September 17, 2021
By Saira Kothari, MS4, Drexel University College of Medicine
Athletes who menstruate are at high risk for developing decreased energy availability, menstrual dysfunction and low bone mineral density, a phenomenon known as the female athlete triad. People socialized as women in American society inherently face pressure to be lean. Athletes socialized as women face additional pressure for their bodies to look and function a certain way to excel in their sport, commonly causing weight loss due to disordered eating patterns in addition to frequent exercise. As the number of these athletes has increased over time, there has been an interrelationship of symptoms established in many of these women when compared to the general population . It is believed that the latter two components, menstrual dysfunction and low bone mineral density, result from the initial decrease in energy availability.
Decreased energy availability is determined from a patient’s dietary and exercise habits as well as physical characteristics such as weight, slow heart rate, poor dentition, thinning hair and several other signs providers can identify. Their dietary habits may reveal one of several eating disorders that can result from the social pressure to be at a certain weight. A patient may be losing too much weight due to their sport and not regaining sufficient energy from their diet.
The second component of this triad is menstrual dysregulation. When there is low energy availability to the body, there is resulting insufficiency of the ovaries, thus causing either irregular menses or a complete lack of menstruation.
The final component of the triad is low bone mineral density, determined through imaging, although often the decreased bone density is realized after stress fracture has occurred. A necessary ingredient to reverse low bone mineral density is estrogen, which is only available in low amounts in these patients due to failing ovaries.
It is apparent that there is a clear interrelationship between these three components that female athletes are particularly susceptible to. If this triad is left untreated, there can be many negative long-term health effects, including irreversible bone loss, fractures, infertility and decreased cardiovascular health. Treatment includes mostly non-pharmacological approaches. It is important to first address the low energy availability of the athlete through nutritional supplementation and gradual weight gain in addition to working with athletic coaches to redesign their exercise regimen. Behavioral therapy can be an important component to recovery as well. There is no medication that will fully address this disorder, but there is some evidence that hormone replacement therapy and osteoporosis drugs can be beneficial in addition to certain antidepressant medications for cases complicated by an eating disorder. This is an important women’s health issue to be aware of for providers seeing active adolescents, especially in the context of today’s female beauty standards.
- Ranson, William A, et al. “Female Athlete Triad: Past, Present, and Future Directions.” Annals of Joint, AME Publishing Company, 11 Jan. 2018, aoj.amegroups.com/article/view/4023/4643.
- Thein-Nissenbaum, Jill, and Erin Hammer. “Treatment Strategies for the Female Athlete Triad in the Adolescent Athlete: Current Perspectives.” Open Access Journal of Sports Medicine, Dove Medical Press, 4 Apr. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5388220/.