athletic training female athlete triad

By Michael Cordas, Jr., DO

Studies have shown that teen girls who participate in athletic activities are healthier, get better grades and have higher self-esteem are less likely to smoke, use alcohol or take drugs than their peers who do not participate in sports. However, intense participation in competitive athletic activities can sometimes cause teen girls to develop a medical problem called female athlete triad.

What is female athlete triad?

Female athlete triad is a condition that can result from intense athletic training and an extremely disciplined diet. It is a combination of three interrelated conditions:

  • Disordered eating. Many female athletes attempt to lose weight or reduce body fat to improve their athletic performance. Disordered eating can range from not eating enough calories and avoiding certain “bad” foods to serious eating disorders such as anorexia and bulimia.
  • Menstrual disturbances (amenorrhea). Intense physical activity and extreme dieting can cause female athletes to experience irregular periods or, in some cases, not get their first period in the expected timeframe. Sometimes a girl’s period will stop completely due to decreases in the hormones that regulate her menstrual cycle.
  • Decreased bone density. Low calcium intake, poor nutrition and low estrogen levels can weaken a female athlete’s bones and cause symptoms of osteoporosis, which increases the risk of stress fractures and other injuries.

If left untreated, female athlete triad can cause stress fractures, reduced physical performance and other serious injuries. It can also do long-term damage to the heart and reproductive system and impact overall bone health.

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Who is at risk of female athlete triad, and why?

Female athlete triad is becoming increasingly common among active teen girls. Although many teenage girls are concerned about appearance, competitive sports can sometimes cause teens to become obsessed with their weight and athletic performance. As a result, many girls severely restrict their diets, which can cause menstrual disturbances and problems with bone development.

Girls who participate in sports such as gymnastics, running, figure skating or ballet may feel pressure to achieve an “ideal” thin and lean body shape, placing them at higher risk of developing female athlete triad. Girls who are involved in sports that divide participants by weight class, such as rowing or martial arts, may also be at higher risk. And any female athletes who have less than 12 percent body fat are at high risk of developing the condition.

What are the signs and symptoms of female athlete triad?

The signs and symptoms of female athlete triad include:

  • Weight loss
  • Fear of weight gain
  • Signs of eating disorders, such as laxative use
  • Menstrual disturbances, such as irregular or no periods
  • Fatigue
  • Decreased ability to concentrate
  • Stress fractures

What are possible treatment options for female athlete triad?

Because of the physical and emotional problems associated with female athlete triad, treatment may include consultation with coaches, athletic trainers, parents, physical therapists, sports medicine doctors, pediatricians, nutritionists or mental health specialists. Depending on the specific condition, treatment may include:

  • Working with a dietitian to increase caloric intake and maintain a healthy weight.
  • Reducing the intensity of physical training.
  • Talking to a psychologist or therapist to cope with competitive pressure, depression or low self-esteem.
  • Osteoporosis treatment, such as taking hormones to increase estrogen and prevent further bone loss.
  • Taking medicine for amenorrhea.
  • Receiving treatment for eating disorders, such as anorexia nervosa treatment or binge eating treatment.
  • Increasing calcium intake or taking calcium supplements.
  • Participating in physical therapy to help recover from injury.

How can you prevent female athlete triad?

In order to prevent female athlete triad, it is important to pay close attention to how your athletic training is affecting your body. If you observe a significant decrease in body fat or if your periods stop or become irregular, you should talk with your doctor. If your doctor suspects that you may be suffering from female athlete triad, he or she will conduct a physical exam and may order bone density or blood tests.

Other things you can do to prevent female athlete triad include:

  • Avoiding carbonated beverages, which can contribute to decreased bone density.
  • Increasing your calcium intake to 1,300 mg per day by eating calcium-rich foods.
  • Eating enough calories to keep your weight and body fat from dropping too low.
  • Not skipping meals and snacks.
  • Seeking help from a dietitian or nutritionist.
  • Seeking help from a therapist or psychologist to learn how to cope with competitive pressure.

If you or someone you love is experiencing the symptoms of female athlete triad, please consult with your primary care physician to see if a referral to a specialist at the PinnacleHealth Bone and Joint Center at UPMC Pinnacle is necessary.

About UPMC Harrisburg

UPMC Harrisburg is a nationally recognized leader in providing high-quality, patient-centered health care services in south central PA. and surrounding rural communities. UPMC Harrisburg includes seven acute care hospitals and over 160 outpatient clinics and ancillary facilities serving Dauphin, Cumberland, Perry, York, Lancaster, Lebanon, Juniata, Franklin, Adams, and parts of Snyder counties. These locations care for more than 1.2 million area residents yearly, providing life-saving emergency care, essential primary care, and leading-edge diagnostic services. Its cardiovascular program is nationally recognized for its innovation and quality. It also leads the region with its cancer, neurology, transplant, obstetrics-gynecology, maternity care, and orthopaedic programs.

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