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Female Athlete Triad

What is the female athlete Triad?

Sports and exercise are part of a balanced, healthy lifestyle. Girls who play sports are healthier; get better grades; are less likely to experience depression; and use alcohol, cigarettes, and drugs less frequently than girls who aren't athletes. But for some girls, not balancing the needs of their bodies and their sports can have major consequences.

Some girls who play sports or exercise intensely are at risk for a problem called female athlete triad. Female athlete triad is a combination of three conditions: disordered eating, amenorrhea and osteoporosis. A female athlete can have one, two, or all three parts of the triad.

Triad Factor #1: Disordered Eating

Most girls with female athlete triad try to lose weight primarily to improve their athletic performance. The disordered eating that accompanies female athlete triad can range from avoiding certain types of food the athlete thinks are "bad" (such as foods containing fat) to serious eating disorders like anorexia nervosa or bulimia nervosa.

Triad Factor #2: Amenorrhea

Because a girl with female athlete triad is simultaneously exercising intensely and not eating enough calories, when her weight falls too low, she may experience decreases in estrogen, the hormone that helps to regulate the menstrual cycle. As a result, a girl's periods may become irregular or stop altogether. Of course, it is normal for teen girls to occasionally miss periods, especially in their first year of having periods. A missed period does not automatically mean a girl has female athlete triad. A missed period could mean something else is going on, like pregnancy or a medical condition. If you have missed a period and you are sexually active, talk to your doctor.

Some girls who participate intensively in sports may never even get their first period because they've been training so hard. Other girls may have had periods, but once they increase their training and change their eating habits, their periods may stop.

Triad Factor #3: Osteoporosis

Low estrogen levels and poor nutrition, especially low calcium intake, can lead to osteoporosis, the third aspect of the triad. Osteoporosis is a weakening of the bones due to the loss of bone density and improper bone formation. This condition can ruin a female athlete's career because it may lead to stress fractures and other injuries.

Usually, the teen years are a time when girls should be building up their bone mass to their highest levels — called peak bone mass. Not getting enough calcium during the teen years can also have a lasting effect on how strong a girl's bones are later in life.

Who Gets Female Athlete Triad?

Most girls have concerns about the size and shape of their bodies, but girls who develop female athlete triad have certain risk factors that set them apart. Being a highly competitive athlete and participating in a sport that requires you to train extra hard is a risk factor.

Girls with female athlete triad often care so much about their sports that they would do almost anything to improve their performance. Martial arts and rowing are examples of sports that classify athletes by weight class, so focusing on weight becomes an important part of the training program and can put a girl at risk for disordered eating.

The truth is, though, that losing those few pounds generally doesn't improve performance at all. People who are fit and active enough to compete in sports generally have more muscle than fat, so it's the muscle that gets starved when a girl cuts back on food. Plus, if a girl loses weight when she doesn't need to, it interferes with healthy body processes such as menstruation and bone development.

In addition, for some competitive female athletes, problems such as low self-esteem, a tendency toward perfectionism, and family stress place them at risk for disordered eating.

What Are the Signs and Symptoms?

If a girl has risk factors for female athlete triad, she may already be experiencing some symptoms and signs of the disorder, such as:

  • weight loss
  • no periods or irregular periods
  • fatigue and decreased ability to concentrate
  • stress fractures (fractures that occur even if a person hasn't had a significant injury)
  • muscle injuries

Girls with female athlete triad often have signs and symptoms of eating disorders, such as:

  • continued dieting in spite of weight loss
  • preoccupation with food and weight
  • frequent trips to the bathroom during and after meals
  • using laxatives
  • brittle hair or nails
  • dental cavities; in girls with bulimia, tooth enamel is worn away by frequent vomiting
  • sensitivity to cold
  • low heart rate and blood pressure
  • heart irregularities and chest pain

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