Female Athlete Triad - An Overview

Introduction:

Sports and exercise are essential for girls and women to be healthier. Athletes being thin eat too little or exercise too much, which causes long-term damage to health. It also affects athletic performance, and it becomes necessary to stop doing physical activity. This leads to the development of interrelated illnesses in women or young athletes- the female athlete triad.

What Is the Female Athlete Triad?

The female athlete triad consists of amenorrhea (absence of menstruation), improper eating, and osteoporosis (condition of weak and brittle bones). This condition often goes unrecognized. Early recognition can be made by a family physician through risk factors and screening.

• Disordered Eating: Females are more likely to develop disordered eating. Disordered eating is preoccupied with body shape and weight and has poor nutrition. It can be of any form. Some people starve themselves, and some people engage in overeating and purging. Some people will restrict the quantity of food intake for a longer period and some misuse diet pills. Individuals with disordered eating will exercise more to reduce their weight. These persons will have complex disturbances in eating habits. This illness causes problems like dehydration, muscle fatigue and weakness, irregular heartbeat, kidney disorders, and other serious conditions.

• Amenorrhea: Amenorrhea or the absence of menstruation due to poor nutrition intake, higher energy demands, physical and emotional stress, and low body fat. Missing two or three periods should be a concern. During normal menstruation, the body produces the estrogen hormone that makes the bones stronger. During this condition, the bone loses its density and strength. When it affects younger people, it will be difficult in their older age after menopause. Also, normal menstruation is essential for pregnancy.

• Osteoporosis: Osteoporosis causes the bones to become weak and brittle. This is due to low bone mineral density. Menstrual dysfunction alters the body's bone-building capacity, thus weakening the skeleton and making the bones more prone to fractures.

What Are the Symptoms of the Female Athlete Triad?

There are several clinical manifestations of female athlete triads and mentioned below are a few of them.

• Irregular periods.

• Low body mass index.

• Stress fractures (crack in bones).

• Sports injury causing bone fractures.

What Is the Mechanism Behind the Female Athlete Triad?

Doing a lot of exercises and reducing the intake of calories decreases the estrogen hormone levels- which are responsible for maintaining the menstrual cycle. Also, low estrogen levels, poor diet, and reduced vitamin D and calcium levels lead to brittle and weak bones.

What Are the Risk Factors?

• Frequent weigh-ins.

• Weight gain.

• Pressure to win at all costs.

• More involvement in sports.

• Social perpetuation of the ideal body image- thin psyche.

Who Is Affected by the Female Athlete Triad?

• Athletes who play sports such as gymnastics, dancing, cheerleading, figure skating, distance running, and rowing.

• Individuals who focus on one sport at a time.

• Too much training.

• Dieting and feeling pressure to lose weight.

• Problems in the family.

How to Diagnose?

The physician will come to a conclusion about the female athlete triad- when the individual has weight loss, menstruation problems, and stress-related bone fractures. A regular yearly checkup associated with filling up the questionnaire asked by the physician will help to diagnose the condition. The physician may suggest a blood test, electrocardiogram (ECG), and bone density testing.

• Blood Test: To check for anemia (decrease in red blood cell count), low vitamin D levels, and other nutrition problems.

• Electrocardiogram: To check for irregular heartbeats in athletes with eating disorders.

• Bone Density Testing: Bone health is measured using dual-energy radiographic absorptiometry (DEXA or DXA) scan. This is done to identify stress fractures.

How to Treat the Female Athlete Triad?

Specialists to Treat: A team of doctors, nutritionists, mental health specialists, and athletic trainers work together to treat the female athlete triad.

The Goal of the Treatment: The aim of the treatment is to restore balanced weight, bring back the menstrual cycle, and improve bone density. Female athletes are trained to eat well to support their exercise schedule. Mental health specialists help athletes to overcome eating disorders.

Treatment Plan: The treatment plan includes:

• Eating more calories.

• Doing minimal physical activity so that calories burned out will be low.

• Incorporating vitamin D and calcium supplements into the diet.

• Lifestyle Changes: The dietician will educate and monitor the athlete for adequate nutrition and also helps to attain and maintain a goal weight. The athlete need not stop doing exercises. Exercising should be reduced to twenty percent, and weight gain should be monitored for two to three months.

• Hormonal Replacement Therapy: It regulates menstruation by taking oral contraceptives and is done only on a required basis. But they are not beneficial in treating the female athlete triad.

• Family Involvement: Involving family members in treating the female athlete triad is crucial for the success of the treatment.

What Are the Precautionary Measures to Be Followed?

• Tracking the Menstrual Cycle: It is normal to miss periods once in a while. But consult a physician when an individual has missed periods often, had regular periods before and missing periods now, and never had a period when an individual is fifteen years or older.

• Not Skipping Meals: Compared to a normal individual, athletes need more energy. Should take three meals a day followed by one to two healthy snacks.

• Taking Guidance From a Sports Nutritionist: The sports nutritionist will guide the athlete to get the right amount of calorie intake and also key nutrients like calcium, vitamin D, and protein. Proper nutrition helps to enhance sports performance.

• Taking Appropriate Breaks: Appropriate breaks are necessary for the athlete to prevent injury and reduce burnout at least one day a week and at least three months a year. It is mandatory to do physical activity, even during break times but with a little fun.

Conclusion:

Following the proper diet and changing the frequency of exercise may result in a natural return of the menses cycle. Loss of bone density can be prevented by hormone replacement therapy. A combined effort of physicians, athletes, coaches, and parents helps in the recognition and prevention of the female triad. Increased education among them helps in reducing life-threatening illnesses among athletes.