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What Is Female Athlete Triad?

Sports and exercise are part of a balanced, healthy lifestyle. Girls who play sports are healthier; get better grades; are less likely to experience depression; and use alcohol, cigarettes, and drugs less frequently than girls who aren't athletes. But for some girls, not balancing the needs of their bodies and their sports can have major consequences.

Some girls who play sports or exercise intensely are at risk for a problem called female athlete triad. Female athlete triad is a combination of three conditions: disordered eating, amenorrhea, and osteoporosis. A female athlete can have one, two, or all three parts of the triad.

Triad Factor #1: Disordered Eating

Most girls with female athlete triad try to lose weight primarily to improve their athletic performance. The disordered eating that accompanies female athlete triad can range from avoiding certain types of food the athlete thinks are "bad" (such as foods containing fat) to serious eating disorders like anorexia nervosa or bulimia nervosa.

Triad Factor #2: Amenorrhea

Because a girl with female athlete triad is simultaneously exercising intensely and not eating enough calories, she may experience decreases in estrogen, the hormone that helps to regulate the menstrual cycle. As a result, a girl's periods may become irregular or stop altogether. Of course, it's normal for teen girls to occasionally miss periods, especially in their first year of having periods. A missed period does not automatically mean a girl has female athlete triad. It could mean something else is going on, like pregnancy or a medical condition. If you are having sex and miss your period, talk to your doctor.

Some girls who participate intensively in sports may never even get their first period because they've been training so hard. Other girls may have had periods, but once they increase their training and change their eating habits, their periods may stop.

Triad Factor #3: Osteoporosis

Low estrogen levels and poor nutrition, especially low calcium intake, can lead to osteoporosis, the third aspect of the triad. Osteoporosis is a weakening of the bones due to the loss of bone density and improper bone formation. This condition can ruin a female athlete's career because it may lead to stress fractures and other injuries.

Usually, the teen years are a time when girls should be building up their bone mass to their highest levels — called peak bone mass. Not getting enough calcium during the teen years can also have a lasting effect on how strong a girl's bones are later in life.

Who Gets Female Athlete Triad?

Most girls have concerns about the size and shape of their bodies, but girls who develop female athlete triad have certain risk factors that set them apart. Being a highly competitive athlete and participating in a sport that requires you to train extra hard is a risk factor.

Girls with female athlete triad often care so much about their sports that they would do almost anything to improve their performance. Martial arts and rowing are examples of sports that classify athletes by weight class, so focusing on weight becomes an important part of the training program and can put a girl at risk for disordered eating.

Participation in sports where a thin appearance is valued can also put a girl at risk for female athlete triad. Sports such as gymnastics, figure skating, diving, and ballet are examples of sports that value a thin, lean body shape. Some girls may even be told by coaches or judges that losing weight would improve their scores.

What Are the Signs and Symptoms?

If a girl has risk factors for female athlete triad, she may already be experiencing some symptoms and signs of the disorder, such as:

  • weight loss
  • no periods or irregular periods
  • fatigue and decreased ability to concentrate
  • stress fractures (fractures that occur even if a person hasn't had a significant injury)
  • muscle injuries

Girls with female athlete triad often have signs and symptoms of eating disorders, such as:

  • continued dieting in spite of weight loss
  • preoccupation with food and weight
  • frequent trips to the bathroom during and after meals
  • using laxatives
  • brittle hair or nails
  • dental cavities because in girls with bulimia tooth enamel is worn away by frequent vomiting
  • sensitivity to cold
  • low heart rate and blood pressure
  • heart irregularities and chest pain

Tips for Female Athletes

Here are a few tips to help teen athletes stay on top of their physical condition:

  • Keep track of your periods. It's easy to forget when you had your last visit from Aunt Flo, so keep a calendar in your gym bag and mark down when your period starts and stops and if the bleeding is particularly heavy or light. That way, if you start missing periods, you'll know right away and you'll have accurate information to give to your doctor.
  • Don't skip meals or snacks. Girls who are constantly on the go between school, practice, and competitions may be tempted to skip meals and snacks to save time. But eating now will improve performance later, so stock your locker or bag with quick and easy favorites such as bagels, string cheese, unsalted nuts and seeds, raw vegetables, granola bars, and fruit.
  • Visit a dietitian or nutritionist who works with teen athletes. He or she can help you get your dietary game plan into gear and determine if you're getting enough key nutrients such as iron, calcium, and protein. And if you need supplements, a nutritionist can recommend the best choices.
  • Do it for you. Pressure from teammates, parents, or coaches can turn a fun activity into a nightmare. If you're not enjoying your sport, make a change. Remember: It's your body and your life. You — not your coach or teammates — will have to live with any damage you do to your body now.

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