Abnormal Menstrual Period of Hockey Athlete: Association with

Body Fat Percentage and Dietary Fat Intake

Syifa Khaerunnisa

, Debby Endayani Safitri

and Leni Sri Rahayu

Study programme of nutrition: Faculty of health science, Muhammadiyah Prof. Dr. HAMKA University, South Jakarta,

Indonesia

Keywords: Abnormal Menstrual Period, Body Fat Percentage, Fat Intake, Hockey Athlete

Abstract: Most women athletes have an abnormal menstrual period due to decreasing estrogen and progesterone. This

study aimed to analyze the association between body fat percentage and fat intake in a hockey athlete. This

was a cross-sectional study with purposive sampling. This study was conducted in East Jakarta region in July

2018. The analysis involved 40 participants of Hockey Women Athlete. Body fat percentage was measured

using skinfold caliper, while dietary fat intake was estimated using 24 hours recall. Most participants had

oligomenorrhea (62,5%), body fat percentage less than 22% (70,0%), and low dietary fat intake (57,5%).

Body fat percentage was significantly associated (p<0,05) with abnormal menstrual period but dietary fat

intake was not associated (p>0,05) with an abnormal menstrual period of Hokey Women athlete.

1 INTRODUCTION

An abnormal menstrual period is a disruption during

menstruation which consists of bleeding patterns,

abnormalities in the amount of blood release, and

duration of bleeding (Kusmiran, 2012). Abnormal

menstrual period; such as polymenorrhea,

oligomenorrhea, and amenorrhea; are often

experienced by athletes. Female athletes are included

in risk group for menstrual disorders, that is around

50%. There was an association between weekly

running distance and the prevalence of amenorrhea,

nearly 28% of 40-mile runners per week compared to

amenorrhea, and at 80 miles of runners a week

compared to amenorrhea by 45%; whereas ordinary

women who experience amenorrhea are only about

2%(Bean A, & Wellington, 2010).

Low body fat is related to menstrual cycle

disorders(Khans dan Burkner, 2009). Dr. Frisch,

Harvard University, said that women who

experienced a weight loss of 12-15% had a greater

chance of experiencing a break in the menstrual cycle.

Intake of energy and macronutrients, such as

carbohydrates, fats, and proteins related to the

composition of body fat. Also, these macronutrients

also affect energy use for athletes. Hockey is a sports

game that uses aerobic and anaerobic metabolism.

The most important nutritional role in hockey is fat

(Kemenkes, 2014).

The risk of soft tissue injury and stress fractures

has happened commonly in athletes who experience

a short menstrual cycle. Besides, infertility, early

atherosclerosis, osteoporosis, and cancer of the

reproductive organ can also occur (Mellion, Morris

B., 2009). Estrogen loss is occurring in women who

have an excessive activity or excessive exercise.

Estrogen hormones will decrease after regular

exercise (Wiarto, 2013). All sex hormones are

steroids that are converted from precursor molecules

through cholesterol to their final form. Cholesterol is

a steroid precursor stored in large quantities in theca

cells. Follicle maturation is regulated by GnRH.

Khaerunnisa, S., Saﬁtri, D. and Rahayu, L.

Abnormal Menstrual Period of Hockey Athlete : Association with Body Fat Percentage and Dietary Fat Intake.

DOI: 10.5220/0008380700610065

In Proceedings of the 1st International Conference on Social Deter minants of Health (ICSDH 2018), pages 61-65

ISBN: 978-989-758-362-9

Thus, low fat in the body can interfere with GnRH

secretion in female athletes and interfere with GnRH

secretion that causing the menstrual irregularities

athletes (Paath, Rumdasih, & Heryati, 2005).

2 SUBJECTS AND METHODS

This research belongs to quantitative research

with a cross-sectional research design. The

population in this research includes 45 female hockey

athletes. The inclusion criteria for the sample of this

research willing to be a subject in the research, aged

19-25 years, are not married. Whereas the exclusion

criteria include smoking, using hormonal medicine or

long-term therapeutic medicines, extremely losing

weight (it's 2kg / week), menarche age> 16 years, and

vegetarian. This research employs purposive

sampling and selected 40 samples that fulfill the

inclusion and exclusion criteria.

The primary data were collected in 2x24 hours

through food recall interviews, filling out

questionnaires related to the menstrual cycle, and

measuring body fat using skinfold in female athletes

in Jakarta State University hockey associations and

Hockey at Indonesian College of Economics. The

results of body fat data percentage obtained by

measurements using skinfold caliper on the triceps,

biceps, subscapular, and suprailiac sections were then

calculated using the Lohman formula. Furthermore, it

is categorized into two. First was Risk, if percent

body fat ≤22%, and second is not at risk, if body fat

percent> 22%(Stokic & Scrdic, 2014). Meanwhile,

the results of the intake data were calculated using the

Indonesian Food Composition Table. Furthermore, it

is categorized into two: Less (if fat intake is <60%

compared to total energy requirements) and Normal

(if fat intake is 90%-110% compared to total energy

requirements). The results of the menstrual cycle data

were obtained through the date of the first day of the

last menstrual cycle and the date of the first day of the

last two menstrual cycles. Then, the distance between

menstrual cycles was calculated and categorized into

two: the duration of the menstrual cycle disorder (if

polymenorrhea (menstrual cycle <21 days),

Oligomenorrhea (menstrual cycle>35 days) and

Normal (menstrual cycle 21-35 days) (Kusmiran,

2012).

Bivariate analysis of data was done and the chi-

squared test of significance was done where

appropriate. Logistic regression analysis was

performed to investigate factors associated with

menstrual disorders.

3 RESULTS

The research found that some subjects were

included in the category of body fat risk percentage

(70.0%) with the average body fat percentage of was

20.40%, and the body fat percentage of subjects was

between 5.62% and 47.33%. Also, some of the

subjects’ fat intakes are included in the category of

less fat intake (57.5%) and 62.5% of subjects

experienced menstrual cycle disorders, that was

oligomenorrhea (Table 1).

Table 1: Body fat, fat intake, and abnormal menstrual

period.

Variable

Body Fat

At Risk

Not at Risk

70.0

30.0

Fat Intake

Less

Normal

57.5

42.5

Abnormal Menstrual Period

Polymenorrhea

Oligomenorrhea

Normal

2.5

62.5

35.0

Table 2 shows that menstrual cycle disorders

occur more in subjects who have body fat risk

percentage 78.6% compared to subjects who have

body fat percentage of not being at risk (33.3%). This

shows that there is a tendency for body fat percentage

to be at risk with menstrual cycle disorders. The lower

the percentage of body fat, the more the subject is at

risk of experiencing menstrual cycle disorders. The

results of the statistical tests performed showed a p-

value of 0.011. It means that there was a relation

between body fat percentage and menstrual cycle

disorders. Subjects who experienced menstrual cycle

disorders 2,357 times were more at risk compared to

those who were not at risk. This research is in

accordance with the research conducted by

Wahyuningsih (2014), mentioning that body fat

percentage is associated with abnormal menstrual

period, in which 66.7% of athletes have less body fat

percentage and experience abnormal menstrual

period.

Abnormal menstrual period occurs more in

subjects with less fat intake (69.6%) compared to

subjects with normal fat intake (58.5%). It shows that

there was a tendency for less fat intake with menstrual

cycle disorders. The less fat intake, the more the

subject is at risk of menstrual cycle disorders. There

was no relation between fat intake and cycle

disturbances (p>0.05). This happens because not only

ICSDH 2018 - International Conference on Social Determinants of Health

fat intake, but also energy, carbohydrate, and protein

intake can affect the composition of body fat, which

will result in menstrual cycle disruption.

Table 2: Associations of Body Fat and Fat Intake with

Menstrual Period.

Variables

Menstrual Period

p-value

Abnormal

Normal

n (%)

Body Fat

At Risk

22 (78,6)

6 (28,4)

2,36

0,011

Not at

Risk

4 (33,3)

8 (66,7)

Fat Intake

Less

16 (69,6)

7 (30,4)

1,18

0,481

Normal

10 (58,8)

7 (41,2)

Fisher Exact

4 DISCUSSION

A person's body fat level is mostly related to the

level of activity and food intake, one of which is

energy intake (Wiarto, 2013). Energy is the result of

the metabolism of carbohydrates, proteins, and fats

contained in foods that a person takes. Energy

functions as energy for metabolism, growth,

temperature regulation, and physical activity. Thus,

energy intake that exceeds the needs will be stored as

energy reserves in the form of body fat (Thompson,

D., Karpe, F., Lafontan, M., Frayn, 2012)

In sports activities, such as hockey, which is

carried out with high intensity and requires fast power

such as when running to catch a ball. When hitting the

ball hard, the body's energy metabolism will run

anaerobically through energy sources obtained from

PCr and glycogen deposits. Whereas, when doing low

intensity, the energy source is obtained from

carbohydrate, fat and protein deposits. Then when

exercising, body energy savings, carbohydrate

deposits (blood glucose, muscle, and liver glycogen)

and fat deposits in the form of triglycerides will

contribute to the rate of energy production aerobically

in the body. Among the three deposits of nutrients

that become the main energy source when exercising

are carbohydrates and fats (Kemenkes, 2014).

In athletes, there are several metabolic and

morphological changes if the exercise is carried out

for several days or weeks. Metabolic changes that

occur depend on the type of exercise with the use of

aerobic or anaerobic energy system (Wilmore, Jack

H. Costill, 2008). Then, in athletes, there will be a

maximum burning of calories and fat. Although the

athlete's intake is high, burning in her body will also

remain high and will lessen the body fat percentage.

In this research, it was found that the food intake of

respondents had not reached optimal or less. The lack

of food intake with high exercise intensity and

metabolic adaptation will result in high-fat burning,

causing no fat deposits in the body, causing the body

fat percentage of respondents to be low.

The minimum body fat percentage needed to

achieve menarche is 17% (Stokic & Scrdic,

2014)while the minimum body fat percentage

required to maintain menstrual cycle regularity is

22%. In this study, it was found that 70% of subjects

had a risk of body fat percent, which is <22% with an

average body fat percentage of 20.40% and the body

fat percentage of subjects is between 5.62% and

47.33%. This indicates that most of the subjects’ body

fat is below 22% which can be at risk of experiencing

menstrual cycle disorders. Thus, female athletes

should pay more attention to optimal intake and

composition of body fat so that they are not at risk of

suffering abnormal menstrual period and have long-

term effects, such as infertility, cancer of reproductive

organs and other problems (Mellion, Morris B.,

2009).

Body fat is one of the factors that play an

important role in maintaining the regularity of the

menstrual cycle. Fat tissue in the body is needed to

synthesize female reproductive hormones. All sex

hormones are steroids that are converted from

precursor molecules through cholesterol to their final

form. Cholesterol as a precursor steroid is stored in

large quantities in theca cells. Follicle maturation is

regulated by GnRH. Thus, low fat in the body can

interfere with GnRH secretion in female athletes and

then interfere with GnRH secretion, causing athletes

to experience menstrual irregularities (Paath et al.,

2005).

In this research, it was found that 69.6% of

subjects had less fat intake. This can be because when

the data were collected, some respondents claimed to

be on a diet by limiting their food intake to reduce

weight for excellent performance during a match.

Besides, most respondents said they were

experiencing stress so that their appetite was reduced.

The diet of female hockey athletes is still not

appropriate, such as eating only twice a day.

Also, some respondents did not eat breakfast and

practiced hockey for 4 hours. Some athletes pay little

attention to what foods are consumed, such as

frequent consumption of instant noodles, and other

snacks. However, some other respondents ate food

with more carbohydrates and vegetables than protein

Abnormal Menstrual Period of Hockey Athlete : Association with Body Fat Percentage and Dietary Fat Intake

and others. It can cause less fat intake. Meanwhile,

Wahyuningsih (2013) stated that eating patterns for

an athlete can be fulfilled in three meals (morning,

afternoon and night) and by paying attention to the

addition of certain types of food to provide energy

during training and matches. Thus, hockey athletes in

the research have not paid attention to the quality of

food that must be chosen. Besides, they did not

consider the fat intake needs. In fact, fat is also

beneficial for athletes who need long-running

activities, such as hockey.

Intake of nutrients consumed by athletes will

produce energy and fat which are useful as building

materials and regulators in the body. This nutrient is

needed by athletes in fulfilling daily nutritional needs

that will be used in carrying out daily tasks, exercises,

and physical activities that will support athletic

physical fitness (Maulana & Sulistyarto, 2016).

Fat intake related to the menstrual cycle is equal

to a percentage of body fat, but the latter is the most

influential. It happens because the percentage of body

fat is fat deposits in the long term, while fat intake can

change. If the energy savings are too much, it will be

stored in the form of fat in the body. Food

consumption affects the percentage of body fat. Also,

the excess energy from food fat intake is easily stored

as body fat compared to excess energy from

carbohydrates (Heriyanto, 2012). Also, to convert

excess carbohydrates into body fat, it takes 23% of

the calories digested. Meanwhile, to turn excess fat

into body fat, only 3% of calories are ingested. It is

consistent with the research conducted in

Switzerland, in that of the 2000 calorie carbohydrates

consumed by one group, only 40 calories from excess

carbohydrates are converted into body fat. This is

because the body is more efficient at converting fat

into body fat, compared to turning carbohydrates into

body fat (Clark, 1996).

Fat is undoubtedly influential at the level of

secretion and balance of reproductive hormones that

regulate menstruation in the body because adipose

tissue is significant in forming, converting, and

storing reproductive hormones in regulating the

menstrual cycle. Low levels of body fat can result in

low estrogen levels associated with infertility.

Meanwhile, the amount of increased body fat will

increase the amount of estrogen in the blood so that

the menstrual cycle becomes longer. Excess body fat

can also cause blood vessel hyperplasia which is the

pressure of blood vessels by fat tissue. If this happens

to the female reproductive organs, the blood that

should flow during the menstrual process is disrupted,

resulting in longer menstruation and irregular

menstrual cycles (Rakhmawati A and Dieny FF.,

2013).

5. CONCLUSION

The majority of female hockey athletes in East

Jakarta are at risk of body fat and less fat intake. There

is a relation between body fat percentage and

menstrual cycle disorders of female hockey athletes

in East Jakarta region. There was no relation between

fat intake and menstrual cycle disruption of female

hockey athletes in East Jakarta.

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Abnormal Menstrual Period of Hockey Athlete : Association with Body Fat Percentage and Dietary Fat Intake