Understanding The Female Athlete Triad

Over the past three decades, the number of girls and women participating in organized athletic activity has skyrocketed. Increased participation has enabled girls and women of all ages to reap the benefits of physical activity, and, indeed, many have become highly elite athletes and competitors.

However, this increased participation has created a new set of problems and medical issues, one of which is the female athlete triad.

The female athlete triad is a syndrome consisting of disordered eating, lack of menstrual periods (amenorrhea), and low bone density (osteoporosis). The components of the triad are intricately interrelated.

Athletes often experience a variety of abnormal eating occurrences that range from restriction of food intake or avoidance of certain foods, to such full-fledged eating disorders as anorexia and bulimia.

Disordered eating behaviors can cause both short-term and long-term health consequences, including decreased performance, menstrual dysfunction, and even death.

Menstrual dysfunction can range from missed and irregular periods (oligomenorrhea) to lack of menses (amenorrhea). Intense stress on the body and under-nutrition cause the hypothalamus (the area of the brain that produces essential hormones) to function poorly, resulting in low ovarian hormone production. This imbalance then causes menstrual cycles to occur irregularly or not at all.

Osteoporosis is a disease state characterized by low bone mass and deterioration of
bone leading to skeletal fragility and increased risk of fractures. At the very time young women should be developing peak bone mass, those with disordered eating and lack of regular periods are at high risk of losing bone mass and consequently suffering from stress fractures and long-term skeletal problems.

While any female athlete can be susceptible to developing the triad, those at greatest risk include individuals who compete in sports at elite levels, those in sports with subjective judging (for example, diving, figure skating, gymnastics), competitors in sports with weight classification (such as rowing, weight lifting, and bodybuilding), and those in sports in which a lean physique is beneficial (such as running, swimming, ballet).

Warning signs that signal an athlete may be at risk include menstrual irregularities,
anemia, history of stress fractures, weight gain or loss of at least 10 pounds in the past year, and low intake of calcium, fat, or calories. Coaches, peers, parents, teachers and friends should all remain vigilant for signs of the female athlete triad. If a female shows symptoms of one component, she should be screened for the other two.

Treatment involves a multidisciplinary team approach involving physicians, coaches, nutritionists, and mental health professionals. The athlete should receive a
nutritional evaluation and counseling, psychological treatment, calcium and vitamin D supplementation, and hormone replacement therapy, if indicated. If the disorder is caught in its early stages, many or all of its devastating consequences can be avoided.

About the author:

Mary Parks Lamb, M.D.
Medical Director, Urgent Care Center affiliated with The Washington
Hospital
Medical Director, Lakeside Primary Care (opening Summer 2011)
724.969.4321
theurgentcarecenter.org
lakesideprimarycare.net