Female Athlete Triad
The female athlete triad is a condition that is common in physically active females involving three major components:
Low energy availability – this can be with or without disordered eating
Menstrual dysfunction – irregularity or missing periods
Low bone density
An individual does not necessarily have to show clinical manifestations of all three components of the triad to be affected by the condition, and therefore it is very difficult to diagnose and often overlooked.
Who is at risk?
All female athletes are at risk of developing this condition however those who participate in sports where weight or appearance are considered an important factor are at a higher risk. Sports such as martial arts, boxing or rowing are sports that include weight divisions and therefore a focus on how much a female weighs becomes every important for her training. Other sports such as gymnastics, cheerleading, dancing and swimming are sports where it is considered valuable or advantageous to have a thin appearance and therefore the coaches, judges or individual may encourage weight loss. Even other sports where body shape and size aren’t as important and the sport is endurance based such as long distance running, cycling or cross country skiing often can result in excessive energy output over energy input.
A sustained low energy supply can impair both psychological and physiological health. If low energy is as a result of an eating disorder side effects can include depression, low self-esteem, complications of the cardiovascular system, endocrine, skeletal, central nervous system and the gastrointestinal systems. Having an energy imbalance (due to either under eating or over-training) can disturb the pituitary gland resulting in not secreting enough pulses of the luteinizing hormone that plays an important role on regulating menstruation in females. This results in females having either irregular (oligomenorrhea) or absent (amenorrhea) periods, for some girls who participate in intensive sports early in life, it may result in them not getting their first period all together. A deficiency in estrogen (due to irregular or missing periods) and nutrition especially calcium, ends up in a decreased bone mineral density. Decreased bone density can result in a brittle, porous bones (osteoporosis) which are more at risk of developing stress fractures and other injuries. It is common that these bone injuries are step 1 in diagnosing the triad, but is often too late as bone density is typically the last component to present itself as it is a consequence of the other two components.
How can you prevent this?
As the triad is hard to diagnose it is important that physically active females are trying to stay on top of their overall physical condition, not just weight/shape of their body. Here are a few tips for female athletes:
Keep track of your periods, consider the signs/symptoms you have as a result of your monthly cycle and how regular your period is
Avoid crazy diets or fads to try and lose weight
Don’t skip meals or snacks to lower your caloric intake
Build quality relationships with your coaches where they understand the pressure you are under, are well aware of the amount of exercise you are completing and have your health and happiness as a priority
See a sports dietitian to help plan out your dietary game plan to ensure you are getting enough calories and key nutrients to match your training
If you need help balancing your training contact one of our Accredited Sports Scientists/Exercise Physiologists