The Female Athlete Triad

A 16-year-old gymnast is attempting to lose weight and improve her vaulting routine for the upcoming Olympic Trials. This athlete currently is 4’11” and weighs 82lbs, which obviously is underweight. However, the gymnast continues to count her calories to make sure that she is burning more calories than eating. As time progresses, the athlete tells her physician that she has been having absent menstrual periods for the last several months. The physician tells her that this is due to the fact that she is not getting enough nutrition, and refers her to a nutritionist to get back on a healthy adequate eating plan. However, one week later, while practicing, the gymnast misses her landing, which results in a stress fracture of her right ankle.
This is a classic example of what is called the Female Athlete Triad. In 1992, there has been an increase in female athletes who are suffering from the Female Athlete Triad, which the American College of Sports Medicine described as the presence of:
1. Disordered eating: Anorexia nervosa is where the athlete will starve themselves to prevent weight gain, whereas Bulimia nervosa is characterized by eating and then vomiting or using laxatives to prevent weight gain. Both of these eating disorders are dangerous and may result in multi-organ failure leading to death, so medical attention is required immediately.
2. Amenorrhea: This is defined by the lack of a menstrual cycle for more than three months and results due to decreased levels of estrogen. There are low estrogen levels due to the excessive exercise in combination with poor nutrition.
3. Osteoporosis: Bone weakens due to the lack of adequate nutrition intake, especially calcium. In addition, a decrease in estrogen will also result in weak bones. The teenage female athlete should be getting at least 1,300 mg and the adult female athlete should be getting at least 1,000 mg of calcium per day in order to maintain strong bones. A teenage female athlete, with less than 12% body fat will be unable to maintain strong bones.
These three health conditions are intertwined and will usually present as a triad. Other common symptoms may include: depression, hair loss, dry skin, anemia, bradycardia (slow heart beat), chest pain, and an increased sensitivity to cold.
Risk factors for the Female Athlete Triad are:
1. Sports that require athletes to track weight or maintain very low weights, for example: gymnastics, ballet, figure skating, weightlifting, wrestling, swimming, diving, and track and field athletes.
2. Competing at a high level and having a must win attitude
3. Low self-esteem
4. Poor coaching: One study found that 75% of female college gymnasts, who were told they needed to lose weight by their coaches, lost the weight by using “pathogenic behaviors” to lose the weight.
Having an observant and positive coaching team that encourages adequate nutrition, which is appropriate to the amount of exercise, can help to prevent the Female Athlete Triad.
However, if an athlete is suffering from the Female Athlete Triad, the treatment plan will involve several health care providers, such as family physician, nutritionist, and psychologist. Also, if the coach is not already aware of the athlete’s condition, it is important that they are involved in the treatment plan to help encourage healthy eating and training.

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