INTRODUCTION:

Youth is not a time of life; it is a state of mind; it is not a matter of rosy cheek, red lips and supple knees; it is a matter of the will, quality of the imagination, a vigor of the emotions; it is the freshness of the deep springs of life.

The period of transition from childhood to adulthood is called Adolescent with accelerated physical, biological and emotional development. It is a unique period of dynamic change which may be referred to as “Growing up”.¹Adolescent’s Health is one of the WHO’s highest priority. A healthy woman makes a happy Nation. Adolescent’s health is a personal and social state of balance and wellbeing in which she feels strong, active, creative, wise and worthwhile, where she may make choices, express herself move about freely.²

nternational conference of population development understands the long overdue challenge of orientation of population stabilization towards such urgent issues an environment, social development, women development and human right. It also emphasized the shift from family welfare activities towards a more holistic approach of promotion.³

NEED FOR THE STUDY:

“Adolescence is the time in life when girls quit believing in fairy taller and start to believe in love, snow and adolescence are the only problem that disappear if you ignore them long enough”

A healthy life always leads to happiness and prosperity. Health is the weapon that keeps a human being to maintain his regular activities and functions.⁴ The most important period in the life span of women is the reproductive period which extends from menarche to menopause.⁵ Menarche is a hallmark eventin the life of most adolescent girls. It marks the transition from childhood to puberty. Although mechanisms triggering puberty and menarche remain uncertain, they are dependent on genetics, nutrition, body weight and maturation of the hypothalamic pituitary – ovarian axis . The complete maturation of the axis may take up to 2 years . During this time, it is common for adolescents to present with complaints of menstrual irregularities.⁶ A normal menstrual cycle is taken to be 28 days long and recurs regularly.⁷

Regular menstruation is a natural and normal physiological process in woman’s life. Moreover, it is the healthy phenomena which begins with menarche and ends in menopause. It occurs every 21 to 35 days and lasts for 2 to 7 days with a normal blood loss of 35 to 80ml. The monthly menstrual period reassures a woman in reproductive age that she is normal. Indeed, many different things have to go right for this to happen hormones and other substances, everything has to be synchronized correctly to get regular menstrual period. Hormonal imbalance in the body leads to menstrual irregularities or abnormal uterine bleeding. So necessary steps should be taken to control this. A gynecological saying that ‘control bleeding and restore your health’.⁸The common form of abnormal uterine bleeding is menorrhagia. It refers to abnormal bleeding from the uterus without any organic disease of the reproductive system. Changes in the menstrual cycle occur in perimenarchal and premenopausal years because of the unstable responsive state and hormonal fluctuations. Anovulatory menorrhagia result from a disturbance in the Hypothalamic-pituitary-ovarian (HPO) axis and ovulatory menorrhagia is due to defects in local haemostasis and not due to disturbance in HPO axis. Menorrhagia commonly affects the young girls i.e. between the ages of 14 to 20 years. The students under intensive stress, excessive exercises, obesity are risk factors for menorrhagia.⁹

STATEMENT OF THE PROBLEM:

“A study to assess the knowledge and attitude of menorrhagia among adolescent girls in selected College of Raichur, with a view to develop health education module”.

OBJECTIVE OF THE STUDY:

1. To assess the knowledge and attitude of adolescent girls regarding menorrhagia.

2. To find out the association between knowledge and attitude of adolescent girls regarding menorrhagia with demographic variables.

3. To develop health education module regarding menorrhagic girls.

OPERATIONAL DEFINITION:

1. Knowledge:

Refers to the level of understanding of adolescent girls regarding menorrhagia as measured by their correct responses to the knowledge items of questionnaire.

2. Attitude:

Refers to the opinion, ideas, beliefs and feeling of adolescent girls regarding menorrhagia as responded to the attitude scale.

3. Menorrhagia:

It refers to abnormally heavy and prolonged menstrual period at regular intervals. Causes may be due to abnormal blood clotting, disruption of normal hormonal regulation replacement, leading to anemia.

4. Health Education Module:

Systematic and scientific and specific instruction related to menorrhagia will be prepared in the form of a module.

5. Adolescent Girl:

Refers to the girls in the age group between 15 to 18 years.

HYPOTHESES:

On the basis of the objective of the study the following hypotheses have been formulated.

H₁- There will be significant relationship between the knowledge of adolescent girls regarding the menorrhagia and selected variable.(Age, Religion, Education and Body Mass Index).

H₂- There will be significant relationship between the attitude of adolescent girls regarding the menorrhagia and selected variables (Age, Religion, Education and Body Mass Index).

ASSUMPTION:

The investigator assumes that the adolescents:

1. Will have knowledge regarding menorrhagia.

2. Will have positive attitude towards menorrhagia.

3. Will cooperate.

DELIMITATION:

The study is delimited to adolescents, who are:

§ In the age between 15 to 18 years

§ Studying in selected college

§ Available at the time of the data collection

§ Willing to participate in the study

CONCEPTUAL FRAME WORK:

“Dr. Pender” Health Promotion Model is used based on the assumption that the adolescents will have knowledge regarding menorrhagia and have a positive attitude towards menorrhagia, which is influenced by their demographic variables like age, education, and religion and body mass index. The modifying factors and perceptual factors directly influence the adolescents to participate in health promotion activity. The outcome of this can be favorable, moderately favorable or unfavorable.

MATERIAL AND METHODS:

Research Approach:

A descriptive survey was adopted for in this study.

Research Design:

Descriptive research design was adopted to carry out the present study.

Research Setting:

LVD College Raichur, Karnataka.

Variables under study:

In the present study, the independent variable was menorrhagia and adolescent girls were the dependent variable.

Population:

In the present study, population comprised of the adolescent’s girls who are studying in LVD College, Raichur.

Sample and Sample Size:

The sample for the present study consisted of 100 adolescent girls studying in LVD College, Raichur.

Sampling Technique:

The sampling technique used for the study was purposive sampling technique is used to select the area and simple random sampling i.e. lottery method is used to select the sample.

Description of Tool:

The structured interview schedule and check list were used for the study. It consists of three parts namely A, B, C.

Section A:

It deals with demographic data of the sample which including age, religion, education and body mass index.

Section B:

It deals with the items relate to knowledge of adolescent girls regarding menorrhagia. It consists of 26 multiple choice questions. The score value of 1 was allotted to each correct response. The total score was 26. The knowledge of the respondents was arbitrarily categorized into three categories:

Low knowledge : 0-50%

Average knowledge : 51-75%

High knowledge : above 75%

Section C:

It consisted of 12 attitudinal statements of “agree” and “disagree” type based on rating scale. The check list consists of “6” positive and “6” negative statements related to attitude of adolescent girls regarding menorrhagia. Statement 2, 4, 5, 7, 8 and 11 were positive, 1, 3, 6, 9, 10 and 12 were negative. The response of agree was allotted a score “1” for positive item and the response of disagree was allotted a score “1” for negative items, thus the total score for check list was 12. The attitude of the respondents was arbitrarily categorized into three categories:

Unfavorable attitude : 0 – 50%

Moderate favorable attitude : 51 – 75%

Favorable attitude : above 75%

RESULTS:

I. Findings related to significant relationship between the knowledge of adolescent girls regarding the menorrhagia and selected socio-demographic variables

Table 1: Frequency and percentage distribution of adolescent girls by their Age.

Age in years	Frequency	Percentage
15 – 16 years	75	75
17 – 18 years	25	25

Table – 1 describes the percentage distribution of adolescent girls by their age. Majority of the adolescent girls were within the age group of 15 – 16 years (75%) followed by the age group of 17 – 18 years (25%) respectively

Fig 1: percentage distribution of adolescent girls according to their age.

Table 2: Frequency and percentage distribution of adolescent girls by their religion.

Religion	Frequency	Percentage
Hindu	47	47
Muslim	28	28
Christian	25	25

Table – 2 illustrates the percentage distribution of adolescent girls by their religion. Majority of adolescent girls (47%) were Hindu followed by Muslim (28%) and Christian (25%).

Fig 2: Percentage distribution of adolescent girls according to their religion

Table – 3:- Frequency and percentage distribution of adolescent girls by their education.

Education	Frequency	Percentage
1^stPUC	77	77
2^ndPUC	23	23

Table – 3, narrates the percentage distribution of adolescent girls by their education. Majority of adolescent girls (77%) were 1^st PUC followed by 2^nd PUC (23%).

Fig 3: percentage distribution of adolescent girls according to their education.

Table 4 :Frequency and percentage distribution of adolescent girls by their BMI.

BMI	Frequency	Percentage
Underweight	9	9
Normal	77	77
Overweight	11	11
Obese	3	3

Table – 4 illustrates the percentage distribution of adolescent girls by their body mass index. Majority of adolescent girls were normal (77%) followed by overweight (11%), underweight (9%) and obese (3%).

Fig 4: Percentage distribution of adolescent girls according to their BMI

II. Findings related to the knowledge scoring levels of adolescent girls regarding the menorrhagia.

This section deal with overall knowledge level and attitude level related to menorrhagia among adolescent girls. The knowledge levels of adolescent girls were categorized into three levels as followed:

Knowledge level	Percentage	Range of score
Low knowledge	0 – 50	0 – 13
Average knowledge	51 - 75	14 – 20
High knowledge	Above 75	21 – 26

Based on knowledge score, the adolescent girls were categorized into three groups. Adolescent girls who score 0–13 (0-50%) were categorized into low knowledge group, adolescent girls who scored 14–20 (51–75%) were categorized into average knowledge group and adolescent girls who scored 24–30 (above 75%) were categorized into high knowledge.

Table – 5: Frequency and Percentage Distribution of Level of Knowledge of Adolescent girls regarding Menorrhagia in selected college of Raichur. N = 100

Level of knowledge	Frequency	Percentage
Low knowledge	56	56
Average knowledge	37	37
High knowledge	7	7

Table–5 represents the overall knowledge level of adolescent girls regarding menorrhagia. Among 100 adolescent girls more than half (56%) adolescent girls had low knowledge followed by average knowledge (37%) and few had high knowledge (7%). It is very important point here that very few had high knowledge; it indicates the poor knowledge of menorrhagia. This indicates there is urgent need of a health education module regarding menorrhagia.

Fig 5: percentage distribution of adolescent girls according to their level of knowledge

III. Findings related to the attitude scoring levels of adolescent girls regarding the menorrhagia.

The attitude levels of adolescent girls were categorized into three levels as followed:

Attitude level	Percent	Range of Score
Unfavorable attitude	0 - 50	0 – 6
Moderate favorable attitude	51 – 75	7 – 9
Favorable attitude	Above 75	10 – 12

Based on attitude score, the adolescent girls were categorized into three groups. Adolescent girls who score 0 – 6 (0 - 50%) were categorized into unfavorable attitude group, adolescent girls who scored 7 – 9 (51 – 75%) were categorized into moderate favorable attitude group and adolescent girls who scored 10 – 12 (above 75%) were categorized into favorable attitude.

Table – 6:- Frequency and Percentage Distribution of Level of attitude of adolescent girls towards menorrhagia in selected college of Raichur.

Attitude level	Frequency	Percentage
Unfavorable attitude	62	62
Moderate favorable attitude	36	36
Favorable attitude	2	2

Table – 6 represent the distribution of levels of attitude of adolescent girls regarding menorrhagia. Among 100 adolescent girls more than half (62%) had unfavorable attitude followed by moderate favorable attitude (36%) and favorable attitude (2%) towards menorrhagia.

Fig 6: percentage distribution of adolescent girls according to their level of Attitude.

IV. Findings related to Mean and standard deviation of the knowledge and attitude scoring of adolescent girls regarding the menorrhagia.

This section deals with the Mean and Standard Deviation of knowledge and attitude scores.

Table – 7:- Mean and standard deviation of the knowledge scores of adolescent girls regarding menorrhagia.

Variables

Mean Scores

Standard Deviation

Age

15 – 16 years

17 – 18 years

12.8

4.8

3.9

Religion

Hindu

Muslim

Christian

12.7

11.8

11.7

4.6

4.0

5.3

Education

1^st PUC

2^ndPUC

12.0

12.9

4.8

4.0

BMI

Under weight

Normal weight

Over weight

Obese

12.9

12.4

10.3

13.3

3.9

4.5

5.5

6.4

Knowledge and Age:

The respondent in the age group of 17 – 18 years got highest mean score of 12.8 ± 3.9 followed by 15 – 16 years (mean score of 12 ± 4.8).

Religion:

The respondents of Hindu religion scored highest when compared to other two groups ( mean score of 12 ± 4.6) followed by Muslim( mean score of 11.8 ± 4.0) and Christian ( mean score of 11.7 ± 5.3).

Education:

Gradual increase of knowledge was seen in education level of the respondents where 2^nd PUC score (mean score of 12.9 ± 4.0) and 1^stPUC scored ( mean score of 12.0 ± 4.8).

BMI:

The body mass index of respondents where obese got highest scored ( mean score of 13.3 ± 6.4) followed by underweight scored ( mean score of 12.9 ± 3.9), normal weight scored (mean score of 12.4 ± 4.5) and overweight scored (10.3 ± 5.5).

Table – 8:- Mean and standard deviation of the attitude scores of adolescent girls regarding menorrhagia.

Variable

Mean Score

Standard Deviation

Age

15 – 16 years

17 – 18 years

5.0

4.3

1.9

1.8

Religion

Hindu

Muslim

Christian

4.7

5.2

4.6

1.9

2.1

1.5

Education

1^st PUC

2^nd PUC

5.0

4.3

1.9

1.8

BMI

Underweight

Normalweight

Overweight

Obese

4.2

5.0

3.0

1.7

1.8

2.2

1.7

Attitude and Age:

The mean score of 15 – 16 years got highest ( mean score of 5.0 ± 1.9) and the respondents of 17 – 18 years got ( mean score of 4.3 ± 1.8).

Attitude and Religion:

The Muslim respondent got highest mean scores of 5.2 ± 2.1 followed by Hindu respondents got mean score of 4.7 ± 1.9 and Christian responds mean score of 4.6 ± 1.5, which reveal that Muslim had more positive attitude regarding menorrhagia than Hindu and Christian respondents which may be due to the religious constrains.

Education:

The 1^stPUC respondents had the highest mean scores ( mean score of 5.0 ± 1.9) followed by 2^nd PUC ( mean score of 4.3 ± 1.8).

BMI:

The normalweight and overweight respondents got highest mean scores ( mean score of 5.0 ± 1.8 and 5.0 ± 2.2) followed by underweight ( mean score of 4.2 ± 1.7) and obese ( mean score of 3.0 ± 1

V. Findings related to Association between the knowledge score regarding the menorrhagia of the adolescent girls and selected demographic variables.

Table – 9:- Association between age of adolescent girls with their knowledge score.

Age in years	Low knowledge		Moderate knowledge		High knowledge		Total
Age in years	F	%	F	%	F	%	Total
15 -16	44	59	25	33	6	8	75
17 – 18	12	48	12	48	1	4	25
Total	56		37		7		100

( χ2 = 0.2, df = 2, p = 0.64, not Significant)

Table – 9 describes the association between the age and knowledge of adolescent girls on menorrhagia. A chi – square test was done to see the association between age and knowledge of adolescent on menorrhagia. The chi – square value computed for the knowledge scores of adolescent girls and age ( χ2 = 0.2), was less than table value at 5% level of significant which indicated there is no statistical significance between them. Hence H₁ was rejected i.e. there is no significant association between age and knowledge.

Table – 10:- Association between religion of adolescent girls with their knowledge score. N = 100

Religion	Low knowledge		Moderate knowledge		High knowledge		Total
Religion	F	%	F	%	F	%
Hindu	23	49	21	45	3	6	47
Muslim	18	64	9	32	1	4	28
Christian	15	60	7	28	3	12	25
Total	56		37		7		100

( χ2 = 0.29, df = 4, p = 0.6, not Significant)

Table – 10 describes the association between the religion and knowledge of adolescent girls on menorrhagia. A chi – square test was done to see the association between religion and knowledge of adolescent on menorrhagia. The chi – square value computed for the knowledge scores of adolescent girls and religion ( χ2 = 0.29), was less than table value at 5% level of significant which indicated there is no statistical significance between them. Hence H₂ was rejected i.e. there is no significant association between religion and knowledge.

Table – 11:- Association between education of adolescent girls with their knowledge score

Education	Low knowledge		Moderate knowledge		High knowledge		Total
Education	F	%	F	%	F	%	Total
1^st PUC	46	60	25	32	6	8	77
2^nd PUC	10	44	12	52	1	4	23
Total	56		37		7		100

( χ2 = 0.7, df = 2, p = 0.4, not Significant)

Table – 11 describes the association between the education and knowledge of adolescent girls on menorrhagia. A chi – square test was done to see the association between education and knowledge of adolescent on menorrhagia. The chi – square value computed for the knowledge scores of adolescent girls and education ( χ2 = 0.7), was less than table value at 5% level of significant which indicated there is no statistical significance between them. Hence H₃ was rejected i.e. there is no significant association between education and knowledge.

Table – 12:- Association between BMI of adolescent girls with their knowledge score. N = 100

BMI	Low knowledge		Moderate knowledge		High knowledge		Total
BMI	F	%	F	%	F	%	Total
Underweight	6	67	2	22	1	11	9
Normalweight	41	53	31	40	5	7	77
Overweight	8	73	2	18	1	9	11
Obese	1	33	2	67	0	0	3
Total	56		37		7		100

( χ2 = 0.001, df = 6, p = 0.98, not Significant)

Table – 12 describes the association between the BMI and knowledge of adolescent girls on menorrhagia. A chi – square test was done to see the association between BMI and knowledge of adolescent on menorrhagia. The chi – square value computed for the knowledge scores of adolescent girls and BMI ( χ2 = 0.001), was less than table value at 5% level of significant which indicated there is no statistical significance between them. Hence H₄ was rejected i.e. there is no significant association between BMI and knowledge.

VI. Findings related to Association between the attitude score regarding the menorrhagia of the adolescent girls and selected demographic variables.

This section includes the association between attitude score and selected socio-demographic variables of adolescent girls on menorrhagia in selected college of Raichur.

Table 13:Association between age of adolescent girls with their attitude score.

Age in years	Unfavorable attitude		Moderate favorable attitude		Favorable attitude		Total
Age in years	F	%	F	%	F	%	Total
15 - 16	44	59	30	40	1	3	75
17 – 18	18	72	6	24	1	4	25
Total	62		36		2		100

( χ2 = 0.75, df = 2, p = 0.38, not Significant)

Table – 13 describes the association between the age and attitude of adolescent girls on menorrhagia. A chi – square test was done to see the association between age and attitude of adolescent on menorrhagia. The chi – square value computed for the attitude scores of adolescent girls and age ( χ2 = 0.75), was less than table value at 5% level of significant which indicated there is no statistical significance between them. Hence H₅ was rejected i.e. there is no significant association between age and attitude.

Table 14:Association between religion of adolescent girls with their attitude score.

Religion	Unfavorable attitude		Moderate favorable attitude		Favorable attitude		Total
Religion	F	%	F	%	F	%	Total
Hindu	30	64	16	34	1	2	47
Muslim	16	58	11	39	1	4	28
Christian	16	64	9	36	0	0	25
Total	62		36		2		100

( χ2 = 0.002, df = 4, p = 0.96, not Significant)

Table – 14 describes the association between the religion and attitude of adolescent girls on menorrhagia. A chi – square test was done to see the association between religion and attitude of adolescent on menorrhagia. The chi – square value computed for the attitude scores of adolescent girls and religion ( χ2 = 0.002), was less than table value at 5% level of significant which indicated there is no statistical significance between them. Hence H₆ was rejected i.e. there is no significant association between religion and attitude.

Table – 15:- Association between education of adolescent girls with their attitude score. N = 100

Education	Unfavorable attitude		Moderate favorable attitude		Favorable attitude		Total
Education	F	%	F	%	F	%	Total
1^st PUC	45	58	31	40	1	2	77
2^nd PUC	17	74	5	22	1	4	23
Total	62		36		2		100

(χ2 = 0.96, df = 2, p = 0.32, not Significant)

Table – 15 describes the association between the education and attitude of adolescent girls on menorrhagia. A chi – square test was done to see the association between education and attitude of adolescent on menorrhagia. The chi – square value computed for the attitude scores of adolescent girls and education ( χ2 = 0.96), was less than table value at 5% level of significant which indicated there is no statistical significance between them. Hence H₇ was rejected i.e. there is no significant association between education and attitude.

Table – 16:- Association between BMI of adolescent girls with their attitude score. N = 100

BMI	Unfavorable attitude		Moderate favorable attitude		Favorable attitude		Total
BMI	F	%	F	%	F	%	Total
Underweight	8	89	1	11	0	0	9
Normal weight	45	58	31	40	1	2	77
Overweight	6	55	4	36	1	9	11
Obese	3	100	0	0	0	0	3
Total	62		36		2		100

( χ2 = 0.36, df = 6, p = 0.54, not Significant)

Table – 16 describes the association between the BMI and attitude of adolescent girls on menorrhagia. A chi – square test was done to see the association between BMI and attitude of adolescent on menorrhagia. The chi – square value computed for the attitude scores of adolescent girls and BMI ( χ2 = 0.36), was less than table value at 5% level of significant which indicated there is no statistical significance between them. Hence H₈ was rejected i.e. there is no significant association between BMI and attitude

CONCLUSION:

The following conclusion was draw from the finding of present study;

1. Among 100 adolescent girls more than half (56%) adolescent girls had low knowledge followed by average knowledge (37%) and few had high knowledge (7%).

2. Among 100 adolescent girls more than half (62%) had unfavorable attitude followed by moderate favorable attitude (36%) and favorable attitude (2%) towards menorrhagia.

3. The mean score for knowledge was 12.2 and standard deviation 4.60. The mean score for attitude was 4.84 and standard deviation 1.88.

4. There was significant association between knowledge scores of the respondents with their demographic variables of age, religion, education and body mass index. Whereas there was no significant association found between knowledge scores of adolescent with age, religion, education and body mass index at 5% level of significance.

5. There was significant association between attitude score respondents with their demographic variables of age, religion, education and body mass index. Whereas there was no significant association found between attitude scores of adolescent with age, religion, education and body mass index at 5% level of significance.

IMPLICATIONS:

The findings of the study have several implications for nursing education, nursing practice, nursing administrations and nursing research.

Nursing Education:

· Nurse educator can teach the students to acquire adequate knowledge of menorrhagia among adolescent girls.

· Nurse educator can teach adolescent girls about valid factors which affect the health due to menorrhagia.

· Nurse educator can teach in community to adopt appropriate management measures against menorrhagia among adolescent girls.

· Nurse educator can teach adolescent girls about the important treatment and follow-up of menorrhagia.

Nursing Practice:

Nurses are the key persons of the health team, who play vital role in the promotion and maintenance of health.

· Nurses can conduct community awareness campaigns programme for adolescent girls on menorrhagia.

· Nurses should plan health education on home management of menorrhagia for adolescent girls.

· Nurse as a practitioner can prepare structured teaching module to teach regarding menorrhagia among adolescent girls.

· Nurse can instruct health professionals to teach the adolescent girls during home visits regarding menorrhagia.

Nursing Administration:

· Nursing professionals working in hospitals settings can find opportunity to teach and improve the knowledge of adolescent girls regarding menorrhagia.

· Nurse administrator can plan and organize educational programmed for adolescent girls regarding menorrhagia.

· Nurse administrators can organize the staff development programmed for nurses to update their knowledge regarding menorrhagia.

· Nurse administrators can organize and conduct counseling programmed of adolescent girls with menorrhagia in meeting their needs.

· Nurse administrators can bring awareness among the public in general and specific focus groups regarding the knowledge of menorrhagia in women.

· The nurse, as an administrator can enhance the accessibility, availability and quality of services to people.

Nursing research:

· This study helps the researcher to develop insight into the development of health education module for adolescent girls.

· There is a need to conduct more research studies on specific areas to inculcate the knowledge and attitude on menorrhagia of the adolescent girls and their family members.

· A study can be taken regarding their practices towards menorrhagia.

LIMITATIONS:

The study excludes adolescents who are not

· between the age of 15- 18 years

· studying in selected College

· available at the time of data collection

· willing to participate in the study

RECOMMENDATIONS:

§ A similar study can be undertaken on a large scale for making a more valid generalization.

§ A similar study can be conducted in other college of Raichur district or states to validate and generalize the findings.

§ A similar study can be replicated with teaching strategies between experimental and control group.

§ A similar study can be conducted in hospital and community settings.

§ A similar study can be undertaken using other educational strategies management of menorrhagia like STP.

§ A descriptive study can be conducted among the student nurses.

§ A comparative study can be conducted between adolescent girls of urban and rural areas.

§ The study related to knowledge, attitude and practice of adolescent girls regarding menorrhagia can be done.

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5. Fare Wattleton Quotes. Fundamental right of human sex. BJOG 2001; 3 (1) : 1-3.

6. Sanjay Rao, Vijay Pawar, VR Badhwar, MN Fanseca. Medical Inter ventions in puberty Menorrhagia. BMJ; 2004; 328 : 921

7. Myles. Textbook for Midwives. 14^th ed. Churchill; Mary Seager; 2003. P – 135

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Received on 26.09.2015 Modified on 17.10.2015

Int. J. Nur. Edu. and Research 4(1): Jan.-Mar., 2016; Page 47-55

DOI: 10.5958/2454-2660.2016.00009.0