The Female Athlete Triad (January 2013)
What is the Female Athlete Triad? Unless you are an athlete or a competitive you may have not heard this term before. This is a syndrome that is composed of three overlapping components. These are reduced bone mineral density, menstrual irregularity (menstrual dysfunction) and low energy availability.
Reduced bone mineral density reflects having a lower than be expected bone density for a patient of that age. A reduction in bone formation and an increase in bone resorption are responsible for the decrease in bone mineral density. There is also an increase in fracture risk which may affect an athlete later in her life.
Menstrual irregularity composes a large range of this triad including the luteal phase defects, oligomenorrhea, primary and secondary amenorrhea. The majority of the irregularity is considered to be secondary to a hypoestrogenic state following suppression of the hypothalamic-pituitary gonadal axis, possibly via leptin and resulting in a hypoestrogenic state.
Low energy availability refers to the energy consumed vs. the energy output. Whether this is intentional or not has a lot to do with the amount of exercise based on the amount of nutrition consumed. When the individual is consciously limiting their caloric intake, it may fall into the department of disordered eating, sporadic eating, to ultimately diagnosing an eating disorder. This disordered eating could be prevalent in sports that encourage a lean body or low body weight.
Management of the female is best addressed with a team approach (it would ideal to have all members or multiple members be experts in the eating disorder field). These members would include a physician), registered dietitian, a psychologist, a coach, parents, trainer, etc.
Prevention of the triad would be ideal. This would entail educating coaches, parents about what to say/not to say regarding food, body image and such as often times the sport/ coaches may bring on the eating disorder due to the pressure to look a certain way, to be faster if you could drop a few pounds, be fitter, etc.
It would be great if screening for the triad would be done for the sports examination. To check if the individual has amenorrhea and if they have had amenorrhea for more than six months or has a sustained stress fracture a bone density (DXA) scan should be obtained. In athletes, the ACSM (American College of Sports Medicine) recommends a BMD Z-Score less than 1.0 suggests further investigation.
An at risk athlete should be referred to an RD for nutritional recommendations. The nutritional goal is to prevent anabolism, increase her calcium intake and Vitamin D. Also her training regimen may have to be altered with reducing her exercise schedule.
The Female Triad effects all ages in athletics. Early screening is necessary to prevent any long term complications, with having a treatment team in development.
