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, amenorrheaamenorrhea, and
osteoporosisosteoporosis. A female athlete can have one, two, or all three
parts of the triad.
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.
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.
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.
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.
Participation in sports where a thin appearance is valued can also
put a girl at risk for female athlete triad. Sports such as gymnastics, figure
skating, diving, and ballet are examples of sports that value a thin, lean body
shape. Some girls may even be told by coaches or judges that losing weight
would improve their scores.
Even in sports where body size and shape aren't as important, such
as distance running and cross-country skiing, girls may be pressured by
teammates, parents, partners, and coaches who mistakenly believe that
"losing just a few pounds" could improve their performance.
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.
If a girl has risk factors for female athlete triad, she may already
be experiencing some symptoms and signs of the disorder, such as:
no periods or irregular periods
fatigue and decreased ability to concentrate
stress fractures (fractures that occur even if a person hasn't had a
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
brittle hair or nails
dental cavities because 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
An extensive physical examination is a crucial part of diagnosing
female athlete triad. A doctor at A+ clinic who thinks a girl has female
athlete triad will probably ask questions about her periods, her nutrition and
exercise habits, any medications she takes, and her feelings about her body.
Poor nutrition can also affect the body in many ways, so doctor at
A+ clinic might advise blood tests to check for anemia and other
problems associated with the triad. The doctor also will check for medical
reasons why a girl may be losing weight and missing her periods. Because
osteoporosis can put a girl at higher risk for bone fractures, the doctor may
also request tests to measure bone density.
Doctors don't work alone to help a girl with female athlete triad.
Coaches, parents, physical therapists, pediatricians and adolescent medicine
specialists, nutritionists and dietitians, and mental health specialists can
all work together to treat the physical and emotional problems that a girl with
female athlete triad faces.
It might be tempting for a girl with female athlete triad to shrug
off several months of missed periods, but getting help right away is important.
In the short term, she may have muscle weakness, stress fractures, and reduced
physical performance. Over the long term, she may suffer from bone weakness,
long-term effects on her reproductive system, and heart problems.
A girl who is recovering from female athlete triad may work with a
dietitian to help get to and maintain a healthy weight and ensure she's eating
enough calories and nutrients for health and good athletic performance.
Depending on how much the girl is exercising, she may have to reduce the length
of her workouts. Talking to a psychologist or therapist can help a girl deal
with depression, pressure from coaches or family members, or low self-esteem
and can help her find ways to deal with her problems other than restricting her
food intake or exercising excessively.
Some girls with female athlete triad may need to take hormones to
supply their bodies with estrogen so they can get their periods started again.
In such cases, birth control pills are often used to regulate the menstrual
cycle. Calcium and vitamin D supplementation is also common for a girl who has
suffered bone loss as the result of female athlete triad.
A girl with female athlete triad may try to hide it, but
she can't just ignore the disorder and hope it goes away. She needs to get
help from a doctor and other health professionals. If a friend, sister, or
teammate has signs and symptoms of female athlete triad, discuss your concerns
with her and encourage her to seek treatment. If she refuses to seek treatment,
you may need to mention your concern to a parent, coach, teacher, or school
You may worry about being nosy when you ask questions about a
friend's health, but you're not: Your concern is a sign that you're a caring
friend. Lending an ear may be just what your friend needs.
Tips for Female Athletes
Here are a few tips to help teen athletes stay on top of their
Keep track of your periods.
keep a calendar in your gym bag and mark down when your period starts and stops
and if the bleeding is particularly heavy or light. That way, if you start
missing periods, you'll know right away and you'll have accurate information to
give to your doctor.
Don't skip meals or snacks.
Girls who are constantly on the go between school, practice, and competitions
may be tempted to skip meals and snacks to save time. But eating now will
improve performance later, so stock your locker or bag with quick and easy
favorites such as bread, cheese, unsalted nuts and seeds, raw vegetables, and
Visit a dietitian or nutritionist who works with teen athletes.
He or she can help you get your dietary game plan into gear and determine if
you're getting enough key nutrients such as iron, calcium, and protein. And if
you need supplements, a nutritionist can recommend the best choices.
Do it for you.
Pressure from teammates, parents, or coaches can turn a fun activity into
a nightmare. If you're not enjoying your sport, make a change. Remember: It's
your body and your life. You — not your coach or teammates — will have to
live with any damage you do to your body now.