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The Female Athlete Triad

The Female Athlete Triad is a combination of amenorrhea (absence of periods), osteoporosis (weak bones), and disordered eating. This occurs when calorie intake does not provide enough energy for exercise-related use. This can lead to severe problems in a female’s reproductive, bone, and cardiovascular health. The athlete may have 1, 2, or all 3 components. Girls who are at the highest risk are participants in sports with endurance, aesthetic, or weight class components such as gymnastics, wrestling, dance, figure skating, cheerleading, long distance running, and pole vaulting. Female athletes require 45cal/kg of body weight daily. For example, a 120lb (54.5kg) athlete needs 2454 calories per day to meet her energy needs. Less than 30kcal/kg intake will disrupt menstrual function and bone mineralization.

Menstrual Function: Menstrual disturbances can be primary amenorrhea (no period by age 15), secondary amenorrhea (absence of periods for 3 consecutive months), or oligomenorrhea (cycles longer than 35 days).

Cardiovascular HealthAmenorrhea causes low estrogen levels, which can cause cardiac tissue dysfunction and elevated levels of total cholesterol and bad (low density lipoprotein) cholesterol. 

Bone Health: Adolescence is the critical time for building bone strength. The maximum rate of bone formation occurs from ages 10 to 14. Stress fractures are a common occurrence in these athletes.

With improved caloric intake, menses can resume and catch up bone mass may be possible. Periods may take up to a year or longer after normal calorie intake resumes. If weight loss is necessary for the athlete, seek medical assessment and nutrition supervision before starting a weight loss plan. It is important for athletes, coaches, and parents to realize that menstrual dysfunction and restricted calorie intake is not normal in athletes and may be detrimental to their health and athletic performance. If you are concerned that you or a family member may be suffering from Female Athlete Triad, please call our office to set up an appointment for more information and to discuss a treatment plan.   

Brian A Levitt, MD

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