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\def\RunningAuthor{Lakshmi Narasimha G et al.}
\firstPage{2950}
\articleType{Original Article}
\receivedDate{03 Nov 2020}
\acceptedDate{17 Dec 2020}
\revisedDate{08 Dec 2020}
\journalVolume{2020, 11 (SPL4)}
\journalDoi{ijrps.v11iSPL4.4586}
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\title{Impact of promoting healthy lifestyle interventions among adolescents, young adults with polycystic ovarian disease in resource limited settings}
\author{Sireesha~M\textsuperscript{1},  
            Gnaneswari~RV\textsuperscript{1},  
            Reddy~Santhosh~C\textsuperscript{1},  
            Mahesh~PA\textsuperscript{1},  
            Lakshmi~Narasimha~G\textsuperscript{*}\textsuperscript{1}, 
            Madhavi~K\textsuperscript{2}~\\[5pt]{\textsuperscript{1}Department of Pharmacy Practice, Annamacharya College of Pharmacy, Andhra Pradesh, India}~\\{\textsuperscript{2}Department of Gynaecology, Government General Hospital, Kadapa, Andhra Pradesh, India}}

\begin{abstract}
Polycystic Ovarian Disease (PCOD) is a reproductive metabolic disorder caused by hormonal imbalances within women of fertile age. Mainstay for treating patients with PCOD includes pharmacological therapy and lifestyle modifications. Lifestyle modifications that play a key role in the management of PCOD are weight management, reduction in stress, physical activity, body mass index and dietary changes. There is sparse information regarding the impact of these interventional parameters among the PCOD women in the literature. This study aims to determine the impact of healthy lifestyle modifications in the management of PCOD among young adults and adolescents. It was a prospective interventional study conducted in the Gynaecology outpatient department in Government General Hospital, Kadapa over the time of 6 months from June 2019 to November 2019. Counseling on lifestyle changes and implementation of healthy lifestyle interventions were given to the study population by using the standard questionnaire forms and post counseling changes were collected after 90 days of visit to the clinic. The statistical significance was done by using the unpaired t-test and graph pad version 8.3.0. The total sample of 30 PCOD patients was compared to before patient counseling on lifestyle modifications and after follow-up. The total population was categorized into 2 groups as adolescents (10\%) and young adults (27\%). The current study showed that there is a significant association between dietary intervention (p {\textless}0.0113) and physical activity scores (p{\textless}0.029) among the PCOD patients. In PCOD patient's healthy lifestyle modifications like dietary interventions and Physical activity serves as an effective treatment strategy adjunct to pharmacological therapy and improved the patient reproductive health.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Hormonal Disturbances,\newline Lifestyle Changes,\newline Non-Pharmacological Therapy,\newline Polycystic Ovarian Disease,\newline Reproductive Health
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Lakshmi~Narasimha~G~\\ Phone:\ -~\\  Email:\ gunturunarasimha007@gmail.com
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
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\section{Introduction}
Polycystic ovarian disease (PCOD) a multiple system metabolic disorder because of hormonal imbalances \unskip~\citep{985174:21240065}. Its epidemiology ranges from 2-7.5\% and 6.3\% in Asian countries like India, China and Sri Lanka \unskip~\citep{985174:21240067}. In most of the health care settings the classification of PCOD patients is mainly based upon the rotterdam criteria that needs existing symptoms like a) Chronic or oligo anovulation b) Presence of excess male sex hormones c) Polycystic ovaries when diagnosed on ultrasound. Aetiological features associated with the PCOD remain unclear, but evidence support genetic, environmental and lifestyle modifications are important contributors for development of PCOD \unskip~\citep{985174:21240069}. Treatment strategy for patients with PCOD is the combination of pharmacological therapy and lifestyle modifications. However, lifestyle modifications that play an important role as first line treatment options include stress reduction, dietary changes, exercise management and blood pressure \unskip~\citep{985174:21240059}. There are little shreds of evidence on the impact of lifestyle modifications like blood pressure, dietary intake, stress reduction and body mass index in PCOD patients. Many of the literature report a mutual association among healthy lifestyle and PCOD. Therefore, the key objectives of our study were to determine the impact of the lifestyle modifications like BP, dietary intake, and Physical activity in PCOD patients in tertiary care hospital settings.
    
\section{Materials and Methods}
\textbf{Study design}

It is a prospective Interventional study.

\textbf{Study period}

Present work was carried out for a period of 6 months from June 2019 to November 2019.

\textbf{Study site}

The present study was conducted at Government General Hospital, at the out-patient department Kadapa.

\textbf{Ethical approval}

Institutional ethical committee approval was obtained Prior to initiation of the study and informed consent was taken from all the subjects included in the study.

\textbf{Source of data}

Entire required data was collected from the patients through medical case sheets and lab reports.

\textbf{Sample size}

During the study period of six months, the total sample size was 30 patients.

\textbf{Inclusion criteria}

Patients with age group 12-24 years (adolescents and young girls) diagnosed with PCOD were included in the study. All the adolescents and young adult patients receiving drug therapy for PCOD on a clinical basis were included in the study.

\textbf{Exclusion criteria}

Patients who did not give consent to participate in the study were excluded. Patients above the age of 25 years were excluded from the study. Patients who had been receiving the drug therapy for more than 3 years were excluded from the study due to chances of misleading the results and errors.

\textbf{Methods of collection of data}

All the patients were given counseling and data was collected by using the following:


  
  \begin{enumerate}
  \item \relax Data on dietary intake was collected by using the self-designed diet questionnaire form
  \item \relax Data regarding physical activity was noted on the IPAQ (International Physical Activity Questionnaire) short form.
  \item \relax BP measurements were done during the baseline and follow-up after 90 days.
  \end{enumerate}
  \textbf{Statistical Analysis}

All the data of recruited subjects were entered on a Microsoft Excel spreadsheet. In order to assess the statistical significance of interventional parameters like BP, diet and physical activity, we used the graph pad version 8.3.0 and a statistical significance of p-value (p \ensuremath{\leq } 0.05) was observed to be significant.
    
\section{Results and Discussion}
In present work total sample size was 57, out of them 7 patients were excluded as they are unwilling to give their consent form. Out of 50 patients, 5 patients were adolescents and the remaining 45 patients were young adults. Among 50 patients, 30 patients were willing to participate and the rest of 20 patients were excluded as they were not willing to continue their treatment in the present study site as shown in Figure~\ref{f-7367cff69167}. In this research study, entire 30 study participants were recruited and categorized into two groups based upon age-wise categorization i.e., Group I: adolescents (12-18 yrs) and Group II: young adults (19-24).


\bgroup
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\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/adaa400e-30b3-435a-ac32-ce59b4a7ddf4-upicture-1.png}{\includegraphics{images/adaa400e-30b3-435a-ac32-ce59b4a7ddf4-upicture-1.png}}{}
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\caption{\boldmath {Recruitment of subjects for the study}}
\label{f-7367cff69167}
\end{figure}
\egroup

\begin{table*}[!htbp]
\caption{\boldmath {Categorization of percentage of age groups among PCOD patients} }
\label{tw-ba9a494c1bea}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.4441\linewidth-2\tabcolsep}p{\dimexpr.30300000000000004\linewidth-2\tabcolsep}p{\dimexpr.25290000000000003\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\textbf{Demographic details of PCOD patients} & \cAlignHack \textbf{Age categories} & \cAlignHack \textbf{No. of patients (\%)}\\
\tblmidrule 
\multicolumn{1}{p{\dimexpr(.4441\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{\cAlignHack Age groups}} &
  \cAlignHack Adolescents (12-18 years)  &
  \cAlignHack 3(10\%) \\
 &
  \cAlignHack Young adults (19-24 years)  &
  \cAlignHack 27(90\%) \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Comparison of baseline and follow-up (90 days) average blood pressure in PCOD patients} }
\label{tw-f97c58105b92}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1222\linewidth-2\tabcolsep}p{\dimexpr.1645\linewidth-2\tabcolsep}p{\dimexpr.1294\linewidth-2\tabcolsep}p{\dimexpr.1209\linewidth-2\tabcolsep}p{\dimexpr.12240000000000006\linewidth-2\tabcolsep}p{\dimexpr.12599999999999998\linewidth-2\tabcolsep}p{\dimexpr.10320000000000002\linewidth-2\tabcolsep}p{\dimexpr.11139999999999999\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}{\multirow{2}{*}{\textbf{Parameter}}} & \cAlignHack \textbf{Age } & \multicolumn{2}{p{\dimexpr(.2503\linewidth-2\tabcolsep)}}{\cAlignHack \textbf{Baseline}} & \multicolumn{2}{p{\dimexpr(.24840000000000003\linewidth-2\tabcolsep)}}{\cAlignHack \textbf{Follow up}} & \cAlignHack \textbf{P-value} & \cAlignHack \textbf{P-value }\\
\rowcolor{kwdboxcolor} & \cAlignHack \textbf{distribution} &
  \cAlignHack \textbf{Average } \mbox{}\protect\newline \textbf{systolic }\textbf{BP\ensuremath{\pm}SD }\textbf{(mm of Hg)} & \cAlignHack \textbf{Average diastolic }\textbf{BP\ensuremath{\pm}SD }\textbf{(mm of Hg)} & \cAlignHack \textbf{Average } \mbox{}\protect\newline \textbf{systolic }\textbf{BP\ensuremath{\pm}SD }\textbf{(mm of Hg)} & \cAlignHack \textbf{Average diastolic }\textbf{BP\ensuremath{\pm}SD } \textbf{(mm of Hg)} & \cAlignHack \textbf{(systolic BP)} &
  \cAlignHack \textbf{(Diastolic BP)}\\
\tblmidrule 
\multicolumn{1}{p{\dimexpr(.1222\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Blood pressure}} &
  Adolescents &
  \cAlignHack 106.67 \ensuremath{\pm} 15.27 &
  \cAlignHack 80 \ensuremath{\pm} 10 &
  \cAlignHack 113.33 \ensuremath{\pm} 11.54  &
  \cAlignHack 80 \ensuremath{\pm} 0 &
  \multicolumn{1}{p{\dimexpr(.10320000000000002\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{\cAlignHack 0.186}} &
  \multicolumn{1}{p{\dimexpr(.11139999999999999\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{\cAlignHack 0.735}}\\
 &
  Young adults &
  \cAlignHack 109.26 \ensuremath{\pm} 12.38 &
  \cAlignHack 83.33 \ensuremath{\pm} 7.33 &
  \cAlignHack 110.37 \ensuremath{\pm} 10.18 &
  \cAlignHack 81.85 \ensuremath{\pm} 4.83 &
   &
  \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
\textbf{Graphical representation of different groups based on age}

The majority of the PCOD patients in our study were young adults 27 (90\%) and adolescents were 3 (10\%) as represented in Table~\ref{tw-ba9a494c1bea}.

\textbf{Comparing the effect of Blood pressure on PCOD patients}

This was done by measuring the systolic and diastolic BP levels of the patients. Among 30 patients average systolic BP of adolescents at baseline was 106.67 mm of Hg and after followup was 113.33 mm of Hg and average diastolic at baseline and followup was same 80 mm of Hg. Young adult's average systolic BP at baseline was 109.26 mm of Hg and after followup it was 110.37 mm of Hg, the diastolic average BP at baseline was 110.3 mm of Hg and after followup 81.85 mm of Hg. There was no significance in blood pressure of systolic p-value = 0.186 and diastolic BP p-value = 0.735 as shown in Table~\ref{tw-f97c58105b92}.

\textbf{Effect of Diet in PCOD patients}

We categorized the 30 patients into 3 categories based upon the self designed questionnaire of diet chat as shown below Table~\ref{tw-6b79ca8c6d0d} and the final score was calculated by using formula,
\begin{eqnarray*}\style{font-family:'Times New Roman'}{\mathrm{Final}\;\mathrm{score}=\mathrm{Initial}\;\mathrm{score}\times100/40} \end{eqnarray*}
Among 30 patients the average DIET score of adolescents at baseline was 50.55\ensuremath{\pm}10.42 and followup was 77.35\ensuremath{\pm}13.90. The average DIET score of young adults at baseline was 55.08\ensuremath{\pm}11.0 and followup was 75.16\ensuremath{\pm}13.63. A statistically significant value (P{\textless}0.0113) was observed among the younger adults and adolescents with PCOD as shown in Table~\ref{tw-434541d1add7}.

\textbf{Effect of Physical activity in PCOD patients}

We used the standard IPAQ questionnaire short form to categorize the patients into 3 groups as a) Vigorous b) Moderate and c) Low. The IPAQ adolescents baseline average MET-score was 830 \ensuremath{\pm} 661.81 and followup average MET-score was 2382.53 \ensuremath{\pm} 287.31, IPAQ score in young adults was at baseline was 967.69 \ensuremath{\pm} 595.61 and follow-up average MET-score was 1960.10 \ensuremath{\pm} 588.43. The physical activity (IPAQ MET-SCORE) has shown significance with a p-value 0.029 as shown in Table~\ref{tw-70d73957f15a}.


\begin{table}[!htbp]
\caption{\boldmath {Diet Categorization Based on the Score} }
\label{tw-6b79ca8c6d0d}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.51870000000000005\linewidth-2\tabcolsep}p{\dimexpr.48129999999999995\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\multicolumn{2}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{\cAlignHack \textbf{Diet}}\\
\rowcolor{kwdboxcolor}\cAlignHack \textbf{Category} & \cAlignHack \textbf{Score}\\
\tblmidrule 
\cAlignHack Inappropriate  &
  \cAlignHack 0-33 \\
\cAlignHack Quite Appropriate  &
  \cAlignHack 34-66 \\
\cAlignHack Appropriate  &
  \cAlignHack 67-100 \\
\tblbottomrule 
\end{tabulary}\par 
\end{table}
\textbf{Impact of healthy lifestyle interventions on menstrual condition}

Among 30 patients the adolescent's menstrual condition who were with amenorrhea (3.33\%) and oligomenorrhea (6.667\%) are normalized at follow up (10\%) when compared with baseline. The menstrual condition of young adults who are with amenorrhea (10\%), oligomenorrhea (33.33\%), Dysmenorrhoea (3.33) and irregular menses (3.33) at baseline. Most of them are identified normal menstrual status (73.33) and few are oligomenorrhea (16.66) at follow up as presented in Table~\ref{tw-a13757c73b6f}. In the present study overall effect of lifestyle modifications had an improvement in menstrual or reproductive health of


\begin{table*}[!htbp]
\caption{\boldmath {Comparison of percentage of baseline and follow-up (90days) diet score in PCOD patients} }
\label{tw-434541d1add7}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.17680000000000003\linewidth-2\tabcolsep}p{\dimexpr.1933\linewidth-2\tabcolsep}p{\dimexpr.2299\linewidth-2\tabcolsep}p{\dimexpr.22490000000000002\linewidth-2\tabcolsep}p{\dimexpr.17509999999999998\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack \textbf{Intervention} & \cAlignHack \textbf{Age groups} & \cAlignHack \textbf{Baseline} & \cAlignHack \textbf{Follow-up} & \cAlignHack \textbf{p-value}\\
\rowcolor{kwdboxcolor}\cAlignHack  &
  \cAlignHack  &
  \cAlignHack \textbf{Average diet score \ensuremath{\pm} SD} & \cAlignHack \textbf{Average diet score \ensuremath{\pm} SD} & \\
\tblmidrule 
\multicolumn{1}{p{\dimexpr(.17680000000000003\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{\cAlignHack Diet}} &
  \cAlignHack Adolescents &
  \cAlignHack 50.55 \ensuremath{\pm} 10.42 &
  \cAlignHack 77.35 \ensuremath{\pm} 13.90 &
  \cAlignHack 0.0113\\
 &
  \cAlignHack Young adults &
  \cAlignHack 55.08 \ensuremath{\pm} 11.0 &
  \cAlignHack 75.16 \ensuremath{\pm} 13.63 &
  \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Comparing baseline with follow-up IPAQ scores} }
\label{tw-70d73957f15a}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1767\linewidth-2\tabcolsep}p{\dimexpr.1834\linewidth-2\tabcolsep}p{\dimexpr.2399\linewidth-2\tabcolsep}p{\dimexpr.2432\linewidth-2\tabcolsep}p{\dimexpr.1568\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack \textbf{Intervention} & \cAlignHack \textbf{Age groups} & \cAlignHack \textbf{Baseline} & \cAlignHack \textbf{Follow-up} & \cAlignHack \textbf{P-value}\\
\rowcolor{kwdboxcolor}\cAlignHack  & \cAlignHack  & \cAlignHack \textbf{Average IPAQ score \ensuremath{\pm} SD} & \cAlignHack \textbf{Average IPAQ score \ensuremath{\pm} SD} & \cAlignHack \\
\tblmidrule 
\multicolumn{1}{p{\dimexpr(.1767\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{\cAlignHack IPAQ}} &
  \cAlignHack Adolescents &
  \cAlignHack 830 \ensuremath{\pm} 661.81 &
  \cAlignHack 2382.53 \ensuremath{\pm} 287.31 &
  \cAlignHack 0.029\\
 &
  \cAlignHack Young adults &
  \cAlignHack 967.69 \ensuremath{\pm} 595.61 &
  \cAlignHack 1960.10 \ensuremath{\pm} 588.43 &
  \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Categorization of PCOD subjects based on menstrual condition} }
\label{tw-a13757c73b6f}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1385\linewidth-2\tabcolsep}p{\dimexpr.15339999999999998\linewidth-2\tabcolsep}p{\dimexpr.27479999999999997\linewidth-2\tabcolsep}p{\dimexpr.2101\linewidth-2\tabcolsep}p{\dimexpr.22319999999999997\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\textbf{Parameter} & \textbf{Age group} & \textbf{Categorization based on} \mbox{}\protect\newline \textbf{menstrual condition} & \cAlignHack \textbf{No of patients in baseline (\%)} & \cAlignHack \textbf{No of patients in follow-up (\%)}\\
\tblmidrule 
\multicolumn{1}{p{\dimexpr(.1385\linewidth-2\tabcolsep)}}{\multirow{12}{\linewidth}{Menstrual condition}} &
  \multicolumn{1}{p{\dimexpr(.15339999999999998\linewidth-2\tabcolsep)}}{\multirow{6}{\linewidth}{Adolescents}} &
  Amenorrhea  &
  \cAlignHack 1(3.33\%) &
  \cAlignHack 0\\
 &
   &
  Oligomenorrhea  &
  \cAlignHack 2(6.67\%) &
  \cAlignHack 0\\
 &
   &
  Dysmenorrhea  &
  \cAlignHack 0 &
  \cAlignHack 0\\
 &
   &
  Irregular menses  &
  \cAlignHack 0 &
  \cAlignHack 0\\
 &
   &
  Regular  &
  \cAlignHack 0 &
  \cAlignHack 3(10\%)\\
 &
   &
  Polyamennorhea &
  \cAlignHack 0 &
  \cAlignHack 0\\
 &
  \multicolumn{1}{p{\dimexpr(.15339999999999998\linewidth-2\tabcolsep)}}{\multirow{6}{\linewidth}{Young adults}} &
  Amenorrhea  &
  \cAlignHack 3(10) &
  \cAlignHack 0\\
 &
   &
  Oligomenorrhea  &
  \cAlignHack 10(33.33\%) &
  \cAlignHack 5(16.67\%)\\
 &
   &
  Dysmenorrhea  &
  \cAlignHack 1(3.33\%) &
  \cAlignHack 0\\
 &
   &
  Irregular menses  &
  \cAlignHack 1(3.33\%) &
  \cAlignHack 0\\
 &
   &
  Regular  &
  \cAlignHack 11(36.67\%) &
  \cAlignHack 22(73.33\%)\\
 &
   &
  Polyamennorhea  &
  \cAlignHack 1(3.33\%) &
  \cAlignHack 0\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
the PCOD patients. This is clearly explained by the follow-up results of menstrual conditions as represented in Table~\ref{tw-a13757c73b6f} where most of the menstrual where most of the menstrual irregularities in the PCOD females at baseline are normalized after the post counseling and implementation of the lifestyle modifications. This was similar to work done by \unskip~\citeauthor{985174:21240060} which concluded that diet and exercise interventions can improve the hormonal levels in PCOD patients \unskip~\citep{985174:21240060} and also \unskip~\citeauthor{985174:21240064} study which concluded that weight reduction plays a significant role in reduction of PCOD \unskip~\citep{985174:21240064}.

Another study by \unskip~\citeauthor{985174:21240061} also concluded that lifestyle modifications can improve that hormonal status that is exactly proved by our study \unskip~\citep{985174:21240061}. In our study most of the patients having PCOD were observed in the age group of young adults (19-24 years) is 90\%. This may be due to the high burden 

of PCOD among young adults, especially in rural areas. Also a majority of the PCOS patients with lifestyle modifications has shown significant improvement in menstrual condition among adolescents and young adults of PCOD patients to regular in post-intervention, and clinically resemble to \unskip~\citeauthor{985174:21240062}, shown the effective results in 56.4\% of studies population were having regular menstrual cycles after a year following of healthy life style compared to baseline \unskip~\citep{985174:21240063}.

This study inferred that there was a clear significance of intervention on IPAQ MET physical activity rate and dietary lifestyle which has shown to a greater extent on the menstrual condition from baseline to follow-up through the contribution of a clinical pharmacist, that is similar to \unskip~\citeauthor{985174:21240066}, as suitable diet is a contributing factor for restoring hormonal imbalances to normal \unskip~\citep{985174:21240062,985174:21240066}. In many literature is a conflict on evidence regarding the role of androgen whether they can increase hypertension in the PCOD Patients. However, our study concluded that there is no significant relationship between the impacts of blood pressure on PCOD patients.

This contrasts with the findings of \unskip~\citeauthor{985174:21240068} that concluded that there is a significant association among the androgen and blood pressure in PCOD patients \unskip~\citep{985174:21240068}. Nowadays, amending healthy lifestyle by dietary changes and increase in physical activity focus to maintain androgen hormone limits and set ovulation is considered as the first line therapy.

\textbf{Limitations}

This includes small sample size, duration of the study, and follow-up of the subjects.
    
\section{Conclusions}
Our study concluded that blood pressure does not show any impact on PCOD patients also lifestyle modifications like an increase in physical activity and intake of a balanced diet had improved menstrual conditions of PCOD patients. Regardless of pharmacological therapy, all the patients need to improve the physical activity and take an appropriate diet that is less in carbohydrates to maintain good reproductive health. Special care and education is needed among PCOD patients to reduce the long term complications. Onus is on the health care professionals to educate patients regarding lifestyle modifications and complications of PCOD to improve the health community status.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.

\textbf{Conflict of Interest}

The authors declare that they have no conflict of interest for this study.
    

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