PROFORMA FOR REGISTRATION OF SUBJECTS

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PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

DISSERTATION PROPOSAL

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON PREVALANCE AND MANAGEMENT OF PREMENSTRUAL SYNDROME AMONG B.Sc NURSING STUDENTS IN SELECTED NURSING COLLEGES AT TUMKUR. KARNATAKA.

SUBMITTED BY

Ms. SHWETHA RANI.C.M

FIRST YEAR M.SC NURSING

OBSTETICS AND GYNAECOLOGICAL NURSING

BHARATHI COLLEGE OF NURSING,

TUMKUR- 01

2009-2010

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

| | | |

|1 |NAME OF THE CANDIDATE AND ADDRESS |Ms. SHWETHA RANI.C.M |

| | |I Year M.Sc Nursing, |

| | | |

|2 |NAME OF THE INSTITUTION |BHARATHI COLLEGE OF NURSING, |

| | |4th CROSS, K.R.EXTENTION. |

| | |TUMKUR-572101. |

| | | |

|3 |COURSE OF STUDY AND SUBJECT |DEGREE OF MASTER OF NURSING, OBSTETICS AND GYNAECOLOGICAL NURSING |

| | | |

| | | |

|4 |DATE OF ADMISSION |21-10- 2009 |

| | |A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON |

|5 |TITLE OF THE STUDY |PREVALANCE AND MANAGEMENT OF PREMENSTRUAL SYNDROME AMONG B.Sc NURSING |

| | |STUDENTS IN SELECTED NURSING COLLEGES AT TUMKUR. KARNATAKA. |

6. BRIEF RESUME OF THE INTENDED WORK

“Pre-Menstrual Syndrome is a universal problem of women of reproductive age.”1

Puberty refers to the period in life during which the reproductive organs develop and reach maturity. In females, the first signs are breast development and the appearance of pubic hair. Puberty culminates in the onset of menstruation and menarche is the first menstruation of the women.

Menstruation is a normal physiological cycle, common to all females in the reproductive age group. The initiation of menstruation takes place during the early adolescence period.

Yet, many women across a range of very different culture, experience various menstrual problems that ranges from a mild discomfort to acute pain, anxiety, lethargy, household confinement, blood loss, irregularity, weakness and several deep rated cultural taboos make menstruation a regular and nagging but inevitable event to many of them. Often a stress of physical and emotional turmoil are observed in some particular group of females just for few days (7 to 10) days prior to menstruation which are apparently vague, bizarre and troublesome called Premenstrual syndrome (PMS) or Premenstrual tension (PMT).

Culturally, the abbreviation PMS (Premenstrual syndrome) is widely understood in English-speaking countries to refer the difficulties associated with menses, “The term pre-menstrual syndrome is often used with the terms like symptoms and treatment as though premenstrual changes are an illness (Ferrin1993).

Pre-menstrual syndrome is a recurrent disorder this occurs in the luteal phase of menstrual cycle. It is characterized by intense physical, physiological and behavioral changes that interrupt interpersonal relationships and disrupt the lives of affected women.

According to the “Mayo Clinic staff, premenstrual syndrome has a wide variety of symptoms including mood swings, tender breasts, food cravings, fatigue, irritability and depression. These problems tend to peak in late 20’s and early 30’s”.

Cooke (1945) described a hyper sensitization of the nervous system during premenstrual phase. He reported 84% of all violent crimes committed by women are perpetrated during the premenstrual and early menstrual phases.

Pre-menstrual syndrome is very old common panhuman. It has been recognized throughout history (Adam,1939), for references to Hippocrates and Pliny; Prichad,(1847). Frank formally identified premenstrual tension as a medical syndrome in 1931, and Dalton and Greene coined the term premenstrual syndrome and elaborated diagnostic criteria in 1953.

The true prevalence of Pre-menstrual syndrome is difficult to determine because of self treatment, inability to identify the symptoms, difference in availability and access to medical care, definitions and diagnostic criteria and cultural practices. Prevalence estimate ranges from 7.7% (Gaulrapp, Backe and Steek, 1995) to 90% (Riley1986) of women affected.

The (WHO) World Health Organization has concluded that “a large proportion of women in third world nations in different world regions do experience the same kind of emotional and physical symptoms as women in western industrialized nations… data show clearly that the expression of symptoms is not a western phenomenon”. (Ericksen,1987:186;).

Regular premenstrual symptoms have been manifested in 27 million American women. Majority of these have a milder form of the disorder, 10% of these, 3 to 7 million women have symptoms severe enough to disrupt the personal and professional lives, Bio-medical Research Alliance of New York (2000).

More than 80 treatments have been proposed and many more have been tried for alleviating the symptoms of premenstrual syndrome but no treatment has been found to be consistently effective. Women can overcome from her premenstrual symptoms by realizing and sharing the problems with friends, family or with general health practitioners. A Menstrual dairy is useful, which involves keeping a record of each day physical and emotional changes. Members of alternative medical disciplines including homeopathy, naturopathy, acupuncture and osteopathy have developed remedies for Pre-menstrual syndrome. Treatments include diuretics, prostaglandin inhibitors, progesterone inhibitors, ovulation inhibitors, vitamins, lithium and antidepressants. It also includes a life style measure that is non-pharmacological treatments for Pre-menstrual syndrome like diet restriction (salt, carbohydrate, caffeine, chocolate and alcohol) exercise, stress management, yoga, progressive muscle relaxation, relationship skills, self help groups and education. Pharmacotherapy may be initiated only when simple behavioral measures have failed, Women’s Health (2000).

6.1 NEED FOR THE STUDY

Menstruation is a biological stress for females during their reproductive life. Although it is a natural and normal physiological process for all women, it has been shrouded in myth and mystery in many societies. Especially in developing countries like India most of there have been continued even today, the silence and survey of menstruation does not allow an open discussion on the subject.

Because of the taboos and cultural practices associated with the menstruation called premenstrual symptoms. Many women notice changes in emotional and physical feeling during the menstrual cycle for the majority of women such changes are quite acceptable for other women the changes are distressing. Premenstrual syndrome is no longer a taboo in western countries. Lot of publicity, self help books and specialized clinics highlights the importance of premenstrual syndrome to general population and help women to overcome premenstrual syndrome (Lack 1984).

Women being the back bone of the family have not been given enough care in the family or society. The health of the women especially regarding menstrual problems has been neglected by them. In the developing countries like India, the nutrition of the women are not considered even though malnutrition or deficiency of vitamins and minerals results in many disorders including premenstrual symptom. As the literacy rate of women is less in such countries the younger and an uneducated women fails to identify the symptoms of premenstrual syndrome.

Pre-menstrual syndrome has gained its importance because of so many possible implications. As Pre-menstrual syndromes are thought to be the hypersensitive response of the nervous system in the body during the luteal phase of menstruation, it is well apprehended that such hyperactivity might induce bad social impacts, eg. Crime, social acts, accidents or even death from several diseases in the vulnerable females.

A study says that more than 200 different symptoms have been associated with the Pre-menstrual syndrome, but the most prominent symptoms are irritability, tension and dysphoria (unhappiness). Common emotional and non specific symptoms include stress, anxiety, difficulty in falling sleep, headache, fatigue, mood swings, increased emotional sensitivity and changes in libido and physical symptoms includes bloating cramps, constipation, swelling or tenderness in the breasts, engorgement, acne and joint or muscle pain. As Pre-menstrual syndrome involves both physical and emotional symptoms it is also called as psycho-neuro endocrinological disorder and it shares a common platform of day to day medical practice.

According to the National women’s health information centre 30-40 % of women suffer some impairment of daily activity, 75% women have some symptoms, 3-8% women have severe Pre-menstrual syndrome. Higher prevalence rates of Pre-menstrual syndrome are reported among middle class Indians, adolescent girls, Indore. The common symptoms that adolescent girls experienced are behavioral changes, impaired concentration, body pains, bloated feeling, headache and breast tenderness. And their daily intake of calories, fats and proteins are higher during premenstrual period. (Pritiverma Taniya). Another research report revealed that the women experience suicidal idea or death wish during Pre-menstrual period (Santosh.K).

Pre-menstrual syndrome may be primary or secondary, depending on the degree of underlying psychopathology. In primary Pre-menstrual syndrome, the symptoms resolve completely by the end of menstruation leaving a symptom free week, in secondary Pre-menstrual syndrome the symptoms remain following menstruation and symptoms should have occurred in at least 4 of the sin in previous cycles (O Brien 1987). There are many medical problems that deteriorate in the week before the menstrual field. These include asthma, depression, epilepsy, rheumatoid arthritis, migraine and many others (Hawkins 1980).

Certain events may be linked to the onset of Pre-menstrual syndrome like high caffeine intake, increasing age, history of depression, tobacco use, family history, dietary factors like low levels of certain vitamins and minerals particularly magnesium, manganese and vitamin B6, stopping of oral contraceptive pills, sterilization, hysterectomy (Dalton 1984). Stress and stressors associated with family life and responsibility of children may increase the symptoms. Research (Clare,1983) indicated that women who are psychiatrically ill experienced more and more severe Pre-menstrual syndrome than psychologically healthy women, women with Pre-menstrual syndrome have more sexual urge in the Pre-menstrual phase (Warner 1983). A study reported by woods and associate in 1992 found a negative correlation between incidence and prevalence of Pre-menstrual syndrome and socio economic status. So, to take an active step towards an intensive public awareness program, one should have the insight of what exactly is known and to what extent the women suffer with Pre-menstrual syndrome.

Much of the Indian studies could not be traced out by the investigator in this area might be due to lack of systematic data from Indian women regarding an important aspect of women’s life. This necessitates an in depth evaluation and assessment of Pre-menstrual syndrome. Hence, the research felt the need to find out the knowledge and prevalence of Pre-menstrual syndrome among women of reproductive age group and to develop a structured teaching programme which will be useful for educating the women in future.

6.2 REVIEW OF LITERATURE

Review of literature is an ongoing process and covers the entire planning stage. A good researcher does not exist in the vacuum. An intensive review of literature was done by the investigator to lay a broad foundation to the study.

The literature is reviewed and presented under the following headings:-

1. General information about premenstrual syndrome.

2. Literature related to prevalence of premenstrual syndrome.

3. Literature related to causes of premenstrual syndrome.

4. Literature related to treatment modalities of premenstrual syndrome.

General information about premenstrual syndrome.

Pre-menstrual syndrome is a universal problem of women of reproductive age group. Usually 80-95% of phases the symptoms of Pre-menstrual syndrome in any time of their menstrual period.

The definitions of Dalton and Greene (1953; Dalton 1986) and the international classification of diseases [ICD-10, Pre-menstrual tension PMT;WHO,1992] are more inclusive, and accept any number and type of symptoms that warrant presenting to a physician. In the face of these definitions, it is not clear whether Pre-menstrual syndrome belongs to a realm of “psychological/ emotional/mental” disorders (eg. Through DSM-VI criteria), or “physical” disorder (eg. ICD-1O categorization),or if the distinction is even meaningful with respect to this disorder.

Sneha Datta et. al (2002) conducted a study on 500 medical students and staff in Bhopal to identify the symptoms and negative effects during PMS. Ghey were given a questionnaire in which psychological symptoms which were classified accordingly that if they strongly agree, disagree and strongly disagree or undecided. The findings revealed that 36.8% agree that there was decrease in general moral, 52.8% had tension, 67.2%had depressed feelings , while 54.6% experienced irritability during premenstrual period and 17.4% agreed that there was emotional and crying spells.

Literature related to prevalence of premenstrual syndrome.

Madgy Hassan Balahar et al 2,3,4 (2009) a study was conducted to estimate the prevalence, severity and determinants of Pre-menstrual syndrome at the college of medicine, King Faisal university in Al-Asha, Saudi Araebia from June through Dec2009. It included 250 medical students who filled questionnaires covering American college of obstetrics and gynecology (ACOG) criteria to diagnose Pre-menstrual syndrome, demographic and reproductive factors, physical activity and mental condition by a regression analysis method. Pre-menstrual syndrome was diagnosed in 35.6% cases, distributed as 45% mild, 32.6% moderate and 22.4% severe and study revealed that Pre-menstrual syndrome is associated with older age groups, rural residence, lower age at menarche, regularity of menses and family history.

Nour Mohammad Bakhshani, et al 2,3 (2005) conducted a cross-sectional study to investigate the frequency of Pre-menstrual symptoms and prevalence of Pre-menstrual syndrome among young Iranian women of Zahedan university (Iron) aged 18-22 years. The study included 300 participants who were asked to complete an anonymous- questionnaire derived from DSM-VI diagnostic criteria for PMDD and PMS symptoms. Out of 300 participants 98.2% reported at least mild to severe Pre-menstrual symptoms and 16% met the criteria of DSM-VI for Pre-menstrual syndrome.

Literature related to causes of premenstrual syndrome.

A study conducted by Reiber (2008) on 170 women based on questionnaire and prospective daily symptom ratings. The study revealed that Pre-menstrual syndrome is not because something negative happens with the approach of the premenstrum, but rather because evolutionarily adaptive positive states are fostered during the follicular phase of the cycle for some women.

Dr.Harindar singh, Dr.Rani walia et al, conducted a study in 96 females suffering from PMS in the age group of 18 – 45 years. A randomized single blind study was done to find out the link between PMS and behavioral alterations. The study revealed that out of total 96 cases maximum behavioral affection was noticed in females within the age group of 35-45 years. Depression and agitated depression were 80%. From the present study, it has been shown that there is appearance of marked behavioral changes like depression, aggression, irritability, mood swings etc during PMS.The findings revealed that most symptoms were feelings of tiredness or lethargy 84%, depressed mood 72%, sudden feeling of sadness or tearfulness 70.3%, anxiety 70%, backache 69% and sleep problem 66%.

Ross C and Coleman.G (2003) conducted a study to examine the pattern and incidence of premenstrual syndrome in users and non-users of oral contraceptives. A sample of 181 women was given a questionnaire daily for 70 days. The study showed a very high incidence of premenstrual changes where 40% of women demonstrated increased in each symptom, 50% of women experienced increased in negative and over 70% experienced increase in fluid retention oral contraceptive use did not alter the incidence or severity of premenstrual changes. Study also revealed that contraceptive users reported higher levels of fluid retention and somatic symptoms than the non oral contraceptive users.

Literature related to treatment modalities of premenstrual syndrome.

Brown.J, O’Brien conducted a study to evaluate the effectiveness of selective serotonin reuptake inhibitors in reducing the Pre-menstrual symptoms. The study included 2294 women with Pre-menstrual syndrome who were given SSRI for 3 months. The study found to be highly effective in primary analysis (SMD-0.53, 95% CI- 0.68 to -0.39 and P < 0.00001), Secondary analysis showed that they were effective in treating physical (SMD-0.34, 95% CI- 0.45 to -0.22 and P < 0.00001), functional (SMD-0.30, 95% CI- 0.43 to -0.17 and P < 0.00001) and behavioral symptoms (SMD-0.41, 95% CI- 0.53 to -0.29 and P < 0.00001). Leutal phase only and continues administration were both effective and there was no influence of placeborum in period on reduction in symptoms. All SSRI’s [ fluoxetine, paroxetine, sertealine, flavoxaime, citalopram, and clomipramine ] were effective in reducing pre menstrual syndrome. But withdrawal due to side effects was twice as likely to occur in the treatment group (SDM-2.18, 95% CI-1.62 to 2.92; p < 0.00001).

A study was conducted by p.sharma et al 2,3,4 to identify the role of bromocriptine and pyridoxine in menstrual syndrome at Agra Delhi. The study included 60 female patients in a age group of 20-45 yrs. The patients were followed upto 3 months after starting treatment. The patients were divided into 3 groups of 20 patients each – controlled group, bromocriptine group and pyridoxine group. In controlled group, patients were kept on ferrous sulphate tablet for 3 months, as placebo. There was no significant change in the PMS score at the end of study period in control group. Bromocriptine 2.5mg twice a day and pyridoxine 100mg/day showed a significant reduction in the mean PMS score after 3 months of treatment. Study concluded that both the drugs are effective for treatment of PMS but peridoxine showed significantly higher response rate and lesser incidence of side effects than bromocriptine.

A cross sectional community survey among the adolescents in the year 15-19 years of age group by Lindsie Mary.L among 30 college girls to measure the effectiveness of Jacobson’s Progressive muscle relaxation exercise (JPMRE) on premenstrual syndrome. The study revealed that there was a significant reduction in PMS score after the Jacobson’s Progressive muscle relaxation exercise (JPMRE) ( t = 11.75 ; p < 0.05 ).

Pearlstein T.et al (2003) conducted retrospective analysis study to evaluate premenstrual dysphoric disorder symptom severity after the discontinuation of fluoxinate treatment in 2 clinical trials. 100 subjects of reproductive age group were treated with fluoxinate or placebo for 3 cycles with the use of several closing regimens followed by single blind placebo treatment for one cycle. The Sherham disability scale. The premenstrual tension scale clinician rates and the clinical global impression severity were to record the severity of problems daily. The study finding revealed premenstrual dysphoric disorder symptoms significantly increased after fluxonitine discontinuation.

Thys.Jacob.S et.al (1998) conducted a well designed, randomized, controlled trail of calcium supplements for treating manifestations of PMS and founded a great than 50% reduction in the manifestation complex scores after 3 months in more than half of the participants taking 1200mg of supplemental elementary calcium carbonate. The number needed to treat (NNT) from that study versus a placebo was 6 for a 50% reduction in the manifestations of PMS because it was so effective and because the adverse were the same as placebo.

STATEMENT OF THE PROBLEM:

“A study to assess the effectiveness of structured teaching program on prevalence and management of Pre-menstrual syndrome among B.Sc nursing students at selected colleges of nursing, Tumkur, Karnataka”.

6.3 OBJECTIVES

1. To assess the existing level of knowledge among B.Sc nursing students regarding prevalence and management of Pre-menstrual syndrome in both experimental and control group.

2. To implement the structured teaching program on prevalence and management of Pre-menstrual syndrome for experimental group.

3. To assess the effectiveness of structured teaching program among experimental group regarding knowledge on prevalence and management of Pre-menstrual syndrome.

4. To find out the association between the knowledge score with selected demographic variables.

6.4 OPERATIONAL DEFINITIONS

Assess:

It refers to the measurement of knowledge of B.Sc nursing students regarding prevalence of premenstrual syndrome as observed from the scores based on the interview.

Knowledge:

It refers to the awareness or body of information of the students regarding prevalence

of premenstrual syndrome.

Effectiveness:

It refers to the gain or improvement in knowledge regarding prevalence of

premenstrual syndrome among the experimental group students after the structured teaching program.

Structured teaching programme:

It refers to verbal and written information or instruction systematically developed and designed for a selected group of B.Sc nursing students regarding prevalence and management of premenstrual syndrome.

Prevalence:

It refers to the number of students affected by the symptoms of premenstrual syndrome.

Pre-Menstrual syndrome:

It is a recurrent disorder that occurs in the luteal phase of menstrual cycle i,e characterized by intense physical, psychological and behavioral changes in the women.

B.Sc nursing students:

Refers to the pupils, girls who are studying in B.Sc nursing course at selected colleges of nursing.

Management:

Refers to the measures or action to be taken to control the premenstrual syndrome symptoms.

6.5 ASSUMPTIONS

The study assumed that

1. The B.Sc nursing students will be having knowledge regarding Pre-menstrual syndrome.

2. The B.Sc nursing students will be suffering with few or more symptoms of pre-menstrual syndrome.

3. The B.Sc nursing students would be willing to participate in the study.

4. The structured teaching programme will improve their knowledge regarding prevalence and management of premenstrual syndrome.

6.6 Delimitations:

The study is limited to 60 samples who are studying in selected colleges of nursing.

The study is limited to those who can understand, read and write kannada and English.

6.7 RESEARCH HYPOTHESES

H1: There is a significant difference between mean pre test and post test knowledge score regarding Pre-menstrual syndrome.

H2: The mean post test knowledge scores of students attending the structured teaching programme will be highly significant than their mean pre test knowledge score of selected variable.

H3: There will be significant association between the selected variables – age, year of study, religion, caste, type of families, family income, knowledge and attitude etc..

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

The data will be collected from the samples who are studying B.Sc nursing course in

selected nursing colleges at Tumkur by interviewing and questionnaire.

7.2 METHODS OF COLLECTION OF DATA

1. Research design

Quasi-Experimental - one group pretest posttest design

2. Research variables

Dependent variables:

Level of knowledge regarding prevalence of premenstrual syndrome among B.Sc (N)

students in selected nursing college at Tumkur.

Independent variables:

Structured teaching programme on knowledge regarding prevalence and management

of Pre-menstrual Syndrome among B.Sc (N) students in selected nursing college at

Tumkur.

3. Setting

The study will be conducted at selected nursing colleges at Tumkur.

4. Population

The population consists of B.Sc nursing students from selected nursing colleges at

Tumkur.

5. Sample

The sample of the study consists of 60 students from selected nursing colleges in

Tumkur, where 30 are for experimental group and 30 for control group.

6. Criteria for sample selection

Inclusion criteria:

The study includes:

1. Students who are having some knowledge regarding premenstrual syndrome.

2. Who are willing to participate in the study.

3. Who are present at the time of data collection.

Exclusion criteria:

The study will exclude:

1. Who cannot understand Kannada or English language.

2. Who are not willing to participate in the study.

3. Who are unable to respond to questions.

4. Who are not present at the time of data collection.

7. Sampling technique

Purposive sampling technique.

8. Tool for data collection

The tool consists of three sections:

Section A:

Demographic proforma

Section B:

Structured questionnaire is used to assess the knowledge of B.Sc

nursing students regarding premenstrual syndrome.

Section C:

Checklist on symptoms of premenstrual syndrome.

9. Projected outcome

The 30 B.Sc nursing students in the experimental group will

be given knowledge on prevalence and management of

premenstrual syndrome.

10. Plan for data analysis

The data collected will be analyzed by means of descriptive

statistics and inferential statistics.

Descriptive statistics:

Frequency, percentage, mean, and standard deviation.

Inferential statistics:

Non parametric chi square test to determine the association between knowledge and selected demographic variables.

7.3 Does the study require any investigation or interventions to be

conduct on patients or other human or animals?

Yes, the study require data collection through structured questionnaire on knowledge of B.Sc nursing students regarding prevalence and management of premenstrual syndrome.

7.4 Has ethical clearance been obtained from your institution?

Yes, The main study will be conducted after the approval of research committee. Permission will be obtained from the concerned head of the institution. The purpose and after details of the study subjects and an informed consent will be obtained from them. Assurance will be given to study subjects on the confidentiality of the data collected from them.

8. List of references:

Book reference:

1. Joyce. M. Black, Jane Hokason Hawks(2005) “Medical surgical nursing”, 7th edition, Elsevier publishers Singapore, Page no:1055-1059.

2. B.T.Basavantappa (2006) “Midwifery and reproductive Health Nursing”, Jaypee brothers medical publisher New Delhi. Page no: 723-724.

3. Annamma Jacob (2005) “a comprehensive text book of midwifery”,Jaypee brothers medical publisher ,New Delhi. Page no:43-44.

4. Suzanne C. Smeltzer, Brenda Bare(2004), Brunner & Suddarth`s “text book of medical-surgical nursing” 10th edition, lipponcott willams & wilkens publishers Philadellphia, Page no: 1389-1391.

5. M.S.Bhatia (2004) “A concised text book on psychiatric nursing” 3rd edition, CBS publishers and distributors New Delhi. Page no:170-171.

6. Bereck and Novak(2008)”Text book of Gynecology” Voltas Kluwer Private limited.New Delhi. 14th edition. Page no-351,406-410.

7.D.C.Dutta(2005) “Text book of Gynecology’ New central book agency private limited, Culcutta. Page no 74-78

8.Myles et al (2003)“Text book of Midwifes” 14th Edition Elesiver Publication, Page no.678-681.

Journals:

1.Litin,S..ed.Mayo Clinic Family Health Book, 3rd Ed.New York,NY:HarperCollins Books,2003.

2.Daly RC, Schmidt PJ, Davis CL,Danaceau MA,Rubinow DR.Effects of gonadal steroids on peripheral benzodiazepine receptor density in women with PMS and controls . Psychoneuroendocrinology 2001:26(6):539-49.(s).

3.Freeman EW,Kroll R,Rapkin A, et al. Evaluation of uniue oral contraceptive in the treatment of premenstrual dysphoric disorder. Journal of Womens health And Gender Based Medicine 2001;10:561-69.(s)

4.Aruna (2010) “Premenstrual Syndrome” Nightingale Nursing Times, January

Vol-5, No-10. Page no: 21-23.

5.American College of Obstetricians and Gynaecologists “Dealing with Premenstrual Syndrome, from . May 2009.

6.National Association for Premenstrual Syndrome, from .uk/

7.Lindsie Mary L., Tamil mani .R : Jacobson’s Progressive muscle relaxation Excise and Premenstrual Syndrome among college girls”. The nurse,vol-1,No-2Aug-sep.2009:page no.1-4.

8.Davis.J.et.al (2000) “Premenstrual Syndrome” International Journal and Gynecology and obstericts,Vot 73,No-6,page no 183-191.

9.Chris Reibee (2009) “Empirical Support for an evolutionary model of Premenstrual Syndrome” Joournal of social,Evolutionary, and Cultural psychology Volume-3(1),page no 9-28.

10.World Health Organisation (1992). International Classification of disease (10th edition)

ICD-10. Geneva:WHO

11.Joffe,H,et.al (2003) “Impact of oral contraceptive pill use on premenstrual mood: Predictors of improvement and deterioration , American Journal of obstetrics and Gyneocology.189(6), page no-1523-1530

9.Signature of the candidate :

10. Remarks of the guide :

11. Name and designation :

11.1 Guide : Mrs.Jayanthi.C, principal

M.Sc, Obstetrics And GynecologIical

Nursing.

11.2. Signature :

11.3. Co-guide : Mrs.Kathyayani. MBBS,DGO.

11.4. Signature :

11.5. Head of the department : Mrs.Jayanthi.C

Bharathi College of Nursing,

4th Cross, K.R.Extension

Tumkur-572101

11.6. Signature :

12.1. Remarks of the principal :

Mrs.Jayanthi.C, Principal,

M.Sc. Obstetrics and Gynecological Nursing.

12.2. Signature :

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