I wanted to take this time to discuss this phenomenon that has had a significant impact on female athletes over the last few decades for a number of reasons:
1. The increase in the number of women diagnosed with having the female athlete triad has increased annually. It is not known how many additional women are undiagnosed at this time.
2. Western society has placed a strong emphasis on an "ideal" feminine figure which is difficult to near-impossible to attain without harming your body.
3. The New Year is approaching and with that comes the resolutions to achieve the body image standard that Western society has set. I believe that crash diets and excessive exercise programs are at one of the highest levels of use at this time of year. Many women will jump into these programs with both feet because they view the New Year as a clean slate, fresh start, etc.
So, what is the female athlete triad and what are the three interrelated conditions that make the triad complete?
The female athlete triad is a spectrum disorder that involves issues with bone health, the menstrual cycle and energy availability. The three cardinal signs of the triad are dysfunctional energy availability due to disordered eating, amenorrhea (missing three consecutive non-pregnancy related periods), and osteopenia or osteoporosis (decreased bone density) . The signs and symptoms of this disorder can vary widely from one woman to the next depending on their diet and exercise habits.
It is not known exactly how many women currently have the triad but studies have shown that 15-62% of female collegiate athletes have disordered eating habits and 3.4-66% of female athletes have amenorrhea. Determining the prevalence of decreased bone density is more difficult due to disagreement in measurement standards. Unfortunately most cases of osteopenia/osteoporosis are picked up after imaging studies have found signs of stress fracture.
The disordered eating habits of these female athletes may resemble anorexia nervosa, bulimia nervosa, or a combination of both and lead to unusually low body fat levels in these females. When a female's percentage of body fat drops below a certain level she is prone to both amenorrhea and bone density issues (osteoporosis/osteopenia).
It is ultimately an unusually low body fat level due to energy/calorie restriction that leads to the symptoms from the other two parts of the triad. It is this reason that women in sports that require high energy expenditure more commonly experience this spectrum of disorders.
A healthy female body fat percentage falls between 16-25% and is slightly less when talking about female athletes. When your current energy demands can't be met by the foods you eat, the body initially fuels your body with its fat stores. Once these stores start reaching abnormally low levels, the body looks to other sources of fuel such as muscle mass. So in an exercise/athletic context, disordered eating is both unhealthy in a general sense and it can also have a profound effect on your athletic performance.
Describing the physiologic processes of how disordered eating coupled with high intensity exercise actually effects both bone density and menstrual cycle is a little more complex and goes beyond the intent of this post. If you have any questions regarding this, feel free to message me.
Management of women with the triad is relatively complex and usually involves a health care team consisting of a physician with experience in managing eating disorders, a registered dietitian or nutritionist, a psychologist or psychiatrist, and a sports medicine professional.
I hope this post has sparked your interest. I simply wanted to bring to light one of the many problems plaguing modern day athletics. Please consider this information during the New Year - and any other time of the year for that matter. If you have ambitious goals this New Year, please consult a health care provider with regards to dietary and exercise advice to avoid the complications that could potentially arise from the behaviors mentioned above. I hope you have had a great Holiday.