1CRITIERIA FOR SELECTION OF SAMPLE Inclusion Criteria:

 Female students with ages ranging from 16 to 19 years.

 Female students not receiving any hormonal therapy or taking regular drugs.

Exclusion Criteria:

 Female students having no experience of premenstrual symptoms during their last

menstrual cycle.

 Female students were taking regular drugs.

 Female students who are not willing to participate in the study.

 Female students who are below 16years and above 19 years.

7.2.2 DATA COLLECTION TOOL: Structured knowledge questionnaire will be prepared to assess the knowledge of female students regarding premenstrual syndrome. A planned teaching programme can be prepared Questionnaire will be divided into two sections as follows;

Section A: Socio Demographic Profile:

It consists of six items such as age, gender, professional qualification, designation, experience, and area of present work.

Section – B: Structured Knowledge Questionnaire

Structured knowledge questionnaire regarding Pre menstrual syndrome.

Scoring Keys

Coding will be done for section ‘A’ which consists of socio-demographic variables and for Section ‘B’. One mark will be given for correct answer and zero for incorrect answer.

20 7.2.3 DATA ANALYSIS METHOD:-

Data analysis will be done in terms considering objectives of the study using descriptive and inferential statistics. Frequency & Percentage Distribution will be done to analyze Demographic Variables. Mean and Standard Deviation will be done to assess the knowledge regarding. premenstrual syndrome The Chi-square test(x) will be done to find out the association between the Mean Knowledge score with selected Demographic

Variables. The finding will be presented in the form of Table, Diagram and Graphs.

7.3. DOES THE STUDY REQUIRES ANY INVESTIGATION TO BE

CONDUCTED ON SUBJECTS OR OTHER HUMANS OR

ANIMALS? IF SO,DESCRIBE BRIEFLY.

Yes, only structured knowledge questionnaire will be used .No other intervention which causes any physical or mental harm will be used in the study.

7.4 HAS ETHICAL CLEARANCE BEEN OBTIANED FROM

INSTITUTION?

Yes. Ethical clearance will be obtained from concerned authorities and consent will be taken from the subjects. Confidentiality and Anonymity will be maintained.

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25 9. SIGNATURE OF THE CANDIDATE

Adequate awareness and knowledge regarding the premenstrual syndrome will 10. REMARKS OF THE GUIDE help the young students to cope up with the situation. MRS.AHITHA.V NAME AND DESIGNATION HOD, OBSTETRIC AND 11. 11.1 GUIDE GYNAECOLOGICAL NURSING. KOSHYS COLLEGE OF NURSING BENGALURU. 11.2 SIGNATURE

11.3 CO-GUIDE (if any)

11.4 SIGNATURE 11.5 HEAD OF THE MRS.AHITHA.V HOD, OBSTETRIC AND DEPARTMENT GYNAECOLOGICAL NURSING.

11.6 SIGNATURE

12 REMARKS OF THE The hormonal changes makes students to CHAIRMAN AND behave in a different way This study helps PRINCIPAL the students to realize why they behave in different ways. 12.1 SIGNATURE