THE FEMALE ATHLETE TRIAD: A SERIOUS PROBLEM NEEDING CAREFUL ATTENTION

Key Points:

  • The “female athlete triad” is a combination of eating disorder, lack of menstrual cycle, and low bone density
  • This is a complex medical issue requiring care from a number of medical professionals
  • If not treated, the female athlete triad can be a career ender as well as have lifetime consequences

There’s an excellent article about American teenage runner Mary Cain in yesterday’s New York Times. Ms. Cain is a teenager but she’s a professional athlete who trains at AlbertosideacheSalazar’s Oregon running facility. Ms. Cain has an entire team of professionals including nutritionists and physical therapists who are tasked with keeping her healthy. The story is also illuminating in pointing out that many female athletes are not so fortunate, indeed Mary Decker likely had her career cut short by something we now know as “the female athlete triad”. This is a very serious condition that can be career threatening and in extreme forms it can also be life threatening.

Female athletes who focus on being thin or lightweight may eat too little or exercise too much. Three interrelated illnesses may develop when a girl or young woman goes to extremes in dieting or exercise. Together, these problems are known as the “female athlete triad.”

The three problems are:

  • Eating disorder

Abnormal eating habits (i.e., crash diets, binge eating) or excessive exercise can lead to poor nutrition.

  • Menstrual dysfunction

Poor nutrition, low calorie intake, high-energy demands, physical and emotional stress, or low percentage of body fat can lead to hormonal changes that stop menstrual periods.

  • Premature osteoporosis (low bone density for age)

Lack of periods disrupts the body’s bone-building processes and weakens the skeleton, making bones more likely to break.

Females in any sport can develop one or more parts of the triad but the greatest risk are those in sports that reward being thin for appearance (such as figure skating or gymnastics) or improved performance (such as distance running).

Psychologists recommend that female athletes should consider these questions:

  • Are you dissatisfied with your body?
  • Do you strive to be thin?
  • Do you continuously focus on your weight?

If the answers are yes, you may be at risk for developing abnormal eating patterns, and that in turn can place you at risk for the female athlete triad.

Disordered Eating

Eating disorders often start with an excessive preoccupation with body shape and weight, specifically, the intense desire to stay as light and thin as possible.

Females are five to 10 times more likely to have disordered eating compared with males, and the problem is especially common in females who are athletic. Some people starve themselves (anorexia nervosa) or engage in cycles of overeating and purging (bulimia).

Others severely restrict the amount of food they eat, fast for prolonged periods of time or misuse diet pills. People with disordered eating may also exercise excessively to keep their weight down.

Disordered eating can cause many problems, including dehydration, muscle fatigue and weakness, an erratic heartbeat, kidney damage, and other serious conditions. Not taking in enough calcium can lead to bone loss. Hormone imbalances can lead to more bone loss through menstrual dysfunction.

Menstrual Dysfunction

Missing your period is a significant cause for concern. With normal menstruation, the body produces estrogen, a hormone that helps to keep bones strong. Without a menstrual cycle the level of estrogen may be lowered, causing a loss of bone density and strength (premature osteoporosis).

If this happens during your teenage years, it may become a serious problem later in life when the natural process of bone mineral loss begins after menopause. Amenorrhea may also lead to stress fractures.

Premature Osteoporosis (Low Bone Density for Age)

Bone mass and bone quality decrease, making your skeleton fragile. Low bone mass puts you at increased risk for fractures.

See your Primary Care Doctor immediately

Recognizing the female athlete triad is the first step toward treating it. See your primary care doctor right away if you miss a menstrual period, get a stress fracture in sports, or think you might have disordered eating.

Your doctor will perform a complete physical examination and may use laboratory tests to check for pregnancy, thyroid disease, and other medical conditions. In some cases, a bone density test will be recommended.

Treatment for the female athlete triad can be successful but takes quite a bit of time and effort. This is one condition that is extremely important to get right, the consequences extend far beyond sports.

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

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