Female Athlete Triad…what is it?

The Female Athlete Triad syndrome consists of three disorders that can occur simultaneously or as the result of one another.  These three disorders are: Osteoporosis/Osteopenia, Disordered Eating, and Amenorrhea/Oligomenorrhea. 

Osteopenia is defined as bone mineral density (BMD) between 1 and 2.5, and Osteoporosis is defined as BMD of 2.5 or higher.  Females reach their peak bone mass between the ages of 20 and 28.  This is also the time when most collegiate female athletes are the most active. 

The two most common types of disordered eating are bulimia and anorexia.  These two are both typically linked with obsessive-compulsive and perfectionism personality traits that are usually acquired within society and the environment in which the athletes were raised.  An eating disorder does not necessarily need to be diagnosed in order for someone to suffer from the female athlete triad. A tendency towards a defined eating disorder is all that is required.

Amenorrhea is the absence of a menstrual cycle while oligomenorrhea is an irregular menstrual cycle; both can be the result of not receiving the correct amount of calories per exercise expenditure. 

            Estrogen levels are inversely related to bone mass and malnutrition can be disruptive to bone as well by directly affecting estrogen levels.  Estrogen is released during the menstrual cycle protecting the bone from resorption; however the menstrual cycle cannot occur if a female does not have enough body fat.  Therefore, if an athlete has an eating disorder, their body will eventually undergo changes, causing a decrease in percent body fat, setting them up for either Amenorrhea or oligomenorrhea, causing a decrease in estrogen levels, directly affecting the bone mineral density, and consequently predisposing them to osteopenia.  Participation in sports usually accelerates this chain of events due to the increase in energy expenditure and therefore the increase in fat burn.  In order to maintain proper levels of estrogen and other essential nutrients, athletes need to have their caloric intake exceed their energy expenditure.  This is often a difficult concept for female athletes to accomplish because they often associate less food with appearing skinnier, therefore being healthier.  The truth is quite the opposite. 

This issue raises the question: Do changes in the training program need to be made in order to prevent the signs and symptoms from starting?  If so, which changes are most beneficial?  Is the underlying problem for female athletes overtraining? Are they not eating enough? Or is it perhaps a combination of both? Let us know what you think!

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