The female athlete triad is a health condition in which active women experience three inter-related disorders due to unhealthy body weight and eating habits. In the case of the triad, the word active refers to females who display moderate to high intensity levels of performance. The rate of performance must be high in order to counterbalance the decrease in calorie intake. Females who perform at a high intensity are at risk for the triad since they do not take in enough calories to fulfill the amount expended.
The three disorders within the female athlete triad are osteoporosis, disordered eating, and menstrual dysfunction. Not all females experience all three of the conditions, however new data has indicated that even having one or two elements of the triad can greatly increase a female’s long term morbidity and mortality rate (6). Adolescent girls and women are the two categories who are mainly affected by the triad. The causation of this disorder is mainly due to the pressure placed on these females to maintain a slim body image in order to enhance their sports performance.
The female athlete triad does not only affect elite athletes, it also affects active women and girls participating in physical activities. If females compete at elite levels and do not consume the adequate amounts of calories, vitamins, and/or water, then they will develop the female athlete triad. The three conditions of the female athlete triad are caused by low energy availability, irregular menstrual cycles, and low bone mineral density. Disordered eating can be defined as the imbalance between the amount of energy consumed and the amount of energy expended during exercise.
The Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition (DSM-IV) detects that the two main types of eating disorders included within the disordered eating category are anorexia nervosa and bulimia nervosa (3). Anorexia nervosa is an eating disorder in which people go for long periods of time without eating because they have a fear of gaining weight. Bulimia nervosa is an eating disorder in which people binge eat, meaning they consume excessive amounts of food in short increments of time followed by some form of purging.
Types of purging include taking laxatives, diuretics and/or diet pills, however the most common form of purging is vomiting. Disordered eating usually occurs when the pressure and stakes are high for weight loss to occur. If pressured by individuals such as family members, friends, and/or coaches, females will undergo unhealthy eating habits and unhealthy over-exercising habits in order to obtain their goal weight. One factor that contributes to unhealthy eating habits is that active women frequently avoid animal products and strictly limit their fat intake which increases susceptibility to disordered eating (7).
By not consuming the proper amounts of food, there is not enough energy available for female athletes to perform at their full potential. Disordered eating can also result in and also enhance amenorrhea. Amenorrhea is a disorder that can be divided into two categories: primary and secondary amenorrhea. Primary amenorrhea (delayed menarche) is the absence of menstruation by age sixteen, and secondary amenorrhea is the absence of three or more consecutive menstrual cycles after menarche (3).
However, in the case of the female athlete triad, the requirement to be diagnosed is three to six consecutive missed menses (6). The two aspects that disrupt the menstrual cycle of women are energy restriction and high levels of physical activity. Missed menstrual cycles may also be attributed to periods of physical stress while the individual takes in inadequate amounts of energy (7). Around 50% of female athletes experience exercise-induced menstrual dysfunction. Amenorrhea is also associated with low bone mineral density.
Osteoporosis is a disease characterized by a loss of bone mineral density or an inadequate bone formation. This then leads to increased skeletal fragility, micro architectural deterioration, and low bone mass. Low bone mineral density can result in stress fractures within a female’s body (6). Female athletes with menstrual dysfunction often display low levels of the reproductive hormones estrogen and progesterone. When the levels of these hormones are low, it is difficult for bones to retain calcium which causes a gradual loss of bone mass.
It has been proven that when comparing amenorrhic athletes to athletes with regular menstrual cycles, the bone mineral density if reduced by 14% in amenorrhic athletes and 27% in regular athletic women (7). All three conditions result in serious health and body conditions which can decrease a female’s ability to participate in physical activities. The female athlete triad is considered to be a significant health concern. In relation to the female athlete triad, some women are more prone to the condition than others.
Sports that emphasize performance based on weight specifications increase the prevalence of the female athlete triad. Women who participate in sports such as ballet, figure skating, gymnastics, diving, and other aesthetic component sports have a higher risk of developing aspects of the female athlete triad in addition to women who participate in sports that involve weight classes such as tae kwon do, judo, wrestling, rowing, and equestrian (6). Most female athletes who participate in either high-intensity or endurance exercise have a greater chance of developing the triad.
Studies have shown that women who run more than seventy miles per week will have a 43% higher chance of developing amenorrhea. An example that proves gymnasts have a high prevalence for the triad is with US gymnast Christy Henrich. An American judge for gymnastics told Henrich that she would need to drop some weight in order to qualify for the 1988 Olympic team. Henrich tried to control her diet and exercise which resulted in a five year battle with anorexia and bulimia. At the time of Henrich’s death, she was four foot ten inches, sixty one pounds and only twenty-two years old (2).
Sports that involve the athletes to wear body-contouring or body-revealing clothing such as swimming, volleyball, aerobics, cheerleading, gymnastics, and track are also associated with high risk for the female athlete triad (7). Athletes should know their limits in order to prevent the development of an unhealthy diet condition, which has the potential to lead to death. Finally, college females are prone to the triad since they are in a hormonal transitional phase in college (4). Generally, they have finished puberty and are leaving home to be on their own.
In addition to their own weight control, they are now worried about being independent and fitting in to the social atmosphere. Athletes especially do not want to undergo this difficult transition and therefore participate in whatever exercise and diet habits that can make them happy. There are many methods that can be utilized to prevent female athletes from developing the female athlete triad. Prevention is sometimes difficult due to the fact that athletes will hide the fact that they are experiencing ealth problems, however, there are ways to initially prevent the triad. Coaches and sports instructors have strict rules regarding weight and body type among their athletes and control weight by performing weigh-ins at the beginning and end of each week of exercise. This causes athletes to become worried that they must maintain a certain weight which can result in unhealthy diet and exercise habits. Coaches should not set maximal weights for eligibility and should not punish athletes by making them run or perform push ups for not meeting their set weight requirement (6).
This public humiliation will embarrass the athlete, making them want to lose the weight that their coach requested. Team physicians and trainers should discourage weight requirements unless it is a sport that depends on weight class (i. e. wrestling). Coaches and trainers should de-emphasize weight and instead they should use mental training in order to improve the athletic abilities of females (4). Another way to prevent the female athlete triad is for physicians to properly examine athletes via yearly physicals to see if there are any noticeable changes in the patient’s health or weight.
If the symptoms of the triad are spotted early, the conditions are easier to fix. Many physical questionnaires include questions about the female’s menstrual history in addition to tracking their individual body weight (6). In general if these prevention guidelines are followed, there will be smaller chances for females to develop the triad. Females with the female athlete are able to overcome their condition with proper treatment. Females who are diagnosed should seek out a professional primary care physician in addition to a mental health practitioner.
The athlete should make sure that the doctors have experience with disordered eating and athletic health conditions (1). The physician will help the athlete’s body regain its natural weight while the mental heath practitioner will prepare the athlete mentally by emphasizing that bodyweight is not the only thing that matters when being athletic. The practitioner will also deal with depression, self-consciousness, and loss of self-esteem. The athlete should begin treatment by establishing the proper intake of foods for her body weight and size.
She should examine how much weight she has lost over the course of her disorder. If more than 35% of the body weight has been lost, hospitalization is recommended. For women with amenorrhea, doctors are able to prescribe estrogen, or progesterone pills, as well as dermal patches in order to obtain regular periods. Most females prefer taking contraceptives such as birth control to regain their menstrual cycles (2). In regards to decreasing fatigue, there is separate treatment for women who need to increase energy.
When undergoing treatment, athletes should reduce their exercise by at least 10%. They should also increase their energy intake in order to regain the energy they had before becoming unhealthy. For women with osteoporosis, they should increase their calcium intake to about 1500 to 2000 mg per day. The combination of Vitamin D and calcium has sown to have benefits. Calcium will not increase bone mineral density however it will prevent other conditions that may happen in the future (1). The female athlete triad affects many athletes every year.
A recent study found that amenorrhea is present in 50% of female runners and ballet dancers, and disordered eating is present in 15-62% of female athletes. The wide range of athletes with disordered eating is explained by the athlete’s denial or secrets about their disordered eating (5). With educational information and preventional techniques, the rate of the condition has great potential to decrease. If females compete at elite levels and do not consume the adquate amounts of calories, vitamins, and/or water, then they will develop the female athlete triad.
Athletes should keep track of their diet and exercise in order to prevent the serious health problems of disordered eating, amenorrhea, and osteoporosis.
Bibliography: 1. Birch, Karen. “ABC of Sports and Exercise Medicine: Female Athlete Triad. ” British Medical Journal 330 (2005): 244-246. 16 Apr. 2008 . 2. Furia, John. “The Female Athlete Triad. ” Medscape Orthopaedics & Sports Medicine (1999): 1-6. 23 Apr. 2008 . 3. Otis, Carol L. “ACSM Position Stand: the Female Athlete Triad. ” Medicine and Science in Sports and Exercise 29 (1997). 16 Apr. 2008 . 4. Sherman, Roberta. “Good Nutrition Promotes Health Enhances Performance. ” NCAA: Coaches Handbook: Managing the Female Athlete Triad. NCAA. 24 Apr. 2008 . 5. Smethurst, Marianne. “Female Athlete Triad: This Profound Risk to Aspiring Young Athletes Remains Under-Recognised by Support Professionals. ” Sports Injury Bulletin. 1 May 2008 . 6. Sutton, Amy L. Fitness and Exercise Source Book. Third ed. Detroit, MI: Omnigraphics, 2007. 543-554. 7. Thompson, Janice, and Melinda Manore. Nutrition: An Applied Research. San Francisco, CA: Pearson Education, Inc. , 2005. 480-481.