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What is Female Athlete Triad?

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April 9, 2018
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Female Athlete Triad is a collection of three pathologies that affect athletes. There are some sports that have a greater risk of developing female athlete triad, or simply an eating disorder, and include aesthetic, endurance and weight class sports 

Amenorrhea

While I’ve covered amenorrhea before, you should know that there are two types: primary and secondary amenorrhea. Primary amenorrhea occurs when menstruation hasn’t happened by the age of 16, despite the presence of secondary sex characteristics. Secondary amenorrhea occurs in women who previously experienced a cycle, but haven’t done so in the last 3 months.

We need to be mindful of all causes of amenorrhea, and not just weight or exercise. Typically amenorrhea may occur because of under-eating or a calorie deficit. Women who experience dietary restriction may experience changes in their cycle due to low levels or suppression of the lutenizing hormone. Normal menstrual cycles may reoccur with weight gain, decreasing the intensity of exercise or other physical and psychological reasons. 

Osteoporosis

Osteoporosis is a disease which consists of low bone mass and deterioration of the bone tissue which can ultimately lead to bone fragility and an increased fracture risk. 

In order to determine your risk, you must have your bone mineral density (BMD) calculated using a DEXA scan. If your BMD is greater than 2.5 standard deviations below the mean of young adults, then it considered osteoporosis. If the BMD is 2.5 to 1 standard deviation below the mean, this is defined as osteopenia. 

Women who experience menstrual irregularities often have a low BMD. Low estrogen may be a cause of osteoporosis, as it plays a role in bone modeling and formation. Estrogen also prevents the production of chemicals that cause bone breakdown. 

Disordered Eating

Two eating disorders to be aware of are anorexia nervosa and bulimia nervosa.  Anorexia nervosa occurs when a woman is less than 15% below her expected weight/height ratio. She may also be restricting or purging her food. 

Whereas bulimia nervosa occurs in women with a normal weight/height ratio. However may binge eat, purge food, use laxatives, diuretics or other medications, as well as fast or engage in excessive exercise. 

Athletes who partake in sports which emphasize thinness and weight-dependance are usually more at risk than other sports. 

Other Signs and Symptoms

Lanugo

Fine hair that may predominately grow on the face, as a result of decreased fat tissue. 

Oral Complications

These may include: increased cavities, enamel loss, periodontal disease, and salivary gland hypertrophy. 

Where to Start

This is one of those conditions where you can’t ‘fix’ a period unless you start with nutrition. This may be as simple as including more carbs in your diet (ie. rice or sweet potatoes), or including a psychologist to your health team to address and support a potential eating disorder. 

Ideally treatment should begin right away as more menstrual cycles that missed in women, there is increased loss of BMD and this may not be reversible – ultimately making fractures a common occurrence in the future. 

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