Sports Medicine

Female Athlete Triad

• What Is It?
• Risk Factors
• How to Keep It from Happening to You

What Is It?

In 1992, the American College of Sports Medicine described the term ‘Female Athlete Triad’ as a syndrome which included:

a) disordered eating (inadequate calorie intake to meet the body’s needs),
b) amenorrhea (lack of menstrual periods), and
c) osteoporosis (weakening of the bones).

It was noted that there was a rapid increase in this set of problems in young, otherwise healthy females. Amenorrhea is defined as the lack of menstrual periods. The decreased estrogen levels (female hormones) associated with the absence of a period may be the cause of premature osteoporosis in female athletes. Osteoporosis is defined as the loss of bone mineral density and the inadequate formation of bone, which can lead to bones that are brittle and break easily. If you don't have periods for more than three to four months, it can hurt your bone strength. You start to lose strength in your bones after only a few months with no periods.

The three components of the “Female Athlete Triad” are of growing concern, especially due to the increasing societal pressure placed on adolescent girls to maintain an “ideal” body weight. In fact, many sports easily lend themselves to further increasing the pressure that girls feel to be thin (i.e., gymnastics, figure skating, ballet, distance running). Unfortunately, some female athletes restrict the amount of calories they eat to dangerously low levels in order to keep their body weight down. In some cases, female athletes may even develop eating disorders such as bulimia (eating and vomiting) and anorexia nervosa (eating dangerously small amounts of food or avoiding food all together). These are potentially fatal diseases if gone undetected.

When coupled with the stress of athletic participation, the problems associated with an eating disorder can be magnified and significantly increase the long-term risk of problems for the individual. Problems such as low bone mineral density, foot and leg stress fractures, hip fractures, vertebral compression fractures, and an inability to bear children have all been documented in these situations.

Risk Factors

Risk factors for the Female Athlete Triad include (American Academy of Family Physicians, 2000):

• Being a competitive athlete
• Playing sports that require you to check your weight often
• Not having time to spend with your friends because your sport takes up all your free time
• Exercising more than is necessary for your sport
• Being pushed by your coach or your parents to win at all costs

How to Keep It from Happening to You

• Eat a nutritious, well-balanced diet
• Exercise in moderate amounts
• Tell your doctor about any changes in your periods

Information Provided by Jeffrey M. Anderson, M.D., director of sports medicine and team physician for the University of Connecticut Athletic Department. He is also assistant clinical professor of family medicine at the UConn Health Center in Farmington. He completed a family practice residency and sports medicine fellowship at the University of Connecticut School of Medicine.

Reprinted from Connecticut Medicine, Vol.11(6), 1999.