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The Female Athlete Triad
The Female Athlete Triad is an important issue for females participating in sports. This disorder can occur at any age or skill level if the pressure or desire to excel in athletics leads an athlete to attempt to lose weight through dietary restrictions or other inappropriate methods.

In 1972, Congress passed Title IX which prohibited sex discrimination in federally funded institutions. The implications of this law were that females should have the same opportunities as males to participate in sports.

In 1998, 2.4 million girls were playing high school sports, up 80% since Title IX was passed.

Regular exercise has many positive effects. Females who exercise 4 hours a week reduce their risk of breast cancer by 50% and those who exercise 1-3 hours a week reduce their risks by 30%.

Exercise increases bone mineral density and improves cardiovascular function. Studies have also shown that girls who participate in sports have higher grades and higher self-esteems than non-athletes do.

Females should be encouraged to participate in sports or regular exercise. However females driven to excel and achieve perfection in their sport may be at risk for injury and medical problems.

In 1992, the American College of Sports Medicine first described a condition that occurred in female athletes: The Female Athlete Triad. The Female Athlete Triad is composed of 3 interrelated conditions: disordered eating, amenorrhea, and osteoporosis.

Disordered eating is any eating behavior that is harmful. It can range from a preoccupation with body image and thinness to inappropriate dieting to anorexia or bulimia. Signs of disordered eating include:

· frequent bathroom visits, especially after meals

· frequent comments about food, weight, and appearance

· restriction of food intake

· use of diet pills or laxatives

· unexplained weight loss or fluctuations

· moving food around plate without eating it

· erosion of tooth enamel

· fine hair on face or body

An athlete who does not eat an adequate diet does not supply the body with enough fuel to meet the body’s needs. Disordered eating decreases caloric intake and can cause fluid and electrolyte imbalances.

These disturbances from the body’s normal state will lead to decreased endurance, strength, reaction time, speed, and ability to concentrate.

Normal menstruation is dependent upon calorie intake. If an athlete does not have adequate intake to meet the body’s daily needs and the amount expended during exercise, a female may experience menstrual dysfunction.

Amenorrhea is the loss of a normal menstrual cycle or a menstrual cycle that has not begun by age 16. Irregular menstruation is not a normal response to exercise and requires medical attention.

In the general population 2% to 5% of women have amenorrhea and in athletes 3.4% to 66% of women have amenorrhea. The loss of a normal menstrual cycle will lead to decreased estrogen production; estrogen is essential for proper bone construction.

The third aspect of the triad is premature osteoporosis. Osteoporosis is defined as low bone mass and inadequate bone formation. A lack of estrogen, secondary to amenorrhea, predisposes a female to osteoporosis at an early age. Athletes with inadequate bone mass will have fragile bones and increased risk of fractures.

Female reach peak bone mass at 18-25 years old and after that time bone is no longer formed. Studies have shown that females who have not had a menstrual cycle for 3 years have irreversible bone loss.

The Female Athlete Triad is an important issue for females participating in sports. This disorder can occur at any age or skill level if the pressure or desire to excel in athletics leads an athlete to attempt to lose weight through dietary restrictions or other inappropriate methods.

Disordered eating causes a calorie deficit and the body does not have enough energy to sustain all of its daily functions. Menstruation is one function frequently shut down. Amenorrhea causes a decrease in estrogen production, which will lead to a decrease in the amount of bone formed and eventually premature osteoporosis.

Signs and symptoms of the Female Athlete Triad include:

· loss of menstrual cycles, no menstruation for 3 months

· anemia

· stress fractures

· increased risk of injury and decreased healing time

· decreased performance

· fatigue

· depression

· decreased ability to concentrate

· decreased heart rate

· chest pain

· erosion of tooth enamel due to frequent vomiting

Athletes with symptoms of the Female Athlete Triad should seek medical attention. Treatment may require a team approach of a physician, nutritionist, and a psychologist.

The aim of treatment is to help the athlete attain and maintain a goal weight, follow an appropriate diet, and modify exercise frequency and intensity in an effort to restore normal menstruation. Athletes should also be encouraged to focus on strength and physical conditioning to improve performance, not on weight reduction.

Hormone replacement therapy may be required to treat amenorrhea and prevent further bone loss. Appropriate calcium intake of 1,500 mg per day is also recommended to help promote bone development.

The best treatment approach is prevention. Female athletes should be educated about the signs and symptoms of the female athlete triad as well as the risks associated with this disorder.

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