The Female Athlete Triad is a combination of three interconnected health issues. The three components are energy deficiency, menstrual disturbances (amenorrhea), and bone loss. The syndrome is common in athletic girls and woman, who may be over-exercising and not eating enough to fuel their lifestyle.
The term Female Athlete Triad was first coined in 1992 by The College of American Sports Medicine after experts in sports science noticed a pattern among female athletes. Despite having been named over 25 years ago, there still a lot to learn about the syndrome and how to best manage it.
For women who participate in sports that emphasize leanness, the likelihood of developing secondary amenorrhea (amenorrhea with onset anytime after normal initial menstruation) jumps as high as 69% compared with 2-3% in the general population. The specific type, functional hypothalamic amenorrhea, is most commonly associated with stress and exercise both of which are significantly increased for athletes.
The second component of the triad, energy deficiency, may or may not occur in the presence of disordered eating. That said, most athletes compete within a specified weight class and use disordered eating to drop weight strategically in preparation for a sporting event. This under-eating coupled with the extreme physical demands placed on athletes combines to produce an energy-deficient state.
Bone loss is generally thought of as a problem for older adults. Typically, bone density reaches about 92% in females by age 18, and 99% by age 26. Losses in bone mineral density during this time in an athlete’s development can have long-lasting consequences. Although an athlete may engage in regular weight training, which would generally improve bone density, in athletes with the triad compromises in bone strength, may occur much earlier. This can lead to a higher likelihood of fracture due to bone fragility.
The challenges associated with treating this condition start with screening and diagnosis. Typically, players are diagnosed at pre-participation or annual health screenings. For doctors of athletes, it is essential to follow-up if one symptom is present in search of the associated symptoms to make a diagnosis.
Components of proper screening should include an extensive questionnaire with questions about physical activity, injury history, typical eating behaviors, and menstrual history. It is possible during the screening to uncover disordered eating habits or body image issues. Athletes, in this case, should be referred to a mental health professional as part of their treatment. Physical exams would ideally include a wide range of tests including a complete blood count. Other tests would help rule-out alternative causes for symptoms, like some chronic illnesses.
When it comes to treating the female athlete triad, a multifaceted approach is generally required. This may take a team of providers including primary care, nutritionist, and mental health specialists. The main goal of treatment is to restore an athletes menstrual cycle and improve bone mineral density. Firstly, this requires a change to diet and activity level. After that careful monitoring of diet, activity level, and psychological challenges will be necessary until normal functioning has been restored.
Sources: The American College of Sports Medicine, National Institutes of Health