The Female Athlete Triad: Screening and Treatment Strategies
Female athletes are at high risk for developing the following conditions:
1) Anorexia Nervosa (AN): A severe form of eating disorder characterized by a persistent fear or preoccupation with weight loss.
AN may result from psychological factors such as abuse, neglect, or trauma; biological factors such as genetic predisposition; or both.
2) Bulimia Nervosa (BN): A chronic pattern of binge eating resulting in significant weight loss and/or malnutrition.
BN is often associated with other mental health disorders such as depression, anxiety, substance abuse, and personality disorders.
3) Eating Disorder Not Otherwise Specified (EDNS): An umbrella term used to refer to a wide range of behaviors that do not meet the diagnostic criteria for any specific eating disorder.
These behaviors include anorexia nervosa, bulimia nervosa, binge eating disorder, and other forms of disordered eating.
4) Exercise-Induced Hypothyroidism (EIH): Thyroxine deficiency is common among women who participate in strenuous exercise.
EIH may lead to fatigue and poor athletic performance. Symptoms usually improve after stopping exercise.
5) Osteoporosis: Osteoporosis is a condition in which bones become fragile and brittle due to low bone mass and density.
It most commonly affects post-menopausal women, but it can also occur in men and pre-menopausal women. Osteoporosis causes the bones to become porous and more likely to break.
6) Female athlete triad (Female AT): The female athlete triad is a combination of three conditions that occur in women who participate in repeated weight-bearing exercise, such as running: disordered eating, menstrual dysfunction, and low bone mass.
The triad most commonly occurs in women who participate in sports that emphasize a low body weight, such as dance, gymnastics, running, and figure skating. Eliminating the disordered eating typically resolves the disordered eating and menarche resumes. The low bone mass and menstrual dysfunction are more difficult to resolve.
7) Eating Disorder Not Otherwise Specified (EDNOS): The current DSM-IV criteria for eating disorders are focused on the following: anorexia nervosa, bulimia nervosa, binge-eating disorder, and eating disorder not otherwise specified (EDNOS).
EDNOS includes a wide range of other eating disorders that do not meet the full diagnostic criteria for anorexia or bulimia.
Source: Female Athlete Triad Poster (2010), Gwen Lawrence, Meredith Framson, & Alison M. Jett
It is important to make an early diagnosis. If you or someone you know is experiencing female athlete triad symptoms such as disordered eating, amenorrhea, osteoporosis, then you should seek medical attention.
If you are concerned that you’re not getting the right nutrition, talk to your healthcare provider about increasing your caloric intake while still adhering to health guidelines.
You should be physically active every day. The amount of exercise you need depends on many factors. These factors include: body type, age, activity level, and medical conditions.
Make sure to get enough calcium. Doing weight-bearing exercises (such as running, dancing, weightlifting) while getting enough calcium enriched food or calcium supplements can help prevent osteoporosis.
Make sure you get enough Vitamin D.
Doing weight-bearing exercises (such as running, dancing, weightlifting) while getting enough calcium and Vitamin D enriched food or Vitamin D supplements can help prevent osteoporosis.
Talk to your physician and make sure that you are getting enough iodine. Iodine is important for proper thyroid function.
Doing weight-bearing exercises (such as running, dancing, weightlifting) while getting enough iodine and a normal thyroid gland can help prevent osteoporosis.
Make sure you are getting enough magnesium. Magnesium plays an important role in activating Vitamin D and Calcium absorption.
Hormone therapy may help female patients with low estrogen levels. Patients can also take estrogen supplements.
Watch out for signs of osteoporosis such as: limp, muscular, and joint pain; difficulty walking; and back, shoulder, or hip pain. When you experience these signs, make sure to consult a physician.
Estrogen supplements are a common treatment for menopause related amenorrhea.
Over-the-counter and prescription weight gain supplements are recommended for underweight patients.
If you suspect that your child is suffering from female athlete triad, make sure you seek medical attention immediately. It is important that your child’s nutrition and physical activity needs are met.
If your child is involved in sports or exercise, it is important that coaches and other staff are educated about female athlete triad. It is important that everybody is educated about the dangers of female athlete triad.
Educate yourself and your family about the risks of female athlete triad.
As a parent, you can encourage your teen to engage in other activities that can help them stay fit and active such as: dance, swimming, biking, yoga, etc.
Make sure your child is fully aware of the importance of good nutrition and getting enough rest. Encourage them to eat well-balanced meals and make sure to get enough sleep every night.
Make sure your child is getting enough calcium and Vitamin D. Teach them ways that they can increase their calcium intake such as through milk, yogurt, and other dairy products.
Sources & references used in this article:
Treatment strategies for the female athlete triad in the adolescent athlete: current perspectives by J Thein-Nissenbaum, E Hammer – Open access journal of sports …, 2017 – ncbi.nlm.nih.gov
The IOC consensus statement: beyond the female athlete triad—relative energy deficiency in sport (RED-S) by M Mountjoy, J Sundgot-Borgen, L Burke… – British journal of sports …, 2014 – bjsm.bmj.com
2014 Female Athlete Triad Coalition Consensus Statement on treatment and return to play of the female athlete triad: 1st International Conference held in San … by MJ De Souza, A Nattiv, E Joy, M Misra… – British journal of sports …, 2014 – bjsm.bmj.com
Update on the female athlete triad by MT Barrack, KE Ackerman, JC Gibbs – Current reviews in musculoskeletal …, 2013 – Springer
2014 female athlete triad coalition consensus statement on treatment and return to play of the female athlete triad by E Joy, MJ De Souza, A Nattiv, M Misra… – Current sports …, 2014 – journals.lww.com
Disordered eating and the female athlete triad by CF Sanborn, M Horea, BJ Siemers, KI Dieringer – Clinics in sports medicine, 2000 – Elsevier
The female athlete triad: the inter-relatedness of disordered eating, amenorrhea, and osteoporosis by A Nattiv, R Agostini, B Drinkwater… – Clinics in sports …, 1994 – sportsmed.theclinics.com