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The female athlete triad is defined as the combination of disordered eating, amenorrhea and osteoporosis. This disorder often goes unrecognized. The consequences of lost bone mineral density can be devastating for the female athlete. Premature osteoporotic fractures can occur, and lost bone mineral density may never be regained. Early recognition of the female athlete triad can be accomplished by the family physician through risk factor assessment and screening questions. Instituting an appropriate diet and moderating the frequency of exercise may result in the natural return of menses. Hormone replacement therapy should be considered early to prevent the loss of bone density. A collaborative effort among coaches, athletic trainers, parents, athletes and physicians is optimal for the recognition and prevention of the triad. Increased education of parents, coaches and athletes in the health risks of the female athlete triad can prevent a potentially life-threatening illness. (Am Fam Physician 2000;61:3357-64,3367.)
According to Title IX of the Educational Assistance Act, any college that accepts federal funding must provide equal opportunities for women and men to participate in athletic programs. Last year marked the 25th anniversary of the passage of Title IX legislation, which dramatically increased the number of women who participate in sports at all competitive levels. Increased participation in exercise can result in a myriad of proven short- and long-term benefits. However, potential adverse health consequences are associated specifically with the overzealous female athlete. The family physician, who may recognize pathologic conditions that are related to exercise, usually has multiple opportunities to intervene.
Definitions and Prevalence
The female athlete triad is a combination of three interrelated conditions that are associated with athletic training: disordered eating, amenorrhea and osteoporosis. Patients with disordered eating may engage in a wide range of harmful behaviors, from food restriction to bingeing and purging, to lose weight or maintain a thin physique. Many athletes do not meet the strict criteria for anorexia nervosa or bulimia nervosa that are listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (Table 1), but will manifest similar disordered eating behaviors as part of the triad syndrome.'
Amenorrhea that is related to athletic training and weight fluctuation is caused by changes in the hypothalamus. These changes result in decreased levels of estrogen. Amenorrhea...