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The Female Athlete Triad

Apr 4, 2019 | The Pointe

By Fitness Manager Matt Struemph

As generations go by and athletics for adolescents being as competitive and intense as ever, it’s important to re-visit potential results of pushing our kids too much.  Self-driven youth (as well as those driven by coaches, parents, etc.) feel pressure to succeed.  For some adolescents this can lead to unhealthy decisions and overtraining.  For females there are common results from these unhealthy training practices.  The term “Female Athlete Triad” was coined and defined in 1993 to describe the three commonalities.

Disordered Eating:  This term covers a wide spectrum of unhealthy eating habits.  It covers disease level eating disorders such as anorexia and bulimia.  It also refers to consciously reducing food intake in the hopes of achieving a lean appearance or any binging and purging that may not reach disease status.  These types of eating habits are unhealthy by themselves, but especially when combined with athletic training.  Disordered eating also refers to the inadvertent failure to meet sufficient caloric intake while training.

Amenorrhea:  Menstrual dysfunction falls along a continuum in which menstrual cycles may be abnormally long to the extreme end, amenorrhea.  Amenorrhea is the absence of menstruation and is defined as primary or secondary.  Primary amenorrhea is the absence of the initial onset of menstruation in a 16 year old female with secondary sex characteristics.  Secondary amenorrhea is the absence of three or more menstrual cycles after the onset of menstruation.  Amenorrhea was originally thought to be a result of low body weight or body fat.  This may be a coincidence as more studies have illustrated that it has more to do with lack of nutrition.  When the body is not getting enough calories to support all of its functions, it will divert energy from       non-essential functions such as reproductive function.  Again, reducing calories to such a point is unhealthy by itself, but adding athletic training to the picture and the added energy needed for it, makes for a dangerous combination.  Another unfortunate aspect of this category is that some female athletes have the misconception that loss of menstruation is an unavoidable by-product of training or that it is a sign that training is sufficient.  The fact is amenorrhea is a sign that the body is not in a healthy, balanced state.

Osteoporosis:  Most know that osteoporosis is the deterioration of bone which leads to increased risk of bone fracture.  The connection to the triad is amenorrhea and how it severely affects bone density.  Amenorrhea leads to low concentrations of estrogen, which is needed to deposit calcium in bone.  While osteoporosis increases bone fracture risk for everyone, it is increased more so in an athlete participating in a high amount of physical activity.  Another unfortunate aspect is that the primary bone building years are from the teens to late 20’s.  Early deterioration of bone results in young athletes with “old bones”.  Although the behavioral cycle can be reversed, the loss of bone density can not.

The female athlete triad has been defined, but how to treat the condition is not as simple.  Because so much of the actions leading to the physical ailments is due to the athlete’s mental state and the misconceptions of an athlete’s training, treatment must include psychotherapy.  The best way to avoid the triad (like so many other physical ailments) is prevention.  Educating athletes, coaches, trainers, and parents in order to notice signs of overtraining and disordered eating is the first step.



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