Exercise in general is very beneficial. It helps improve cardiovascular health, reduce stress, helps with weight maintenance as well as overall quality of life. And yet it can play a role, or be a trigger, for a combination of health issues called the Female Athlete Triad.
This syndrome, which includes disordered eating, menstrual dysfunction, and reduced bone mineral density, can be present in female athletes of all levels; from high school girls just joining the gym or a team, to elite adult athletes. It occurs when, whether intentional or not, there is a lower calorie intake than what the body needs to support increased activity, particularly in adolescents when the body has a heightened need for growth and maturation.
Reduction of calories may occur because a newbie athlete may not know how to fuel their workouts appropriately and how many calories they need to support good health and optimal performance. On the other hand, the pressure of being a certain physique (read: thin), may cause the athlete to control their intake, even becoming anxious of eating certain foods they’ve proclaimed as ‘bad’. This controlled eating may be anywhere on the disturbed eating spectrum, from disordered eating to a full blow eating disorder.
Some sports – such as gymnastics, ice skating, ballet/dance, and endurance running or cycle – emphasize a smaller physique, putting remarkable pressure on a female athlete to restrict their food intake.
Menstrual dysfunction is when menstruation does not happen on a consistent cycle. It may be too short, too long, or may stop all together. Some athletes think missing their period means their training well; but in reality this should not be happening at all. The causes of menstrual dysfunction aren’t completely understood, but may be from a variety of factors from eating too few calories, to too rigorous an athlete training schedule.
Reduced bone mineral density is when the bone is not as strong as it should be, and is a stepping stone to osteoporosis. Causes include low estrogen (if the female has irregular or nonexistant periods), low body weight, or insufficient nutrient intake; particularly of protein, calcium, and vitamin D. Bone mineral density reaches it’s peak during adolescents and young adulthood, and if there are problems accruing enough bone during this time, a girl may never reach her full bone mineral density, leaving her more prone to fractures, breaks, and osteoporosis as an adult.
Prevention, Screening, and Treatment
Prevention of the triad is key. Athletes, coaches, and parents should be educated on healthy eating habits and caloric needs for their sports, as well as good fueling techniques before, during, and after exercise.
The biggest warning sign, which should be screened for, is irregular or absent menstruation. Another red flag is sustaining stress fractures or low impact fractures – at which point the Female Athlete Triad has progressed to a more serious state.
Treatment should include a team approach involving a physician, registered dietitian, and for those with a more serious eating disorder, a mental health practitioner. Of course coaches and parents should be involved in management as well.
At-risk athletes, and those who have already been diagnosed, should be referred to a dietitian for a dietary assessment and recommendation. Ongoing treatment and check-ins should be conducted by the team to ensure the athlete continues to improve, and eligibility to participate in athletic activities should be determined on an individual basis. If improvements are not made, the athlete may need to be taken out of training completely.
Along with dietary changes, weight bearing exercises such as free weights and other resistant exercise can help improve bone mineral density.