Current Sports Medicine Reports

, Volume 6, Issue 6, pp 397–404

The female athlete triad: What’s a doctor to do?

Article

Abstract

Sports medicine physicians often encounter athletes with at least one component of the Female Athlete Triad—disordered eating, menstrual dysfunction, and altered bone mineral density. Recognizing these conditions early is critical because prolonged exposure can lead to serious, potentially irreversible, health consequences. Knowledge of the pathophysiology, detection, and treatment of these problems has evolved significantly. This review focuses on the newer scientific findings in this important area of women’s health. There remains a distinct lack of prospective epidemiologic data assessing prevalence and causes, and outcome studies on the efficacy of prevention and treatment of the Triad disorders. Nevertheless, the underlying message remains that participation in sports and physical activity benefits the long-term health of girls and women, and should be encouraged.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Otis CL, Drinkwater B, Johnson M, et al.: American College of Sports Medicine position stand. The Female Athlete Triad. Med Sci Sports Exerc 1997, 29:i–ix.PubMedGoogle Scholar
  2. 2.
    Nattiv A, Loucks AB, Manore MM, et al.: American College of Sports Medicine revised position stand on the Female Athlete Triad. Med Sci Sports Exerc 2007, 39:1867–1882.PubMedCrossRefGoogle Scholar
  3. 3.
    International Olympic Committee Medical Commission Working Group Women in Sport: Position stand on the Female Athlete Triad. Available at http://multimedia.olympic.org/pdf/en_report_917.pdf. Accessed May 4, 2007.
  4. 4.
    International Olympic Committee Medical Commission: IOC consensus statement on the Female Athlete Triad. Available at http://www.olympic.org/uk/organisation/commissions/medical/full_story_uk.asp?id=1540. Accessed August 24, 2007.
  5. 5.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 1994.Google Scholar
  6. 6.
    Loucks AB, Verdun M, Heath EM: Low energy availability, not stress of exercise, alters LH pulsatility in exercising women. J Appl Physiol 1998, 84:37–46.PubMedGoogle Scholar
  7. 7.
    Redman LM, Loucks AB: Menstrual disorders in athletes. Sports Med 2005, 35:747–755.PubMedCrossRefGoogle Scholar
  8. 8.
    De Souza MJ, Williams NI: Physiological aspects and clinical sequelae of energy deficiency and hypoestrogenism in exercising women. Hum Reprod Update 2004, 10:433–448.PubMedCrossRefGoogle Scholar
  9. 9.
    Kanis JA, Melton LJ III, Christiansen CC et al.: The diagnosis of osteoporosis. J Bone Miner Res 1994, 9:1137–1141.PubMedCrossRefGoogle Scholar
  10. 10.
    International Society for Clinical Densitometry Position Development Conference: Diagnosis of osteoporosis in men, premenopausal women and children. J Clin Densitom 2004, 7:17–26.CrossRefGoogle Scholar
  11. 11.
    Khan KM, Liu-Ambrose T, Sran MM, et al.: New criteria for the female athlete triad. Br J Sports Med 2002, 36:10–13.PubMedCrossRefGoogle Scholar
  12. 12.
    DiPietro L, Stachenfeld NS: The myth of the female athlete triad. Br J Sports Med 2006, 40:490–493.PubMedCrossRefGoogle Scholar
  13. 13.
    DiPietro L, Stachenfeld NS, Pierce JB: The female athlete triad myth. Med Sci Sports Exerc 2006, 38:795.PubMedCrossRefGoogle Scholar
  14. 14.
    Loucks AB: Refutation of “the myth of the female athlete triad.” Br J Sports Med 2007, 41:55–57.PubMedCrossRefGoogle Scholar
  15. 15.
    De Souza MJ, Alleyne J, Vescovi JD et al.: Correction of misinterpretations and misrepresentations of the female athlete triad. Br J Sports Med 2007, 41:58–59.PubMedCrossRefGoogle Scholar
  16. 16.
    Beals KA, Meyer NL: Female athlete triad update. Clin Sports Med 2007, 26:69–89.PubMedCrossRefGoogle Scholar
  17. 17.
    Beals KA, Manore MM: Disorders of the female athlete triad among collegiate athletes. Int J Sport Nutr Exerc Metab 2002, 12:281–293.PubMedGoogle Scholar
  18. 18.
    Nichols JF, Rauh MJ, Lawson ME, et al.: Prevalence of the Female Athlete Triad Syndrome among high school athletes. Arch Pediatr Adolesc Med 2006, 160:137–142.PubMedCrossRefGoogle Scholar
  19. 19.
    Torstveit MK, Sundgot-Borgen J: The female athlete triad exists in both elite athletes and controls. Med Sci Sports Exerc 2005, 37:1449–1459.PubMedCrossRefGoogle Scholar
  20. 20.
    Hoch AZ, Stavrakos JE, Schimke JA: Prevalence of Female Athlete Triad characteristics in a club triathlon team. Arch Phys Med Rehabil 2007, 88:681–682.PubMedCrossRefGoogle Scholar
  21. 21.
    Smolak L, Murnen Sk, Ruble AE: Female athletes and eating problems: a meta-analysis. Int J Eat Disord 2000, 27:371–380.PubMedCrossRefGoogle Scholar
  22. 22.
    Loucks AB, Thuma JR: Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women. J Clin Endocrinol Metab 2003, 88:297–311.PubMedCrossRefGoogle Scholar
  23. 23.
    Thong FS, McLean C, Graham TE: Plasma leptin in female athletes: relationship with body fat, reproductive, nutritional and endocrine factors. J Appl Physiol 2000, 88:2037–2044.PubMedGoogle Scholar
  24. 24.
    De Souza MJ, Leidy HJ, O’Donnell E et al.: Fasting ghrelin levels in physically active women: relationship with menstrual disturbances and metabolic hormones. J Clin Endocrinol Metab 2004, 89:3536–3542.PubMedCrossRefGoogle Scholar
  25. 25.
    Schneider LF, Warren MP: Functional hypothalamic amenorrhea is associated with elevated ghrelin and disordered eating. Fertil Steril 2006, 86:1744–1749.PubMedCrossRefGoogle Scholar
  26. 26.
    Practice Committee of the American Society for Reproductive Medicine: Current evaluation of amenorrhea. Fertil Steril 2006, 86(Suppl):S148–S155.Google Scholar
  27. 27.
    De Souza MJ, Van Heest J, Demers M, Lasley BL: Luteal phase deficiency in recreational runners: evidence for a hypometabolic state. J Clin Endocrinol Metab 2003, 88:337–346.PubMedCrossRefGoogle Scholar
  28. 28.
    Rickenlund A, Thorén M, Carlström K, et al.: Diurnal profiles of testosterone and pituitary hormones suggest different mechanism for menstrual disturbances in endurance athletes. J Clin Endocrinol Metab 2004, 89:702–707.PubMedCrossRefGoogle Scholar
  29. 29.
    Williams NI, Helmreich DL, Parfitt DB et al.: Evidence for a causal role of low energy availability in the induction of menstrual cycle disturbances during strenuous exercise training. J Clin Endocrinol Metab 2001, 86:5184–5193.PubMedCrossRefGoogle Scholar
  30. 30.
    Dueck CA, Matt KS, Manore MM: Treatment of athletic amenorrhea with a diet and training-intervention program. Int J Sport Nutr 1996, 6:24–40.PubMedGoogle Scholar
  31. 31.
    Dueck CA, Manore MM, Matt KS: The role of energy balance in athletic menstrual dysfunction. Int J Sport Nutr 1996, 6:165–190.PubMedGoogle Scholar
  32. 32.
    Zanker CL, Swaine LL: Relation between bone turnover, oestradiol, and energy balance in women distance runners. Br J Sports Med 1998, 32:167–171.PubMedGoogle Scholar
  33. 33.
    Ilhe R, Loucks AB: Dose-response relationships between energy availability and bone turnover in young exercising women. J Bone Miner Res 2004, 19:1231–1240.CrossRefGoogle Scholar
  34. 34.
    Sundgot-Borgen J: Disordered eating. In The Female Athlete Edited by Ireland ML, Nattiv A, eds. Philadelphia: Saunders; 2002:242–243.Google Scholar
  35. 35.
    Sundgot-Borgen J: Risk and trigger factors for the development of eating disorders in female athletes. Med Sci Sports Exerc 1994, 4:414–419.Google Scholar
  36. 36.
    American Dietetic Association: Position of the American Dietetic Association: nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa and other eating disorders. J Am Diet Assoc 2006, 106:2073–2082.CrossRefGoogle Scholar
  37. 37.
    Manore MM: Dietary recommendations and athletic menstrual dysfunction. Sports Med 2002, 32:887–901.PubMedCrossRefGoogle Scholar
  38. 38.
    Casper RC: How useful are pharmacological treatments in eating disorders? Psychopharmacol Bull 2002, 36:88–104.PubMedGoogle Scholar
  39. 39.
    Master-Hunter T, Heiman DL: Amenorrhea: evaluation and treatment. Am Fam Physician 2006, 73:1374–1382, 1387.PubMedGoogle Scholar
  40. 40.
    Zeni Hoch A, Dempsey RL, Carrera GF, et al.: Is there an association between athletic amenorrhea and endothelial cell dysfunction? Med Sci Sports Exerc 2003, 35:377–383.PubMedCrossRefGoogle Scholar
  41. 41.
    Rickenlund A, Eriksson MJ, Schench-Gustafsson K, Hirschberg A: Amenorrhea in female athletes is associated with endothelial dysfunction and unfavorable lipid profile. J Clin Endocrinol Metab 2005, 90:1354–1359.PubMedCrossRefGoogle Scholar
  42. 42.
    Rickenlund A, Eriksson MJ, Schenck-Gustafsson K, Hirschberg AL: Oral contraceptives improve endothelial function in amenorrheic athletes. J Clin Endocrinol Metab 2005, 90:3162–3167.PubMedCrossRefGoogle Scholar
  43. 43.
    Eyre DR: Bone biomarkers as tools in osteoporosis management. Spine 1997, 22(Suppl):17S–24S.PubMedCrossRefGoogle Scholar
  44. 44.
    Leib ES: Treatment of low bone mass in premenopausal women: when may it be appropriate? Curr Osteoporos Rep 2005, 3:13–18.PubMedCrossRefGoogle Scholar
  45. 45.
    Liu SL, Lebrun CM: Effect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: a systematic review. Br J Sports Med 2006, 40:11–24.PubMedCrossRefGoogle Scholar
  46. 46.
    Hergenroeder AC: Bone mineralization, hypothalamic amenorrhea, and sex steroid therapy in female adolescents and young adults. J Pediatr 1995, 5(Part 1):683–689.Google Scholar
  47. 47.
    Rumball JS, Lebrun CM: Preparticipation physical examination: selected issues for the female athlete. Clin J Sport Med 2004, 14:153–160.PubMedCrossRefGoogle Scholar
  48. 48.
    American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine: Preparticipation Physical Evaluation, edn 3. Minneapolis: McGraw-Hill; 2004.Google Scholar
  49. 49.
    DePalma MT, Koszewski WM, Romani W, et al.: Identifying college athletes at risk for pathogenic eating. Br J Sports Med 2002, 36:45–50.PubMedCrossRefGoogle Scholar
  50. 50.
    Black DR, Larkin LJS, Coster DC, et al.: Physiological screening test for eating disorders/disordered eating among female collegiate athletes. J Athl Train 2003, 38:285–297.Google Scholar

Copyright information

© Current Medicine Group LLC 2007

Authors and Affiliations

  1. 1.Glen Sather Sports Medicine Clinic, E-05 Van Vliet CentreUniversity of AlbertaEdmontonCanada

Personalised recommendations