Female Athlete Triad


By Mai Vu, Physical Therapist

We all have family, friends, neighbors who are females that participate in sports. Participation in athletic activity is a great thing, especially with obesity rates on the rise. This is especially true for children and adolescents. However, there is such a thing as over-doing it. One consequence of “over-doing” it is something called the female athlete triad.

The female athlete triad is a term that is used when the following three conditions exist: eating disorder, loss of menstruation (also referred to as amenorrhea), and bone loss (also referred to as osteopenia or osteporosis). If parents, coaches, and friends pressure the athlete to excel, this can contribute to the disorder. It can occur with athletes of any sport. However, females that participate in sports that encourage a lean physique are more likely to develop this disorder. Examples include gymnastics, cheerleading, diving, and dance.

Eating disorders
This is usually the first sign that there is a problem. This can be eating too little (anorexia) or binge eating that is followed by purging (bulimia). Purging can take place in different ways including vomiting, taking laxatives, or taking enemas.

Generally, it is considered abnormal when 3 menstrual cycles in a row are missed. This is usually due to a loss of body fat.

This is a loss of bone mineral density. This can happen due to malnutrition from the eating disorder.

The consequences are serious; the female athlete triad can lead to a permanent loss in bone density, resulting in an increased risk for fractures. Severe long-term cases can even be life threatening.

Warning signs:
Poor body image
Stress fracture
Dizziness when standing up quickly (also referred to as orthostatic hypotension)
Cold hands and feet
Weight fluctuations

This disorder is complicated, involving both emotional and physical aspects of the athlete. Parents, coaches, counselors, doctors, athletic trainers, and physical therapists should be on board when addressing the issue of the female athlete triad. Treatment includes diet modification, exercise modification, psychosocial support, and possibly hormone replacement therapy.

Recognition and prevention are they keys to avoiding permanent damage.

Here are some places to get more information:

NCAA Coaches Handbook

American Dietetic Association

Female Athlete Triad Coalition

Photo Credit: Dimodi

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