NEWS

The Female Athlete Triad

The Female Athlete Triad in a "chain-linked" series of three disorders that affects tens of thousands of women, First identified in 1992, the three-pronged continuum of the triad includes disordered eating, amenorrhea, and osteoporosis.

The disordered eating component of the triad does not necessarily mean an "eating disorder." While disordered eating may include anorexia nervosa or bulimia, it more commonly refers to poor nutritional intake and/or excessive exercise.

Amenorrhea is defined as the cessation of menses for three or more consecutive menstrual cycles in a woman who has previously menstruated. Amenorrhea results from disordered eating; the individual creates an energy deficit in her body leading to a decrease in estrogen production. The prevalence of amenorrhea in the general high as 66% In the past, many female athletes considered this alteration in their menstrual cycle to be the “peak of conditioning,” but in actuality it indicates that the individual’s system is moving slowly but surely towards a breakdown.

The third prong to the triad is osteoporosis, a disease characterized by low bone mass and deterioration of bony tissue. A lack of estrogen combined with a lack of calcium in the diet results in a loss of bone density, creating a fragile skeleton that is at an increased of fractures.

The typical progression of the female athlete triad is disordered eating that creates an energy deficit, leading to a decrease in estrogen production, and finally amenorrhea. Once the athlete is amenorrheic she is considered to be in the triad. Once in the triad, the development of osteoporosis at a later date will almost inevitably follow.

The triad is a serious syndrome that is hard to detect. The triad is often denied and/or under-reported by its victims, and it is often not detected by sports medicine professionals. Detection is crucial however, because in the U.S. overall, limited data has revealed that 15-62% of female athletes suffer from this disorder. The two “red flags” that may be key to detection of the syndrome are amenorrhea, and a history of stress fractures.

Pre-participation sports physical exams should include targeted, non-threatening questions designed to uncover the athlete’s history of nutritional intake, menstruation, and stress fractures. Comprehensive treatment involves the athlete and her family, a medical doctor, psychologist or eating disorder therapist, nutritionist, and the school’s certified athletic trainer. Educating the athlete, parents, and coaches about the syndrome may be the most effective form of prevention, and should include information on how to remain active, but within safe limits.

Patricia Patane, MS, ATC, PT, CSCS is a certified athletic trainer, physical therapist, and strength and conditioning specialist at the Vermont Sports Medicine Center in Manchester.

Back to News