THE FEMALE ATHLETE TRIAD

What is it?

The female athlete triad is a disorder that often goes unrecognized, but effects many female athletes in some way. The female athlete triad is the combination of disordered eating, menstrual dysfunction and osteoporosis/osteopenia (bone mineral density loss). Any female athlete can develop the female athlete triad, but it is most prevalent among sports where thinness is considered advantageous such as gymnastics, track and dance, or in sports with weight classes, such as wrestling. Caused by consuming an inadequate amount of calories due to the amount expended during exercise, the condition can cause lifetime health issues. Athletes can have one, two or all three of the components of the triad. Prevalence of all three is up to 4.7%, however the prevalence up two combined components of the triad is up to 26.6%. Complications of the female athlete triad can be vast, ranging from infertility issues later in life, to regular stress fractures and psychological ramifications such as depression. Eating disorders alone are associated with an increased mortality rate.

Disordered Eating

There is a wide range of disordered eating among athletes, ranging from simple dieting to clinically diagnosed eating disorders. Up to 70% of athletes competing in weight class sports and up to 47% of elite athletes in other sports have some sort of disordered eating pattern. This is compared to a prevalence of up to 10% in nonathletic populations. The most common disordered eating patterns detected are anorexia nervosa, bulimia nervosa, orthorexia, and eating disorder not otherwise specified. Athletes may not meet the strict criteria required to be diagnosed with one of the disorders mentioned above, but may still suffer from disordered eating patterns.

Menstrual Dysfunction-

Menstrual dysfunction in the female athlete can include a wide range of disorders, but the most common is amenorrhea, which is defined as the absence of menses for three months or more. There are two types of amenorrhea, primary and secondary. Primary amenorrhea refers to a delay in development of the menstrual cycle. Secondary amenorrhea refers to the loss of menses after previously developing a normal menstrual cycle. While amenorrhea can be caused by genetic abnormalities and disease, in this case it is generally caused by energy deficiency or stress. Energy deficiency is simply taking in less energy than you are consuming. Reflecting a state of estrogen deficiency, amenorrhea can be related to the loss in bone mineral density, as well as psychological changes in the athlete.

Bone Mineral Density

Healthy athletes tend to have better bone mineral density than their unathletic counterparts because weight bearing exercise is one of the best ways to increase bone mineral density. However, in young athletes with the female athlete triad compromises in bone strength, ranging from low bone mineral density to stress fractures and even osteoporosis can occur at a much younger age than normal. General, bone density issues do not begin to effect women until menopause, but since these athletes are in hypoestrogenic states, there is a disruption to bone remodeling and accelerated bone resorption. Meaning these hormonal issues due to energy deficiency actually override the benefits of the regular physical activity on bone strength.

So what should you do if you have a young female athlete?

Keep an eye out for signs of the triad, including paying attention to their eating patterns, whether or not they are menstruating properly and being aware of things like regular stress fractures. If you begin to grow concerned, it is recommended that you seek out a medical professional for your athlete. Recovery from the female athlete triad is completely possible, especially if detected early on. Oftentimes a multi-disciplinary approach to recovery involving a primary care physician, mental health professional, dietician, an athlete’s coaches and family members is best to help ensure the athlete is getting well-rounded care. The bottom line is that female athlete triad prevention and early recognition are key and should be priorities among all involved in the lives of female athletes.

Here at Black Sheep, our coaches are not only keeping an eye out for the signs of issues such as disordered eating, but also make a point to educate our athletes on the importance of their overall health, including proper nutrition and recovery.

Written by coach Anna Hoots.

We do not claim to be medical professionals or claim to give medical advice. You should consult your physician or doctor if you have any questions or concerns regarding this information.