Menstrual Problems, Osteoporosis And Eating Disorder In Athletes. The Female Triad Syndrome

Women who participate in sports or exercise and train intensely are at risk of a syndrome known as the Female Athlete Triad.

This is a combination of three conditions;

• Eating Disorder
• Menstrual Problems (Amenorrhoea)
• Osteoporosis (or Osteopenia) .

A female athlete can experience one, two, or all three parts of the triad.

The potential impact of the three above factors are on sporting performance and general health. However many of these conditions have potential to be prevented with careful management by athlete and coach.

The primary cause of the Female Athlete Triad is deemed to be a long term imbalance of energy consumption and expenditure during exercise. The primary cause is Energy Deficiency^[1]

The energy defieciency can be due to a conscious restriction of food intake due to body image consciousness or eating disorder.

Disordered eating can be due to internal or external pressures for a young female or woman athlete to be thin. In many cases there is a misconception that a more lean athlete is more successful therefor a very goal orientated, compulsive athlete may concentrate on this approach towards an assumption it will lead to improved performance.

• Rapid weight loss
• Psychological obsession with body weight, food, mealtime rituals, and body image
• Fluctuations in weight
• Daily exercise additional to regular training schedule
• Stress fractures (i.e . micro fractures of bones that may progress to complete fractures)
• Yellowing of the skin
• Frequent sore throats despite no other signs of respiratory illness (possibly seen due to self-induced vomiting- Anorexia)
• Chipmunk-like cheeks due to swollen parotid glands (self-induced vomiting)
• Many dental cavities, foul breath (self-induced vomiting)
• Regular fatigue, light-headedness and dizziness
• Depression, anxiety and low self-esteem.

Osteoporosis is associated with a decreased bone mass despite no alteration in the mineralisation of bone tissue due to a decreased bone mineral density.

Bone tissue is developped during a female's development through nutrition and the bone tissue response to mechanical stress.

Risk factors for Osteoporosis ^[2]

Low Energy Availablility

Low energy availability is addressed through balanced diet and nutrition.

Low Oestrogen Concentrations

The long term risk of developing osteoporosis has been shown to be reduced by attaining a a good peak bone mineral density during childhood and the long term exposure to oestrogen. Oestrogen protects the skeleton from bone resorption.

Inadequate nutition in relation to exercise level can lead to potential menstrual dysfunction as it can lead to decreased levels of oestrogen, the hormone responsible for maintenance of a female's menstrual cycle.

Endurance exercise leads to the production of endorphins which may have a detrimental effect on the hormones a woman requires for normal menstrual function. This may be a possible link between Amenorrhoea and endurance exercise.

Some girls who participate intensively in sports may never even have the onset of their menstrual cycle. Others may have had periods, however on increasing their training and changes to their eating habits may cause the cessation of their menstrual cycle.

For further information I recommend.

Menstruation And Endurance Training - The Effects Of Exercise On The Menstrual Cycle

Researchers have called for the inclusion of Osteopenia within the Female Athlete Triad^[2] due to it's association with decalcification of bone and it's higher prevalence in female athletes.

^[1]Female Athlete Triad Coalition

^[2]Birch, K., ABC of sports and exercise medicine: female athlete triad., BMJ. 2005 January 29; 330(7485): 244–246