The Female Athlete Triad


Women's Sports Medicine Center,
Hospital for Special Surgery

What is the Female Athlete Triad?

The Female Athlete Triad is a term used to describe the relationship between three health problems:

  1. disordered eating,
  2. loss of your monthly period (amenorrhea)
  3. bone loss (osteoporosis)

This syndrome has been observed in women athletes who participate in sports where leanness is perceived to improve performance. Sometimes it occurs in girls or women who are unaware that their food choices or excessive physical activity are having a negative effect on their health. They become trapped in a cycle of dangerous food patterns and obsessive training trying to achieve a low and unrealistic body weight. Unfortunately, these women donít realize that they are heading for significant health problems and compromised athletic performance.

The components of the Female Athlete Triad are related in the following way:

  1. Restrictive eating and excessive exercise can cause a woman to develop an energy deficit.
  2. This energy deficit or stress condition changes the bodyís hormone levels.
  3. The reproductive system shuts down and the normal menstrual cycle is disrupted.
  4. If hormones arenít brought back into balance, the body begins the silent process of destroying bone.

Disordered Eating

When we hear the term "eating disorders", we think of anorexia nervosa or bulimia. These are at the extreme end of a spectrum of unhealthy eating patterns. More subtle forms of disordered eating include:

  • Food restriction (Limiting your overall food intake or there are many foods you just wonít eat because you think theyíre "bad" for you and will make you fat.)
  • Rigid food patterns (You eat exactly the same thing every day. For example, you eat a bagel every morning, yogurt and salad each day for lunch and meatless pasta at dinnertime. You will have significant nutrient gaps with this kind of strict eating.)
  • Inadequate protein diet (You only occasionally eat meat, poultry, fish, dairy products or other good protein sources like beans, legumes, nuts or soy products.)
  • Thought patterns such as preoccupation with food, dissatisfaction with oneís body, excessive fear of becoming fat and a distorted body image (You think youíre fat, but in reality youíre thin or healthy.)
  • Prolonged fasting
  • Bingeing (out-of-control eating) and purging (use of diet pills, diuretics or laxatives to control weight or vomiting because you feel guilty about food youíve eaten)

Disordered patterns of eating deprive your body of needed protein and calories, eventually causing you to lose your monthly period. This is detrimental not only for energy and performance, but for strong bones and good health. Clinical experience shows that the sooner you seek help for eating behaviors that are out of control, the easier it will be to get you back on track.

Amenorrhea

Amenorrhea means that you stop having your period for 3 months or longer. If you havenít had your first period by age 16, this is also considered amenorrhea. Check with your doctor to find out whatís going on. Not having your period is a sign that something is wrong with your hormone balance (or youíre pregnant!). Even though it may be a great relief not to have to worry about the discomfort or inconvenience of your monthly cycle, this is a warning that something is seriously out of balance. If ignored, this can lead to early osteoporosis and high risk of stress fracture.

Osteoporosis

As our bodies grow, our bones grow too. We build bone particularly during times of rapid growth and development, like adolescence, and continue until somewhere between the ages of 25 to 35. Then gradual losses of bone begin. Bone loss accelerates for women during the years right after menopause (around 50). Itís important to enter our adult years with as much bone as possible, to prevent osteoporosis. Osteoporosis refers to bone loss and lack of bone formation which increases your risk of broken bones. We usually think of osteoporosis as a disease of old women. You might picture an elderly, frail woman with a humpback spine. But osteoporosis is destruction of bone that silently progresses over many years and only becomes evident with problems like a fracture, a distorted spine or pain. Young women who are diagnosed with the Female Athlete Triad have demonstrated low bone density similar to women in their 50ís or 60ís! They may have had one or more stress fractures. It may NOT be possible to replace bone thatís been lost during our growing years, so itís important to maintain good habits during this critical bone-building time.

What can you do?

  • Work with your doctor to establish regular menstrual cycles and proper estrogen levels.
  • Seek help from a mental health professional who is familiar with eating disorders. Counseling is an important component because food and weight obsessions often involve emotions and thoughts that begin to dictate our behavior. You can achieve peace with your body.
  • Consult with a nutritionist who can give you suggestions for improving your energy and performance through adequate calcium and protein intake. Learn how to make smart food choices and maintain a healthy weight.
  • Do not overtrain. Fear of getting fat often motivates women to obsessively spend hours at the gym. You may have to force yourself to cut back or take a rest day, but remember that your body needs time to recover. Have an exercise specialist evaluate your workout routine to advise you about an appropriate training volume based on both performance and health goals. There are many more elements to athletic success than body fat and weight.

What else are you doing to improve your performance?

  • Increase your muscle mass.
  • Improve your skills.
  • Improve your energy through good nutrition.
  • Practice mental preparation techniques.
  • Optimize your training regimen.

Athletes have achieved "personal bests" when their body fat levels were higher than other team members.

Everyone has an ideal body composition that is unique to them. Certain body types appear to be more successful in certain sports activities. Have you chosen a sports activity that takes advantage of your genetic body build and natural gifts?

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