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Female Athlete Triad: Three illnesses to know and prevent


atching the USA Women’s Soccer Team perform in the Women’s World Cup in Germany this summer thrilled all American sports fans and inspired many young girls to dream of playing at the national level one day. The number of girls participating in youth sports already has been steadily increasing over the last few years. The 1972 passage of Title IX legislation, providing equal opportunities for women, was the main catalyst for the boom in girls’ sports. T

he many successes of female athletes during the last 15 years — including the creation of the WNBA in 1997, the Brandy Chastain and Mia Hamm-led 1999 World Cup champions, and this year’s team with Hope Solo and Abby Wambach — only further the ambition of young girls to play at the highest levels. But, with the increase in participation, there has also been an increase in injuries and illnesses unique to the female athlete population. The medical condition known as the Female Athletic Triad refers to the three elements of the disease: dis-

ordered eating, osteoporosis and amenorrhea (absence of menstrual cycle). When one of these conditions happens along with certain red flags, screening for the others is highly suggested. Female Athlete Triad is often seen in activities that require a lean physical appearance, by females driven to meet a specific body image or those who are ultra-high achievers and over train their bodies. The disordered eating disease condition is based on frequent low energy availability. This means that the amount of energy intake in the diet is usually not enough to meet the energy needs of the body. The negative energy balance can be due to excessive dieting like fasting or disordered eating diseases like anorexia and bulimia. Energy imbalance can also happen if an athlete increases his or her exercise level without eating more calories as well. If the imbalance is extreme or long-term, body functions that are important for growth, development and health begin to change. In girls, one of the changes is disruption of the LH hormone and estrogen that contributes to the menstrual cycle. While most teenagers have start menses by age 15, with regular cycles afterwards, strenuous sports training or low body weight can delay this onset. Once onset does occur, missing several cycles in a row is called “amenorrhea” and is the second component of the Triad. While it is more common in athletes than the general population, athletes with prolonged amenorrhea are at risk for losing bone mass due to the lack of estrogen. Osteoporosis, the third leg of the triad, is loss of bone mineral density usually associated with elderly women during menopause. With normal nutrition, bone tissue is regularly broken down and formed in the body. The process of bone formation does not occur when estrogen levels are low. The weak skeletal structure can result in stress fractures during participation in sports. In many cases, frequent stress fracture injuries are the first sign of the Female Athlete Triad. The best treatment is prevention by educating athletes, parents, coaches and health providers on healthy body image, proper nutrition, and exercise habits. Athletes who exhibit the signs of disordered eating or are ultra-conscious of appearance should speak to a coach, parent or another trusted adult about healthy activity. Referral to the proper health care provider and early management are very important to the ultimate health of the young, female athlete. While Olympic gold medals are never a sure thing, healthy participation is a good first step. ✪

Health Watch Mikel Jackson

Mikel Jackson is an athletic trainer for the staff of Sports Medicine For Young Athletes, a division of Children’s Hospital Oakland with a facility also located in Walnut Creek. If you have a health-related question for the “Health Watch” column, write the Sports Medicine For Young Athletes staff at Health@



August 25, 2011

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