Questionnaire

NAME: -                                                                                                                       
AGE :-

RELIGION:-

SOCIO-ECONOMIC STATUS:-

 AWARENESS OF RISK FACTORS OF PCOD

1. Change in Waist- hip ratio (<0.80) -Yes / no or don’t know

2. Reduction in physical activities -Yes / no or don’t know

3. Change in intervals OR duration of menstrual cycle than usual. -Yes / no or don’t know

4. Continuous weight gain. -Yes / no or don’t know

5. High-carb and Fatty food Diet. -Yes / no or don’t know

6. BMI<25 . -Yes / no or don’t know

7. Sedentary life-style -Yes / no or don’t know

8. Thyroid disorders -Yes / no or don’t know

9. Hormonal medications -Yes / no or don’t know

10. Family history. -Yes / no or don’t know

11. Where did you first learn about PCOD? -Newspapers and magazines

- Radio - TV - Billboards - Brochures, posters and other printed materials

- Health workers - Family, friends, neighbours and colleagues

KNOWLEDGE ABOUT PCOD SIGN AND SYMPTOMS

12. Skin pigmentation Yes / no

13. Male pattern hair growth Yes / no

14. Baldness and thinning of hair Yes / no

15. Acne and oily skin changes Yes / no

16. Scanty bleeding Yes / no

17. Breast enlargement Yes / no