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The Menstrual Cycle and Nutritional Status

  • The reproductive cycle in women is complex and can be considered to begin with epigenetic programming and end with menopause.
  • Intervening steps involve a variety of processes, including the cellular development of the sex organs, menarche, episodic endocrine cycles, menstruation, ovulation, and conception. These processes can be influenced by diet and nutrition and vice versa.
  • Body composition has an impact on the menstrual cycle and preconception and these factors in turn also influence body composition.
  • Similarly, either food deprivation, dietary excess, or obesity can result in marked changes in the menstrual cycle with a concomitant effect on fertility.
  • This handbook is the first scientific source that provides a comprehensive overview of the relationship of diet and nutrition with puberty, menarche and menstrual cycle, conception and fertility, and infertility.
  • Women’s reproductive health life is influenced by several factors that have the potential to lead to nutritional status.
  • Each woman experiences menstruation 400 times in her fertility age.
  • It is such that one-seventh of a woman’s life is accompanied with menstruation.  Menstruation usually starts between theages of 10-16 years depending on various factors including women’s health, nutritional consumption, and nutritional status.
  • Menstruation should have a regular cycle. The menstrual cycle is the distance between the start of the last menstruation and the start of the next menstruation.
  • Menstrual cycles in women normally range between 21-32 days and only 10-15% have a 28-day cycle with long menstruation of 3-5 days or 7-8 days.

The menstrual cycle is regarded as a physiological phenomenon that results from the precise coordination of events that occur in the hypothalamus, the anterior pituitary gland, and the female reproductive system. This dynamic interaction allows the reproductive process to proceed in the form of a cycle[6]. The menstrual cycle is influenced by several factors including age, physical status, physical activity, nutritional status, hormones, and the environment. Hormonal influences associated with the menstrual cycle influence appetite control and eating behavior. So far it has been known that women with poor nutritional status have a risk of menstrual cycle disorders. However,
menstrual cycle disorders are also found in obese women. A woman who is experiencing malnutrition or excess nutrition will have an impact on the decline in hypothalamic function so there will be an increase in the frequency of menstrual cycle disorders. 
Menstrual disorders can be in the form of prolonged disorders and menstrual blood counts, menstrual cycle disorders, bleeding disorders outside the menstrual cycle, and
other disorders related to menstruation. Long periods normally occur between 4-8 days. If menstruation occurs less than 4 days it is said to be hypomenorrhea and if more
than 8 days it is said to be hypermenorrhea. Women usually have a menstrual cycle between 21-35 days. Called polymenorrhea. if the menstrual cycle is less than 21 days
and oligomenorrhea if the menstrual cycle is more than 35 days. Non-menstrual bleeding is bleeding that occurs in the period between 2 menstruations. Women who experience menstrual cycles for more than 90 days are said to have amenorrhea. Inadequate nutritional intake causes menstrual irregularities in most young women. In over nutritional status (overweight and obesity) usually experience chronic anovulatory or chronic irregular menstruation. Because it tends to have excess fat cells, it
produces excess estrogen. Whereas underweight there will be underweight and do not have enough fat cells to produce estrogen needed for ovulation and menstruation, resulting in irregular menstrual cycles. Poor nutritional intake will affect the growth of bodily functions, will cause disruption of reproductive function, and will have an impact on menstrual cycle disorders. A normal menstrual cycle depends on the actions and interactions of the hormones released from the hypothalamus-pituitary-ovary and their effects on the endometrium. Shortening of the menstrual cycle that causes shorter menstrual cycles (polymenorrhea) is associated with decreased fertility and miscarriage while prolonged menstrual cycles (oligomenorrhea) are associated with events of anovulation, fertilization, and miscarriage. With events of anovulation, fertilization, and miscarriage. The impact of menstrual cycle disorders are not treated will result in the body losing too much blood, causing anemia. Menstrual cycle differences are caused by several factors, including nutritional status, food intake, age, physical activity, reproductive diseases, the influence of smoking, and stress. Research conducted on Turkish teenage girls found 31.2% experienced irregular menstrual patterns.

Nutritional status is a measure of a person’s body condition that can be seen from the food consumed and the use of nutrients in the body. Nearly 50% of teenagers don’t
eat breakfast every morning. Other studies prove there are still many teenagers (89%) who believe that breakfast is important. But those who eat breakfast regularly are only 60%. [11]. Nutritional needs are closely related to the growth period, if nutrient intake is fulfilled then growth will be optimal. Nutritional needs that must be met come from carbohydrates, fats, and proteins. Inadequate nutritional intake can lead to insufficient intake of nutrients which can affect menstrual irregularities in most adolescents Carbohydrate intake is related to calories during the luteal phase, protein intake is related to follicular phase length while the fat intake is related to reproductive hormones.

Nutritional status is the state of the body due to food consumption and nutritional use. So far, it has been known that women with poor nutritional status or more are at risk of
menstrual cycle disorders. Research conducted at PSIK FKUNSRAT Manado showed respondents with underweight nutritional status experienced irregular menstruation as much as 66.7% while the nutritional status of irregular menstrual fat was as much as 81.8%.

A preliminary study conducted by researchers on October 15th, 2019 of 10 midwifery students with interviews obtained from 6 students said that the nutritional
status was normal, 3 students were fat nutritional status and 1 student was underweight nutritional status. Of 6 students who had normal nutrition 4 people with normal
menstrual cycles and 2 people with abnormal menstrual cycles. 3 students with fat nutritional status and 2 students with abnormal menstrual cycles and 1 student with normal menstrual cycles. 1 student who had an underweight nutritional status experienced an abnormal menstrual cycle. 

C. The Correlation between Nutritional Status and Menstrual Cycle

 The results of the study indicate that the menstrual cycle with nutritional status, it can be seen that from 30 respondents studied 25 respondents were normal menstrual
cycles and thin nutritional status of 3 people (10.0%), moderate fat in as many as 6 people (20.0%), and normal in as many as 16 people (83.3%) while 5 respondents, abnormal
menstrual cycles and thin nutritional status of 0 people (0%), obese 1 person (3.33%), and normal 4 people (16.7%).
After cross-tabulation, an analysis is carried out to obtain a p-value of 0.674 <0.05, so that Ho is accepted and Ha is rejected. So, there is no correlation between
nutritional status with the menstrual cycle. The results of this study are not in line with research conducted by Noviandari (2016). There is a correlation between
nutritional status and the menstrual cycle in young women.

According to the results of the study, Sheetal et al. (2015)
show that adolescent girls who are overweight and obese
have irregular menstrual cycles called oligomenorrhea[19].
This condition is in line with Proverawati’s opinion and
Asfuah’s (2009) that excess nutritional status such as fat and
obesity will have an impact on the function of the body’s
hormonal system, given that fat can produce estrogen
which disrupts the menstrual cycle. Forms of
menstrual disorders vary. The nutritional status will affect
the function of hormonal work, in the .form of an increase,
balance, or decrease. The nutritional status itself is influenced by
many factors, in general, an unbalanced diet. Changes in
nutritional status can have an impact on changes in
reproductive hormonal cycles that are directly related to
excess body fat, obesity in the abdomen, and disorders of
ovulation and hyperandrogenism. The hypothesis from
scientists that the appearance of menstruation is influenced
by body fat is associated with total body weight. The
menstrual function is very dependent on the percentage of
body fat. The percentage needed to maintain regular
menstruation is around 22%  Conclusion: Nutritional
status is not the dominant factor influencing the menstrual
cycle in midwifery students of the Muhammadiyah University
of Kudus but other factors influence such as
stress and physical activity.

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