Introduction
The Female Athlete Triad is the name given to describe a trio of conditions commonly affecting women athletes - amenorrhoea, osteoporosis and disordered eating.
About
Amenorrhoea is the absence of menstruation. A woman's normal menstrual cycle is under hormone control and athletic exercise can affect this control. Primary amenorrhoea is diagnosed in girls who have not begun to menstruate by 16 years or who have not begun to menstruate two years after they have developed secondary sex characteristics. This condition commonly occurs in young female gymnasts or dancers. Secondary, or athletic, amenorrhoea occurs when the frequency of a previously normally menstruating woman drops to less than 6-9 periods per year. This is relatively common in women engaged in excessive training activities (especially endurance sports). Rigorous training, achieving a competitive edge and a preoccupation with thinness are pressures that result in many female athletes having diets that greatly restrict the intake of fat. Lean body mass has been considered to be the main cause of amenorrhoea and each woman will have her own point which, when reached, will cause menstruation to cease. Some women, for example, are able to sustain low levels of body fat (10%) without affecting the menstrual cycle whereas others will experience amenorrhoea at below 15% body fat.
Osteoporosis results in bones becoming fragile and more prone to fractures. Like amenorrhoea, osteoporosis is linked to decreased oestrogen levels because this hormone is important for maintaining calcium content of bones. Oestrogen levels in the female athlete can be reduced by a combination of rigorous training and a very low intake of dietary fat. Women with amenorrhoea may start to lose bone density within one year.
Low bone density causes weak, brittle bones that fracture more easily. Female athletes with amenorrhoea (due to low oestrogen levels) are more prone to minor or stress fractures as a result of the workload placed on bones during training and competition. Left untreated, a female athlete suffering amenorrhoea in her 20's could develop the bone density commonly associated with a woman in her 50's.
Surveys show that disordered eating among female athletes ranges from 15-60%. Disordered eating patterns are most common in appearance sports such as gymnastics, ballet, figure skating, equestrian sports and diving, but do occur in many other sports.
Disordered eating patterns can range from moderate restriction of food intake or occasional bingeing and purging to severe food restriction (as occurs in anorexia nervosa) and regular binge eating and purging (as occurs in bulimia nervosa). Patterns of disordered eating may include skipping meals, bingeing, purging, use of laxatives and diuretics, or excessive exercise to compensate for food intake. Excessive exercise does not cause disordered eating, however, it can worsen an existing problem.
Prevention
Preventing the Female Athlete Triad involves close attention to a woman's diet, her ability to sustain high intensity training and her psychological state. Preventing osteoporosis may require calcium supplementation. The menstruating woman has a daily calcium requirement of 800mg and a woman with amenorrhoea requires 1000mg of calcium daily.
The main points to consider in the prevention of Female Athlete Triad include ensuring that a woman involved in physical activity has appropriate energy intake, sufficient calcium intake, regular rest and recovery sessions, maintenance of appropriate bodyweight and nutritional supplementation where necessary.
Signs and symptoms
The signs that may suggest disordered eating include:
- Preoccupation with food and weight.
- Repeatedly expressed concerns about being fat.
- Severe criticism of one's body.
- Use of laxatives.
- Preferring to eat in private.
- Trips to the bathroom during or after meals.
Repeated stress fractures from training may also be a sign of the Female Athlete Triad, particularly if they occur from minimal trauma. Other signs of the triad include: fatigue, anaemia, depression, cold intolerance, low body temperature, sore throat and enlarged parotid glands (the saliva-producing glands at the side of the neck under the ears), constipation, dry skin, lanugo (increased growth of fine body hair covering the skin), lightheadedness and abdominal pain and bloating.
Health care
As with all conditions your Doctor should be consulted. Ask your Doctor about the latest advice regarding Female Athlete Triad. Athletes with symptoms of the Female Athlete Triad may require care from several specialists, including a Physician, Dietitian and a Psychologist or Psychiatrist, who all work with the patient to address issues that may have contributed to her condition and recommend strategies to treat the symptoms. Hormone replacement medications, such as the contraceptive pill, may be prescribed, as the symptoms of the Female Athlete Triad are associated with inadequate hormone levels.
Diet tips
- Patients with symptoms of the Female Athlete Triad need to increase and then sustain their lean body mass by eating a well-balanced, high-carbohydrate diet.
- A female athlete will have individual nutritional requirements as rigorous exercise increases the body's demand for nutrients. A sports dietitian can devise an eating plan to maintain good health while achieving optimum sporting performance.
- See the Sports Nutrition for Women topic for detailed dietary information.
Vits/mins/herbs
- Calcium is recommended at a dose of 1500mg/day to assist in maitainance of bone strength.
- Vitamin D is also essential for maintaining strong, healthy bones.
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