The Female Athlete Triad- Part 1

The female athlete triad is an important topic in sports medicine.  So what is the female athlete triad and why is it so important to know?  

A study providing a questionnaire to about 91 collegiate coaches in 2006 (Pantano, 2006) discovered that only 43% (39 coaches) could accurately list the components of the female athlete triad.  Therefore, as physical therapists it is extremely important for us to be able to recognize this triad when we are often spending a great deal of time with these female athletes during rehabilitation.  

The female athlete triad consists of three interrelated spectrums: low energy availability (with/without eating disorders, amenorrhea, and osteoporosis.

The American College of Sports Medicine (ACSM) has a long history of position statements that have continued to be revised as more evidence and research on the female athlete triad has come out.  Most recently in their 2007 position statement they stated:  
"Low energy availability (with or without eating disorders), amenorrhea, and osteoporosis, alone or in combination, pose significant health risks to physically active girls and women (Nattiv et al., 2007)."  

Low energy availability is one of the more recognizable components to this triad.  Research tells us that dietary energy intake - exercise energy expenditure = energy availability (amount of dietary energy remaining for other body functions post exercise) and when this energy availability is too low, physiological mechanisms reduce the amount of energy used for cellular maintenance, thermoregulation, growth, and reproduction.  Interestingly enough, in a study from 2003, the most common causes for the negative energy balance for these female athletes was unintentional because of the training schedule and lifestyle (Papanek, 2003).  
As far as the amenorrhea component, knowing basic definitions will help you begin to understand.  Primary amenorrhea- delay in the age of menarche (15 years), Secondary amenorrhea- absence of menstrual cycles for more than 90 days, Oligomenorrhea- cycles at intervals longer than 35 days (4-9 cycles per year).  
Lastly, bone mineral density is an important component to be aware of.  Athletes in WB sports usually have 5-15% higher BMD than non-athletes. Therefore, looking into low BMD more closely in these female athletes, even in the absence of a prior fracture, is essential.  

So why is it critical to recognize these 3 key signs for female athlete triad?  Simply put, having this sustained negative energy balance is capable of starting a complicated surge of physiologic adaptations.  These adaptations may be necessary for survival of organs but may cause additional problems such as decreased healing rates or elimination of reproductive processes (menses).  

Hopefully this begins to give you a general overview of the main components of the female athlete triad and why it is important to look out for.  Part 2 will explain ideas on what to do when you recognize these signs and treatment for female athlete triad.  

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