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1. Tool Presentation GROUP 2 (ROLL NO :11-20) GUIDE - MRS.MEENAKSHI (ASSOCIATE PROFESSOR) CO-GUIDE - MRS. ANUREET (NURSING TUTOR)

2. INTRODUCTION Puberty refers to the transition from a child to an adult accompanied by sexual maturity, physical and psychological changes & development of secondary sexual characters. The average age of puberty is at 11 for girls . The most striking change in adolescent girls is the onset of menstruation . In Indian context the age of onset of menstruation or menarche is generally between 11 to 15 years . Menstrual cycle irregularities can have many different causes including extreme weight loss or gain, Pelvic inflammatory disease, dysmenorrhea, menorrhagia, amenorrhea, premature ovarian failure or polycystic ovarian syndrome . Nowadays Polycystic Ovarian Syndrome is considered as widespread among adolescent girls. Polycystic Ovarian Syndrome is describes as a triad of “Amenorrhea, Obesity, Hirsutism.” Nowadays it is also called Syndrome O i.e. over nourishment , overproduction of insulin. Although there is no cure for PCOS but controlling it lowers the risk of infertility, miscarriages, diabetes and heart disease. A healthy lifestyle is one of the important aspect of managing PCOS successfully.

3. INTRODUCTION & NEED Puberty refers to the transition from a child to an adult accompanied by sexual maturity, physical and psychological changes & development of secondary sexual characters. The most striking change in girls is the onset of menstruation . Menstrual cycle irregularities can have many different causes including extreme weight loss or gain, Pelvic inflammatory disease, dysmenorrhea, menorrhagia, amenorrhea, premature ovarian failure or polycystic ovarian syndrome. Nowadays Polycystic Ovarian Syndrome is considered as widespread among girls. Globally, the prevalence of Polycystic Ovarian Syndrome is estimated to be between 5.5% and 12.6% in women in the age group of 17 to 45 years. In India, the prevalence estimates are between 8.2% and 22.5% depending on the diagnostic criteria used. As polycystic ovarian syndrome symptoms often goes undiagnosed because of its many baffling and seemingly unrelated symptoms. Lack of knowledge and lifestyle changes are considered to be the major factor leading to this phenomenon. So, there is a need to increase awareness among girls to avoid complications.

4. NEED 1 IN 5 WOMEN AFFECTED BY POLYCYSTIC OVARIAN SYNDROME IN INDIA ! Globally, the prevalence of PCOS is estimated to be between 5.5% and 12.6% in women in the age group of 17 to 45 years. In India, the prevalence estimates are between 8.2% and 22.5% depending on the diagnostic criteria used. Ramesh Kumari, Bimla Rani, Rajesh. P,Sukhdeep Kaur (2015) conducted a study to assess the effectiveness of structured teaching programme on Polycystic Ovarian Syndrome among adolescent girls in selected pre-university at Amritsar (Punjab) and the result revealed that 1% had adequate knowledge, 37% had moderately adequate knowledge, 62% had inadequate knowledge in pre-test while 35% had adequate knowledge, 53% had moderately adequate knowledge and 12% had inadequate knowledge in post-test. As polycystic ovarian syndrome symptoms often goes undiagnosed because of its many baffling and seemingly unrelated symptoms. Lack of knowledge and lifestyle changes are considered to be the major factor leading to this phenomenon. So, there is a need to increase awareness among girls to avoid complications.

5. PROBLEM STATEMENT A study to assess the effectiveness of planned teaching programme on the knowledge regarding Polycystic Ovarian Syndrome among girls of selected schools of city Ludhiana , Punjab.

6. AIM : To assess the effectiveness of planned teaching programme on the knowledge regarding Polycystic Ovarian Syndrome among girls. OBJECTIVES : To assess pre-test level of knowledge regarding Polycystic Ovarian Syndrome among girls. To assess the effectiveness of planned teaching programme and compare pre-test and post-test level of knowledge regarding Polycystic Ovarian Syndrome among girls. To find out association of pre-test and post-test level of knowledge regarding Polycystic Ovarian Syndrome with selected socio demographic variables.

7. OPERATIONAL DEFINITIONS PLANNED TEACHING PROGRAMME:- It refers to a systematically, organized structured teaching learning activities including lecture cum discussion method on Polycystic Ovarian Syndrome. KNOWLEDGE:- It refers to the extent of information possessed by girls regarding Polycystic Ovarian Syndrome which will be assessed by using Multiple choice Questionnaire which will include: Anatomy and Physiology of reproductive system, Definition and cause, Signs and symptoms, Diagnosis, Complications, Prevention and control. POLYCYSTIC OVARIAN SYNDROME :- Polycystic Ovarian Syndrome is a condition of ovaries among girls characterized by group of symptoms marked by irregular periods, unexplained weight gain, excess hair on face and body, acne, obesity, enlarged ovaries, high levels of male hormones, infertility and other health problems.

8. GIRLS :- It refers to female students studying in class 10 th .

9. NULL HYPOTHESIS Ho – There will be no significant difference between pretest & post test knowledge scores regarding Polycystic Ovarian Syndrome among adolescent girls at 0.05 level of significance.

10. DELIMITATION The study will be delimited to girls studying in 10 th class of Guru Nanak Public School, Indian Public School, Arya Senior Secondary School, Sanatan Vidya Mandir school, City Ludhiana.

11. Review of literature Author Place of study No. Of subjects Findings Ramesh Kumari*, Bimla Rani, Rajesh. P, Sukhdeep Kaur 2015 Amritsar, Punjab 60 Adolescent girls Conducted a study to assess the effectiveness of planned teaching programme on Polycystic Ovarian Syndrome in selected pre-university and the result revealed that 1% had adequate knowledge, 37% had moderately adequate knowledge, 62% had inadequate knowledge in pre - test while 35% had adequate knowledge, 53% had moderately adequate knowledge and 12% had inadequate knowledge in post-test. Jayshree J. Upadhye*, Chaitanya A. Shembekar 2017 Maharashtra, India 200 Medical students Conducted a study to assess the knowledge on the Polycystic Ovarian Syndrome and the result of the study was that 28% of adolescent young girls were unaware of PCOS while 33% adolescent and young girls had information about PCOS from teachers, 19% got information from friends, 11.5% got information from doctor, 3.5% got information from newspaper while 5% got information from internet.

12. Review of literature Author Place of study No. Of subjects Findings B Batra , Sangeeta Tiwari 2018 Ujjain, Madhya Pradesh 30 adolescent girls Conducted an experimental study to assess the effectiveness of planned teaching programme on knowledge of adolescent girls of higher school age group regarding Polycystic Ovarian Syndrome and the result revealed that in pretest knowledge 50%had poor knowledge ,40%girls had average knowledge,10% had good knowledge and in post knowledg e score 75% girls had good knowledge, 25% had average knowledge. Mala, Anney Avarachan , Giji John 2019 New Delhi, India 60 adolescent girls Conducted a research to assess and evaluate the effectiveness of structured teaching programme (STP) in terms of knowledge of adolescent girls regarding Polycystic Ovarian Syndrome and prevention of its complications and the result revealed that in pretest knowledge 20%had poor knowledge ,80%girls had average knowledge and 0% had good knowledge in post knowledge score 60% girls had good knowledge, 40% had average knowledge and 0% had poor knowledge.

13. Research approach Quantitative Research design Pre-experimental ( one group pre-test post-test design) Research setting Guru Nanak Public School, India n Public School, Arya Senior Secondary School, Sanatan Vidya Mandir school, City Ludhiana Target population Girls Sample Girls studying in 10 th class Sampling technique Total enumerative sampling technique ( Excluding boys) Sample size Estimated 136 Material and method Tool PART A :-Socio-demographic profile. PART B:- Structured questionnaire to assess knowledge regarding Polycystic Ovarian Syndrome Method Self report (Paper Pen method) Analysis & interpretation data Descriptive & inferential statistics

14. Inclusion and exclusion criteria Inclusion criteria : Girls who will be available at the time of data collection. Exclusion criteria : Girls who will not be willing to participate in study.

15. Validity of tool The research tool will be validated as follow:- Research guide will be consulted regarding the content and language used in research tool. Experts from the field of Medical ( Gynaecology ), Nursing, and Dietician will be consulted to approve shortcoming in the lesson plan and research tool.

16. Reliability of tool The reliability of research tool will be established with the help of test-retest method. Where r = Correlational coefficient , N = Number of pairs of scores, Σ XY= Sum of the products of paired scores , Σ X= Sum of X scores, Σ Y= Sum of Y scores, Σ X 2 = Sum of squared X scores and Σ Y 2 = Sum of squared Y scores . Pilot study To assess the feasibility of the study a pilot study will be conducted on the sample of 1/10 th participants .

17. Ethical considerations A written permission will be taken from the ethical committee of DMCH, Ludhiana Data collection Procedure Method used will be Paper and Pen. Written Consent will be taken from girls present at the time of data collection. To collect data self-report method will be used by paper and pen. Firstly, socio-demographic data will be collected. The questionnaire will be provided to the subject to assess pre-test knowledge regarding Polycystic Ovarian Syndrome. Then Planned Teaching Programme will be given to improve their knowledge. Post-test will be taken after 7 days to assess the effectiveness of Planned teaching programme on level of knowledge. Plan for references Reference will be given in the format recommended by research committee of DMC & Hospital , Ludhiana, Baba Farid University of Health Sciences , Faridkot &Vancouver’s guidelines(1978 ) .

18. Description of research tool PART A :-Socio-demographic profile PART B:- Structured questionnaire to assess knowledge regarding Polycystic Ovarian Syndrome

19. PART-A ( SOCIODEMOGRAPHIC PROFILE) Date ………. Code no………. INSTRUCTIONS: · Please give accurate information. · Information provided by you will be kept confidential and will be used for research purpose only. PART-I 1. Name of School ______________________ 2. Affiliated Board CBSE PSEB 3. Age _____(in years)

20.   4. Habitat Rural Urban   5. Religion Hindu Sikh Christian Muslim Other   6. Type of family: Nuclear Joint Extended

21.   7. Father’s Educational status Illiterate Primary Secondary Graduate & above graduate   8. Mother’s Educational status Illiterate Primary Secondary Graduate & above graduate 9. . Father’s Occupational status Working Non-Working If working then specify……..

22. 10. Mother’s Occupational status Working Non-Working/ Homemakers If working then specify……..   11. Socioeconomic Class ( Kuppuswamy scale 2022) Upper (I) Upper middle (II) Lower middle (III) Upper lower (IV) Lower (V)  12. Do you have any information about Polycystic Ovarian Syndrome : Yes No If yes, please specify source ……

23.   13. Family history of PCOS Yes No If yes, please specify the relation …………. PART-II MENSTRUAL PROFILE   14. Menarche age………… 15 . Number of menstruating days: Less than 4 4-5 days More than 5 16 . Interval of menstrual cycle………….  

24.     17. Number of sanitary pads used in a day………..   18. Do you experience menstrual cramps : Yes No   19. Do you have regular menstruation: a) Yes b) No 20. How frequently you change your pad during mensturation …   a) 2-3 hourly b) 4-5 hourly c) 6-8 hourly d) More than 8 hourly

25.   21. Have you experienced any of the following signs a) Acne b) Excessive hair growth on face c) Irregular menstruation d) Darkening of skin e) Unexplained weight gain f) None of the above 22. Number of adolescent girls in the family; One Two Three More than 3 None

26. PART-B SELF-STRUCTURED QUESTIONNAIRE ON PCOS   ANATOMY AND PHYSIOLOGY OF FEMALE REPRODUCTIVE SYSTEM 1. The uterus is an Internal female reproductive organ External female reproductive organ External female reproductive muscle Internal female reproductive muscle 2. The number of ovaries present in female reproductive system are 2 3 4 1    

27. 3. The process of releasing mature ovary is called Conception Lactation Ovulation Menstruation   4. The menstrual cycle has 2 phases 3 phases 4 phases More than 4.

28. 5. Menstrual flow occurs due to shedding off Endometrium Myometrium Perimetrium Other   6. Amenorrhea is defined as the Absence of menstruation Painful menstruation Absence of ovulation Irregular menstruation

29. DEFINITION AND CAUSE   7. Polycystic Ovarian Syndrome Means Excessive estrogen with enlarged polycystic ovaries Excessive androgen with hirsutism, amenorrhea, obesity and enlarged polycystic ovaries . Excessive thyroxin with amenorrhea Excessive prolactin with obesity   8. The main causes of Polycystic Ovarian Syndrome are Excess androgen Excess insulin High blood Pressure Prolonged genital infection      

30.   SIGNS AND SYMPTOMS   9. The sign that is present in Polycystic Ovarian Syndrome is Dryness of skin Scaly skin Rashes Darkening of skin   10. Hyperinsulinemia refers to Increase blood cholesterol level Increase blood protein level Increase blood insulin level None of the above

31. 11. Hirsutism means Excessive hormone production Excessive hair Growth Decreased hormone production Decreased hair growth   12. The ultrasound findings in Polycystic Ovarian Syndrome exhibit Small ovaries Enlarged ovaries Ovarian cancer None of the above

32. DIAGNOSIS   13. Polycystic ovarian syndrome is diagnosed by Ultrasound Hormone test Clinical size of ovary All of the above   14. The definitive diagnostic test for Polycystic Ovarian Syndrome is Ultrasonography X-ray CT-scan MRI

33.   COMPLICATIONS   15. The complications of Polycystic Ovarian Syndrome are except Obesity Irregular menstruation Infertility Urinary tract infection   16. A skin condition that causes a dark discoloration in body folds and creases is called Hirsutism Acanthosis Nigricans Dermatitis Eczema

34.   PREVENTION AND CONTROL   17. The primodial management of Polycystic Ovarian Syndrome is Lifestyle modification Medication Surgery Both (a)&(b)   18. Lifestyle changes recommended for girls with Polycystic Ovarian Syndrome except Adequate rest &sleep Healthy diet &exercise Weight control Consumption of junk food.

35. 19. Which of the following should be avoided in Polycystic Ovarian Syndrome Soya Apple Nuts Burgers   20. Which of the following should be taken in Polycystic Ovarian Syndrome Bread Soya Coffee Salt

36. 21. The average amount of milk that can be taken safely after consultation is a) 150-200ml b) 250-300ml c) 350-400ml d) 450-500ml   22. The alternative source of calcium that could be taken by the patient suffering from Polycystic Ovarian Syndrome is Ragi Whole wheat bread Curd Milk

37. 23. The fruit/vegetable that has best antioxidants recommended for the patient with Polycystic Ovarian Syndrome Apple Mango Lemon Banana   24. The main aim of medical management is to Restore regular menstruation Reduce the body weight Improve dietary habits None of the above

38. CRITERION MEASURE Minimum Score - 00 Maximum Score – 24 LEVEL OF KNOWLEDGE SCORE Excellent 19-24 Good 13-18 Average 7-12 Poor Less than 7

39. SUBJECT INFORMATION SHEET Project title:- A study to assess the effectiveness of planned teaching programme on the knowledge regarding Polycystic Ovarian Syndrome among girls of selected school of city Ludhiana, Punjab. Aims and method of research: To assess the effectiveness of planned teaching programme on the knowledge regarding Polycystic Ovarian Syndrome among girls. The quantitative research approach will be used. Participants will be asked questionnaires as follows: Performa for assessing socio-demographic variable. Performa for assessing knowledge regarding Polycystic Ovarian Syndrome. Expected duration of the subject participation: Approximately ----- hours. Benefits of participating in the study: The findings of the study help to impart knowledge and awareness regarding Polycystic Ovarian Syndrome. Potential risks and discomforts There is no risk associated with the study. Confidentiality All the information that you provide during the study will be kept confidential and will be utilized only for the study purpose.

40. Provision of free treatment Not applicable for the study. Financial consideration Neither you will be charged nor awarded prize for inclusion in the study. Voluntary consent: You have the freedom to participate or withdraw from the study at any time without penalty or loss of benefits. Contacts: In the event that anytime during the course of the study you feel that you have not been adequate informed about the study or feel undue stress to continue against your wishes u can contact. Principal investigator: Roll no. 11- 20 B.Sc. Nursing student, DMCH College Of Nursing, Malakpur, Ludhiana.     _________________ ___________________ Signature of witness Signature of participant

41. CONSENT FORM Date________ Code no.________ The subject __________________ has been fully informed about the nature and purpose of the study. The subject is free to ask any question raised regarding the study and the questions have been answered to the best of investigators ability. Investigator’s signature ___________________   I ________________D/O__________________ hereby give consent for my inclusion as a study participant in a research project “A study to assess the effectiveness of planned teaching programme on the knowledge regarding Polycystic Ovarian Syndrome among girls of selected school of city Ludhiana, Punjab.” I have been fully informed about the nature and purpose of the study. I have been given the opportunity to ask questions and have been answered to my satisfaction. I am free to withdraw from the study anytime without penalty. I have been assured that my identity and personal information will be kept confidential. I voluntary give consent to participate in this study.    

42. Name of the Respondent Address _____________________ _____________________ _____________________ ______________________   Signature / Thumb impression Name and Signature of witness ________________________ _______________________

43. POLYCYSTIC OVARIAN SYNDROME (PCOS)

44. REPRODUCTIVE HEALTH DEFINITION : Reproductive health pertains to certain direct and indirect contributors which aids in healthy living during reproductive years of adolescent girls.

45. IMPORTANCE OF REPRODUCTIVE HEALTH It is very important for girls to be aware of sexual health, reproduction, contraceptives, and STDs. This will help in maintaining good reproductive health, physically as well as mentally. People can protect themselves from sexually transmitted infections and diseases only if they are well informed about the same. Women should be aware of their fitment for pregnancy. They must have access to proper medical services when they are pregnant, have a safe delivery and deliver a healthy people.

46. FEMALES REPRODUCTIVE ORGANS: External genitalia: Vulva Mons pubis Labia majora Labia minora Clitoris vestibular bulbs Bartholin glands Urethra Introitus  

47. Internal genitalia: Vagina Uterus Fallopian tubes Ovaries Cervix  

48. MENSTRUAL CYCLE Menstruation is part of women’s cycle when the lining of uterus (endometrium) is shed. It has four phases: Menstruation phase Follicular phase Luteal phase Ovulation phase four phases

49. 1) Menstruation phase : Begins on 1 st day of menstruation and lasts till 5 th day of menstruation. 2) Follicular phase: B egins on 1 st day of menstruation and lasts till 13 th day of menstruation.   3) Ovulation phase: B egins around 14 th day and lasts about 24 hours. 4) Luteal phase : Begins on 15 th day of menstruation and lasts till the end of the cycle.  

50. Disorders of menstrual cycle : Pre- Menstrual syndrome ( It is a change in the mood or behaviour of appearance of some abnormal vague symptoms)   Dysmenorrhea (painful menstruation)   Amenorrhea (absence of menstruation)   Menorrhagia (heavy or lengthy menstruation)   Metrorrhagia (spotting between periods)   Cryptomenorrhoea (characterized by periodic shedding of the endometrium & bleeding but the menstrual flow fails to come out from the genital tract due to obstruction in the passage) Disorders of menstrual cycle:

51. INTRODUCTION Polycystic Ovarian Syndrome (PCOS) was originally described in 1935 by Stein and Leventhal as syndrome manifested by amenorrhea, hirsutism and obesity associated with enlarged ovaries.  This heterogenous disorder is characterized by excessive androgen production by the ovaries mainly. Polycystic Ovarian Syndrome is a multifactorial and polygenic condition  

52. POLYCYSTIC OVARIAN SYNDROME: DEFINITION: Polycystic Ovarian Syndrome is a heterogeneous disorder that is defined by a combination of signs and symptoms of androgen excess and ovarian dysfunction with the clinical manifestations of Oligoamenorrhea , subfertility, hirsutism and acne.

53. PREVALENCE: Globally, the prevalence of Polycystic Ovarian Syndrome is estimated to be between 5.5% and 12.6% in women in the age group of 17 to 45 years. In India it ranges from 3.7% to 22.5% depending upon population studied and the criteria used for diagnosis.  

54. Causes and Risk Factors:

55. SIGNS AND SYMPTOMS: Irregular periods or no periods at all Hirsutism Fatigue Signs :

56. Thinning of hair on head/hair loss Severe acne Obesity Thickening & pigmentation of skin

57. Changes in mood Pelvic pain

58. Symptoms : 1) Hyperinsulinemia   2) Enlarged ovaries

59. 4) Sleep problems (obstructive sleep apnea) 5)Fluid filled ovarian cyst

60. 6) Changes in mood 7) Infertility

61. DIAGNOSIS Medical history: Detailed medical history should be taken to assess the presence of any two of the symptoms: Menstrual history Unexplained weight gain Hirsutism Acne Thinning of scalp hair Dark patches over skin Family history of polycystic ovarian syndrome

62. Pelvic examination: A pelvic examiner can look for any problems with ovaries or other parts of reproductive tract. Blood test: S erum luteinizing hormone Follicle stimulating hormone Testosterone (free) Serum prolactin Serum Insulin Dehydroepiandrosterone sulphate (DHEA-S) test Lipid profile Sensitive Thyroid s timulating hormone 17 Hydroxyprogesterone (OHP)

63. Ultrasound: An ultrasound uses waves to look for abnormal follicles and other problems with ovaries and uterus. Screening for psychological well being: Depression Stress Anxiety

64. COMPLICATIONS : Short term :- Obesity Menstruation abnormalities Abnormal lipid level Hirsutism Acne Alopecia Miscarriage Glucose intolerance Acanthosis nigricans Acanthosis nigricans

65. Long term :- Infertility Diabetes mellitus Hypertension Cardiovascular diseases Endometrial cancer Depression Obstructive s leep apnoea Atherosclerosis

66. PREVENTION AND CONTROL :   Management of Polycystic Ovarian Syndrome is primarily with: Lifestyle Modification Medical Management Alternative therapies

67. LIFESTYLE MODIFICATION:

68. 1.Weight Control :- It can lower insulin and androgen level, restores ovulation. The cycle become more regular, lipid and glucose metabolism improves. 2. Healthy Diet : A healthy diet can work wonders to combat PCOS.

69. FOOD HABITS: SOYA FISH EGG WHITE YOGURT PROTEIN SOURCES :

70. Tofu Beans Cereals Pulses Oilseeds Millets Lentils If not contraindicated.  

71. FIBRE SOURCES: Apple Figs Pear Oats Avocado Almond Chia seeds Broccoli Carrot Cucumber

72. ANTI –INFLAMMATORY DIET: SOURCES: Berries green leafy vegetables like kale, spinach, (reduces inflammation related symptom such as fatigue).

73. GOOD FATS : Ghee Nuts (like cashew, almond) Extra virgin olive oil Chia seeds Sunflower seeds 

74.   WATER:- Drink 2-3 litres (8-12 glasses approx.) of water daily. Antioxidants: SOURCES: Lemon Oranges Tomatoes blueberries chasteberries

75. FOODS TO AVOID: Refined products: Flour Burgers Noodles Pizza Pasta Instant Noodles (fried) Sugar White bread Pastries Choose alternative whole wheat flour bread for the above mentioned food.

76. HIGH GLYCEMIC INDEX FOOD: Bread Ice cream Potatoes Mangoes White rice Flavoured yogurt Cakes Biscuits Jams Chocolates Candies jellies drinks like soda (raises the blood sugar level immediately).

77. Always check glycemic index on labels of canned food.

78. DAIRY PRODUCTS : Milk can raise the level of testosterone in the body which is good for male but bad for female suffering from Polycystic Ovarian Syndrome. However average amount (250–300ml) of milk can be consumed after consultation because it contains Calcium binding protein .

79. ALTERNATIVE SOURCES OF CALCIUM: Amaranth 162mg/100g Ragi 364mg/100g Channa dal 269mg/100g Soyabean 239mg/100g Amaranth leaves 330mg/100g Calocoma 216mg/100g Moringa leaves 314mg/100g Fenugreek 274mg/100g Mustard 191mg/100g Pasley 288mg/100g Radish leaves 234mg/100g Almonds 228mg/100g Foxnut 60mg/100g Gingelly seeds Soya milk Almond milk

80. UNHEALTHY FATS: Saturated fats like: Red meat Hydrogenated vegetable oil Fried food Processed meat Butter These fats may get deposited in ovaries and cause insulin resistance thus worsening Polycystic Ovarian Syndrome.  

81. Alcohol sources: Beer Whiskey Rum Wine Vodka Brandy This leads to elevated estrogen level in body and promotes obesity. Caffeine Sources: Coffee Tea energy drinks Excess intake of caffeine affects the fertility in females which is not good for Polycystic Ovarian Syndrome.

82. Salt: Diet high in salt can lead to water retention causing unwanted weight gain which worsens the symptoms and effects of Polycystic Ovarian Syndrome. Salt – 1 Tsp (5gm/day) Check Sodium content on labels of canned food.  

83. 3. Exercise:- It helps to control body weight, lower blood glucose level, improves sleep cycle and helps regulate hormones. Example jogging cycling swimming 4. Proper sleep: Balanced hormone and your endocrine system depend on proper sleep (7-8 hours). Irregular sleep disturbs the circadian rhythm therefore, proper and regular sleep pattern should be maintained.  

84. 5. Take control of Stress :- Stress triggers the release of cortisol which can break the hormonal system and leads to weight gain. 6. Take high quality Supplements :- Supplements such as vitamin A,D, Omega 3 fatty acids, zinc, magnesium should be taken with doctor’s prescription.

85. 7. Practice Self Love :- Learn to love yourself, live the life you want to live now and treat your body with kindness and patience.   8 .Strive for progress to achieve perfection :- Make a habit of putting your health first and be kind to yourself when you feel inadequate

86. MEDICAL MANAGEMENT: Medical management aims to- Restore regular menstruation Lower insulin level Treat hirsutism or acne

87. RESTORATION OF OVULATION / MENSTURATION: 1. Combined Oral Contraceptives Pills . 2. Cyclic Progesterone and Intrauterine Progesterone Devices.

88. INSULIN RESISTANCE/ HYPERINSULINAEMIA: Insulin Sensitizing Agents: Insulin sensitizing agents are antidiabetic drugs that act by improving the sensitivity of peripheral tissues to insulin which results in decreased circulating insulin levels.  

89.   However, One should avoid self-medication and consult the doctor ( Gynaecologist ) if any of the symptom appear.  

90.  POINTS TO REMEMBER FOR MEDICAL MANAGEMENT . Talk it out Seek medical advice Must consult the gynaecologist Go for diagnosis and confirm it out If you are not willing for the allopathy treatment then must consult the ayush practitioner Adhere to treatment 7. Follow ups

91. ALTERNATIVE THERAPIES: 1.Ayurveda: It includes : dietary modification lifestyle changes Herbal remedies regulates hormones and improves ovulation. Always consult an AYUSH practitioner. 2. Yoga and meditation: practices such as: asanas Pranayama Mudras (are beneficial for regulation of hormones.)

92. Follow-up: Timely follow-up with patients is vital in ensuring they’re moving forward with the prescribed treatment plan, such as undergoing testing and drug compliance.   Side effects: Consult the physician if you experience any side effects for the medication prescribed