Female Athlete Triad Syndrome

Shelly Hack, P.T.

Women’s participation in sports is increasing with every year. Women are strong and competitive athletes. Because of this, it is important to address the concerns specific to women athletes. The major health risk factor facing women athletes today is the Female Athlete Triad. The triad consists of disordered eating, amenorrhea, and osteoporosis.

We, as parents and coaches, need to be comfortable with the issues surrounding female athlete triad, as early diagnosis is a key in treatment.

The first component of the triad, disordered eating, affects 16% to 72% of female athletes. It is important to realize that disordered eating does not necessarily mean anorexia nervosa or bulimia; although, it is a component of these two disorders. The primary component of disordered eating is that the athlete’s current dietary practices do not provide enough calories to cover the costs of their activities and training; and, this does NOT have to be a conscious restriction of caloric intake. Often times, though, these athletes have ritualized dietary habits, compulsive behavior, low intake of food and heightened energy expenditure.  Usually it begins as simply monitoring food intake, progresses to restricting foods from the diet (such as red meats or fats) and then evolves to limiting acceptable foods.

Disordered eating can lead to the second component of the triad, amenorrhea. Primary amenorrhea is the delayed onset of menarche (older than 16 years old). Secondary amenorrhea is lack of menstrual cycle for 6 months or more, having once had normal menstrual function.  Current theories suggest that caloric deficit leaves too little energy to maintain the endocrine reproductive system, and the menstrual cycle stops. Many coaches do not ask their female athletes about their menstrual cycle, and many female athletes are not concerned with the lack of their menstrual cycle because they like not having their period.

It is important to be concerned and to ask about a female athlete’s menstrual cycle because amenorrhea is highly correlated with osteoporosis, premature bone loss or inadequate bone formation. This results in low bone mass, micro architectural deterioration, increased skeletal fragility, and increase risk of stress fracture. It is important for female athletes to maintain their bone mass during their teenage years and early 20’s. If optimal levels of bone mass are not reached during this time, because women are loosing bone mass when bone should be forming, the athlete is predisposed to premature, irreversible osteoporosis. 

To prevent our female athletes from taking this path of destruction, we need to look to the following predisposing risk factors:

• Chronic dieting
• Low self-esteem
• Family dysfunction
• Perfectionism, and
• Lack of nutrition knowledge 

Also, there are risk factors that are sport specific: 

• Emphasis on body weight for performance and/or appearance
• Pressure to lose weight from parents, coaches, judges, and peers
• Drive to win at any cost
• Self-identity as an athlete only
• Early intervention of training or sudden increase in training
• Exercises through injury
• Over-trained and undernourished
• Traumatic event (e.g., loss of coach), and
• Vulnerable times (e.g., growth spurt, entering college) 

Female athletes are under intense pressure to be thin for performance, which may result in a disordered eating, developing amenorrhea, and then suffering the consequences of osteoporosis. We can help prevent it by looking for it, early diagnosis, and educating our female athletes in nutrition and dietary needs.

For personal consulting, please contact us at Sports Reaction Center.

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