Female Athlete Triad

What is the female athlete triad?

The female athlete triad is a condition that may affect women who exercise too much or play sports. It is a combination of three health problems. These health problems include disordered eating, amenorrhea, and low bone density. When a person has abnormal eating patterns or behaviors it is called disordered eating . Amenorrhea is a condition where menstrual (monthly) periods stop or become irregular. Low bone density leads to osteopenia or osteoporosis where the bones become weak and thin. Women affected with the female athlete triad may have problems exercising and with their sports performance. The female athlete triad may result in long-term damage to a woman's health that may lead to an early death.

What causes the female athlete triad?

The female athlete triad occurs when a female athlete does intense training and has a strict diet. She may focus too much on being thin or lightweight to help her performance. You can have one, two, or all three problems of the female athlete triad:

  • Disordered eating: Abnormal eating habits include eating too little, not eating for long periods of time, or following crash diets. Some female athletes may also have any of the following serious eating disorders:

    • Anorexia nervosa: This type of eating disorder has a fear of becoming fat. You feel unhappy about the way your body looks. You may see yourself as a fat person, or are afraid that you are fat even if you are very thin. You may spend much of your time thinking about food and dieting. You may also exercise too much to keep from gaining weight.

    • Bulimia: This is another serious eating disorder where there is binge eating and purging. Binge eating happens when a person cannot control eating large amounts of food. This is followed by feelings of guilt and depression. To cope with these feelings, you make yourself sick. This is done by purging where you force yourself to vomit (throw up). Other people may use laxatives, diuretics (water pills), diet pills, or enemas to prevent weight gain.

  • Amenorrhea: As you eat less and undergo intense sports training, your body may lose too much weight. This decreases the amount of the hormone estrogen in the body which regulates the monthly period. When this happens, your monthly period may stop, become irregular, or never start at all.

  • Low bone density: Poor nutrition, especially with a low calcium intake, and low estrogen levels in the body may lead to osteopenia and osteoporosis. Osteopenia is lower bone density than normal. With osteoporosis, the bone loss is greater and the weak and brittle bones are more likely to fracture (break).

What increases the risks of having the female athlete triad?

Females who do not eat enough and exercise a lot may develop one or more problems of the triad. Some female athletes believe that dieting and training hard may help them lose weight easily. They think that being thin and underweight may improve their performance and scores. The following may increase the risks of having the female athlete triad:

  • Being too goal-oriented and competitive. You may not have time for your family and friends because of too much practice.

  • Believing that everything must be perfect and that there is no room for mistakes. Some parents or coaches may even push athletes to win even through illness or injury.

  • History of mental disorder or physical or sexual abuse, or having a family history of eating disorders.

  • Sports in which sexy or fitted clothing, such as swimsuits, bikinis, or shorts, are worn. These include swimming, volleyball, diving, and running.

  • Sports that demand a lean or thin appearance of the athletes, such as figure skating, gymnastics, and ballet.

  • Sports that test an athlete's endurance (power to keep up with stress), such as distance running, cycling, or cross-country skiing.

  • Sports where body weight is important, such as wrestling, horse racing, martial arts, and rowing.

What are the signs and symptoms of the female athlete triad?

Signs and symptoms of the female athlete triad may begin with having abnormal eating habits. You may also have any of the following:

  • Abrasions (small scratches) or bite marks at the back of the hand. You may have marks from your teeth when you are forcing yourself to vomit.

  • Dry, cracked skin and thinning hair. There may be fine and downy (soft and weak) hair covering your body.

  • Fatigue (feeling more tired than usual).

  • Frequent or unexplained injuries, such as stress fractures. Bones may break after a sudden strain, bump, or fall.

  • Irregular or no monthly periods.

  • Too much weight loss.

  • Trouble concentrating (thinking) or mood changes.

How is the female athlete triad diagnosed?

Your caregiver will take a detailed health history from you. This may include information on your eating behavior, exercise habits, monthly periods, and injuries. He may need to learn how well you are doing in your sports. He may also want to know if you have problems with the way you look or feel about yourself. You may have to take different tests or rating scales to learn more about your eating problem. You may also need any of the following:

  • Abdominal ultrasound: This test is done so caregivers can see the tissues and organs of your abdomen. Gel will be put on your abdomen and a small sensor will be moved across your abdomen. The sensor uses sound waves to send pictures of your abdomen to a TV-like screen.

  • Blood and urine tests: Samples of your blood and urine are sent to a lab for tests. These tests measure the amount of hormones and other chemicals in your body.

  • Bone density scan: This test is also called dual-energy x-ray absorptiometry (DXA or DEXA) or bone densitometry. It uses a special x-ray to take pictures of your bones and measure the amount of bone density.

How is the female athlete triad treated?

Treatment is aimed at all the conditions of female athlete triad. Caregivers will teach you the correct way to keep your ideal body weight with good exercise and proper nutrition. They will help you accept that you may have an eating disorder and learn to control it. Caregivers will also work with your family, friends, coaches, or teammates. These will help them know how to cope with your condition. You may also need any of the following:

  • Diet: It is important that you get good nutrition and eat a variety of healthy foods every day. Your diet should include fruits, vegetables, breads, dairy products, iron, and protein (such as chicken, fish, and beans). Eating healthy foods may help you feel better and have more energy. A special diet may be given to you depending on your condition.

  • Medicines: Caregivers may give you medicines to treat your eating disorder, amenorrhea, or low bone density. These include medicines that help prevent bone loss, and increase bone mass which can decrease the risk of stress fractures. You may also be given medicines to relieve your other symptoms, such as an abnormal heartbeat, depression, or vomiting.

  • Counseling and therapies:

    • Nutrition counseling: A caregiver, called a dietitian or nutritionist, may talk to you and your coach or family members about nutrition. The best diet for you may depend on your weight, age, sport activities, and other factors. Your dietitian plans and adjusts the amount of food that you need. He may teach you the right nutrition your body needs. He may also help you have and keep an ideal body weight. Ask your caregiver for more information on the best diet and weight for you. .

    • Cognitive therapy: With a therapist, you will learn how to control your actions and improve your behavior. This is done by teaching you how to change your behavior by looking at the results of your actions. You may also need to know how to cope with situations which make you develop eating problems.

    • Psychotherapy: This is also called talk therapy. Meetings or talks may be held for you and your family. Your coaches, teammates, or people who are close to you may also be asked to attend these meetings. These meetings can help everyone better understand the female athlete triad.

How can the female athlete triad be prevented?

Education is the best way to prevent the female athlete triad. The following tips may help prevent the female athlete triad:

  • Be well informed and learn more about the female athlete triad. You, your coach, trainers, and teammates should be aware of the female athlete triad. Proper nutrition, safe training exercises, and knowing the dates of your monthly menstrual cycle are also important. The more you know about the female athlete triad, the better you will be able to help yourself and your team. Ask your caregiver how to learn more about the female athlete triad, and meet with other women who are recovering from the female athlete triad to help yourself.

  • Do not be afraid to ask for help at any time. Talk to your coach, trainers, friends, or family if you have problems with your sports or health. You may visit a dietitian if you need help with meal planning. Weight loss or gain should be guided by a caregiver.

  • Do not compare yourself to others. Learn to like yourself. Ideal body weight, sports performance, and health status are different for everyone. Try to choose your friends or role models with healthy body images and eating habits. Coaches, trainers, teammates, or family members should avoid pressuring athletes to diet and lose weight.

  • Eat a healthy diet: Eating healthy foods may help you feel better and have more energy. Eat a diet that is high in calcium, iron, and protein. Calcium is found in dairy products such as milk, cheese, and yogurt. Iron is found in red meat and certain vegetables. Protein is found in chicken, fish, meats, and beans. Also include fruit, colorful vegetables, pasta, rice and bread in your diet. You may need to use vitamins and minerals if you are not getting enough nutrients in your food. Avoid skipping meals or even snacks. Ask your caregiver for more information about the best eating plan for you.

  • Monitor your weight and monthly period. You or a caregiver may need to check your weight regularly. Write down your monthly period schedule. Keeping track of your menstrual periods can help check the number of days between cycles.

Where can I find support and more information?

The female athlete triad may be a life-changing condition for you and your family. Accepting that you have the female athlete triad is hard. You and those close to you may feel scared, angry, or sad. These are normal feelings. Talk to your caregivers, family, or friends about your feelings. You may also want to join a support group with other women having similar conditions. Contact the following for more information:

  • American Academy of Family Physicians
    11400 Tomahawk Creek Parkway
    Leawood , KS 66211-2680
    Phone: 1- 913 - 906-6000
    Phone: 1- 800 - 274-2237
    Web Address: http://www.aafp.org
  • The National Women's Health Information Center
    8270 Willow Oaks Corporate Drive
    Fairfax , VA 22031
    Phone: 1- 800 - 994-9662
    Web Address: http://www.womenshealth.gov

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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