Effectiveness of Self Help Strategies {SHS} for PCOS among Young Adult Girls at Selected Colleges at Chennai- Pilot study report

 

Mrs. S. Tamilselvi¹, Dr. S. J Nalini², Dr. R. Vijayaraghavan³

¹Associate Professor, Saveetha College of Nursing, Chennai

²Principal, Faculty of Nursing, Sri Ramachandra University, Chennai

³Director Research, Saveetha University, Chennai, India

 

ABSTRACT:

Background: The diverse and complex female endocrine disorder polycystic ovary syndrome (PCOS), which affects 1 in 15 women worldwide, is a major economic health burden that is likely to expand together with obesity. PCOS (Polycystic Ovarian Syndrome) -A hormonal condition that causes cysts to develop around the ovaries and throw ovulation out of sync. It can also lead to infertility. Prevalence of PCOS in Indian adolescents is 9.13%.This draws attention to the issue of early diagnosis in adolescent girls. The main aim of this study is to assess the effectiveness of Self Help Strategies {SHS} for PCOS among Young Adult Girls. Methods: True experimental pre-test and post-test was obtain for this pilot study to check the feasibility of the effectiveness of SHS among young adult girls with PCOS. An self assessment tool was given to the study participants. The sample size was seven young adults with PCOS.Two group pre test and post test design was used . The Blood investigation (FSH, LHand Blood glucose level, and testosterone), ultrasonogram of pelvis, and BMI was calculated prior to the interventions in both the experimental and control group. Experimental group received SHS and routine care for control group. SHS include mint tea, (includes 50ml of powder boiled in water) diet and exercise that helps in reduce size of the follicles and regulate hormones to normal menstruation. The duration of intervention was one month. The post test in both group was conducted after one month .the results was tabulated and analyses by using SPSS statistical package. Results: The comparison of self assessment mean values(%) in the pre and post test among participants in experimental group showed that the mean value in the pretest was 57.14 as compared to 36.36 in the post test. The difference in the mean value 20.78 was statistically significant (P<0.001). This shows that the SHS was effective and feasibility among girls with PCOS. Conclusion: The interventions strategies in this study, Mint tea, (5gm of dried mint powder boiled in 50ml of water) diet and exercise has a significant effect on hormonal regulation and help to reduce weight. The preliminary findings are encouraging that spearmint has the potential remedies also natural treatment for PCOS.

 

 

 

 

 

 

 

INTRODUCTION:

Adolescence is a time of growth and development. It is a transitional stage between the dependency of childhood and independency of adulthood. It is the time when an individual undergoes tremendous changes both physically, emotionally and psychologically. There is frequent change in the behavioral act of the child at this stage. There is too much of eagerness as well as restlessness. The hormonal changes have an acute impact on the personality of the child. It results either in pride or shame, overexcitement or humiliation. A profound and abrupt change is clearly perceptible into the development of the child who is neither too young nor too old. This sudden growth and development in the child is the unique characteristic of adolescence. Hence it’s an age which requires lots of care, affection, guidance, proper monitoring and motivation.

 

Studies says that young adult is a period of “stress and storm” (Hall, 1985).When adolescence itself is considered as a stressful period then how about the adolescents who are in the problem with PCOS. It is estimated that there are between one in five women worldwide (UNICEF report). According to WHO Polycystic Ovary Syndrome (PCOS) is one of the most common female endocrine disorders affecting approximately 5%-10% of women of reproductive age (12–45 years old) and is thought to be one of the leading causes of female infertility.

 

Adolescents with PCOS are known to be at increased risk for insulin resistance. In Insulin Resistance; the body becomes increasingly less responsive to the action of insulin. As a result, there is more circulating glucose in the blood waiting to be absorbed into the cells resulting in impaired glucose tolerance Women with PCOS also develop abnormal glucose metabolism at a younger age and may demonstrate a more rapid conversion from impaired glucose tolerance to type II diabetes mellitus.

 

Hyperandrogenemia and abnormal insulin response to glucose. Insulin resistance (IR)/hyperinsulinemia in PCOS being the main pathogenic defect are also supported by clinical, biochemical, and hormonal response to insulin sensitizers. With adipose tissue being one of the important sources of pro-inflammatory cytokines, IR in obese has been attributed to elevation of adipocytokines and other inflammatory markers.

 

Adolescent with PCOS have been demonstrated to have elevated cytokines like tumor necrosis factor-a (TNF-a) and IL-6 concentrations independent of obesity, and these alterations in serum inflammatory markers in PCOS are unrelated to PPAR-g variants. It has been demonstrated that the therapy with metformin in PCOS leads to an increase in plasma adiponectin and TNF-a but not plasma IL-6 and C reactive protein.

 

NEED FOR THE STUDY:

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting women of reproductive age and is increasingly recognized as a disorder manifesting in the peripubertal and adolescent period. Diagnosis in the adolescent is difficult due to the high background rate of menstrual irregularity, the high prevalence of polycystic ovarian morphology and hyperandrogenic features in this population.

 

Recent guidelines suggest that menstrual irregularity for over two years, reduced reliance on ultrasound diagnosis of polycystic ovarian morphology, and accurate assessment of hyper androgenic and metabolic features are suitable strategies for the diagnosis of PCOS in the adolescent. Accurate diagnosis is important given the long-term implications of the disorder, with increasing emphasis on metabolic sequel.

 

Grant Pet.al (2010) had conducted a study on effectiveness of Spearmint herbal tea among PCOS. The study evaluated that reduction in androgen level the study duration was not long enough. The time taken for hirsutism to resolve is significant and a much longer future study is proposed as the preliminary findings are encouraging that spearmint has the potential for use as a helpful and natural treatment for hirsutism in PCOS.

 

STATEMENT OF THE PROBLEM:

Effectiveness of Self Help Strategies {SHS} for PCOS on bio physiological and biochemical parameters among Young Adult Girls At Selected Colleges At Chennai.

 

OBJECTIVES:

·        Assess the prevalence of PCOS among young adult girls at selected colleges.

·        To determine the effectiveness of self help strategies for PCOS on bio physiological and bio chemical markers among young adult girls.

·        To associate the selected demographic variables with on bio physiological and biochemical parameters among young adult in three groups.

 

MATERIALS AND METHODOLOGY:

Study design:

This study used to evaluate the effectiveness of (SHS)self help Strategies among young adults with PCOS. Participants were randomly assigned to the control group and experimental group.Tools containing demographic variable, disease related information and self assessment protocol was used for pre and post assessment for both group. Blood investigations include FSH, LH and Fasting blood glucose level and testosterone, Ultrasonogram of pelvis was studied to assess the size of the follicles (12 or more follicles measuring 2-9 mm in diameter with or without ovarian volume >10 cc) of PCOS prior and after interventions

 

Settings and Samples:

Participants were recruited from selected constituent colleges under Saveetha university, Chennai. Young adults who met the inclusion criteria were included. The sample size for the study is seven in each group.

 

 

 

Methodology:

After obtaining ethical approvals from Institute Ethics Committee. The researcher obtained permission from constituent principals and class adviser from each participant. After that self assessment tool and informed consent was explained from each participant, all the participants were explained the procedure of steps of exercises and diet module. The researcher also motivated and maintained the habit of taking mint tea daily 50ml in the morning and evening. This SHS was practiced for the period of one month, totally among 14 participants 7 in experimental and 7 in control groups were included in this pilot study. In the interventional group among 7, 5 samples were followed the SHS regularly. The 5 samples had regular mensuration, reduction in the size of the ovarian cyst and decreased BMI after intervention.

 

 

RESULTS:

Demographic, clinical and biochemical characteristics of participants at baseline:

The majority of the study participants were (Experimental -71.4%, Control - 42.8%) between the age group of 19-20 years in both group.100% in experimental group were from final year , 85.71% in control group were second year students.100% in control group and 85.7% in experimental group were attained menarche at the age of 13-14 years of age. Equal (85.7% ) of study subjects were Non-Vegetarians. All the 14 young adults in both groups are having irregular periods. 100% in study group and 42.86% in control group were having menstrual flow for 5-6 days. Majority in experimental group (85.7%) were not underwent any treatment for PCOS, but in experimental group only few of them were not taking any treatment, about 71.42% were taking treatment for PCOS and that to alternative treatment and home remedies.

 

Table-1. Comparison of mean self – assessment scores (%) among the girls with PCOS in the Experimental group before and after the intervention.

 

Table 2. Comparison of mean assessment scores (%) among the girls with PCOS in the experimental group and control group after the intervention.

 

The comparison of self- assessment tool mean values (%) in the pretest and post test among young adult girls in the experimental group showed that the mean value in the pretest was 57.14 as compared to 36.36 in the post test. The difference in the mean values (20.78) was statistically significant (P<0.001). there was a significant reduction in the level of self assessment and this showed that the intervention of SHS was effective among girls with PCOS.

 

 

Figure 1 shows the mean and SE value of pre and post test- self assessment tool

The mean values in the experimental group and the control group were 36.36 and 48.35 respectively. The difference in the mean values was not significantly different.

 

Parametric tests (Paired and un paired) on blood investigations within and between experimental group and control group were carried out. There was no significant difference except for the mean difference in the fasting sugar between pre and post tests in the experimental group.

 

DISCUSSION:

Polycystic ovarian syndrome (PCOS) is one of the most common reproductive endocrinology abnormalities, and affects 5% to 10% of women of reproductive age. Western medicines, such as oral contraceptives, insulin sensitizers and laparoscopic ovarian drilling (LOD), have been used to treat PCOS. Recently, many studies have been published that consider herbal medicine as an alternative treatment for women with PCOS (Zhou K et.al 2016). This study is conducted to assess the effectiveness of Self Help Strategies (Mint tea, Diet and Exercise) among young adult girls with PCOS.

 

 

In Experimental group the post assessment results shows that there is about 26.7% reduction in weight, 32.3% LH decrease in Fasting blood glucose level, the mean value of reduction in FSH level is about 4.7 of the study participants. Post intervention Ultrasound report shows that the size of PCOS has reduced in few participants. The overall finding of this pilot study reported shows the tools are effective and appropriate to conduct the main study. All the investigations were carried out by a laboratory technician in Saveetha Medical college and Hospital which enhanced accuracy and consistency in the reports. Even the ultrasound examinations were carried out by a trained radiologist on a single machine. The study highlights the need to create awareness among young adult girls.

 

One of the limitations of the study was a poor representation of various socioeconomic strata; hence, the findings cannot be extrapolated to higher socioeconomic group with more westernised lifestyle and intake of junk food.

 

CONCLUSION:

Recent trend move towards herbal treatment creates awareness to propose new research in the health industry. Our present study is about effect of a herb- mint tea in reduces PCOS along with a diet module and exercise. pilot study report reveals that there is a significant relationship between pre and post assessment of self assessment tools among the study participants . The feasibility of conducting such research study justifies the need to upscale this effort to get an overall estimate of the disorder in a diverse socio cultural and economic background, providing an opportunity for early detection and prevention of morbidities among adolescents and young women in India.

 

CONFLICT OF INTEREST:

There is no conflict of interest

 

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Accepted on 21.03.2018        © RJPT All right reserved

Research J. Pharm. and Tech 2018; 11(7):3145-3148.