Female Athlete Triad

The "Female Athlete Triad" is a syndrome consisting of three related conditions: 

• Unhealthy (disordered) eating 
• Irregular or absent menstrual periods 
• Osteopenia (thinning of the bones) 

This syndrome occurs most commonly in athletes participating in sports where a lean physique is thought to provide a competitive advantage; examples include cross-country running, gymnastics, figure skating, and dance. However, any female athlete with unhealthy eating habits is at risk for the female athlete triad. 

What causes the Female Athlete Triad? 

All athletes need a constant source of energy to perform at their best. This energy is provided by the calories in the food they eat, minus the energy they burn during activity. When an athlete is training very hard (and therefore burning higher levels of energy), they have to eat enough calories to counteract their increase in activity. If they don’t, the body does not have enough energy to support normal body functions, like the menstrual cycle. When menstrual cycles are disrupted, estrogen levels fall. Estrogen is known to play a key role in building bone density. This lack of estrogen causes the bones to become thin (due to a reduction in bone density) and more susceptible to fractures. 

What are the symptoms of Female Athlete Triad? 

An athlete may exhibit changes in her eating behaviors, such as restricting her food intake, fasting, or eliminating entire food groups like dairy products or meat. She may also try to lose weight by inducing vomiting or using laxatives, diuretics (water pills), or diet pills. She may also insist on exercising beyond what is required by her team. All of these actions will lead to an energy imbalance and put her at risk for developing the female athlete triad.  

Girls with the female athlete triad may display weight loss, develop irregular menstrual cycles, or won't have the first menstrual period until well beyond the age of most of their peers. These athletes may complain of feeling cold, lightheaded, or fatigued. They may notice a decrease in their athletic performance, or an inability to complete their usual workouts. They may also develop or have a history of one or more stress fractures. 

Diagnosing the Female Athlete Triad 

Healthcare professionals will gather information about the athlete’s eating habits, menstrual cycles, and attitudes about her weight and body image. The doctor will take a family history and measure the athlete’s height and weight to determine if her body mass index (BMI) is abnormally low. Blood tests may be ordered to look for other causes of menstrual cycle dysfunction or bone health irregularities. If there is a history of stress fractures, the doctor may recommend a bone density test that assesses the level of calcium in the athlete’s bones. 

Treatment for the Female Athlete Triad 

The most effective treatment for the female athlete triad involves a team and family approach. The athlete and her family will have regular meetings with a doctor, a nutritionist, and a clinical psychologist: 

• The doctor will monitor the athlete's medical status.  
• The nutritionist will create a plan for healthy eating behaviors and a diet with an appropriate amount of calories to maintain normal body functions, based on the athlete's level of exercise.  
• The psychologist is helpful for athletes who are struggling with stressful circumstances in their lives or are feeling pressured to succeed, both of which may cause athletes to adopt unhealthy eating patterns in an attempt to relieve stress and maintain control.  
• The family should offer a supportive environment, encouraging healthy eating behaviors and safe training practices. 

References 

Anderson SJ and Harris SS, eds. Care of the Young Athlete, 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2010. 

Sarward JF and LaBella CR, eds. Pediatric Orthopaedics and Sports Injuries. Elk Grove Village, IL: American Academy of Pediatrics; 2010.