by Anne Mace

The first time I heard about the Female Athlete Triad, I was 26 years old and had recently began seeking treatment for bulimia. What I learned about it nearly made me fall out of my chair! As I read through the symptoms, I felt as though it was all written about me – and ironically, I knew the impact was far greater than the average public realized.

I immediately began some investigation, which in turn became my area of study and passion. Because the Female Athlete Triad is still considered a relatively “newly discovered” disorder, much of the research is yet to be completed. In this article, I’d like to share with you ladies the things I’ve learned about it so far.

The Female Athlete Triad was first introduced by the American College of Sports Medicine (ACSM) in 1992, and revisited the subject again in 1997, revealing the need for additional study into the triad, including prevention and education (Hinton, P.S., & Kubas, K.L., 2005).

What is it?

It’s basically a combination of three potentially lethal conditions experienced by women, more often than not, one who’s an athlete. These three conditions consist of eating disorders, amenorrhea, and osteoporosis (Hildebrant, T., 2005).

In other words (and according to the newest definition available), the triad consists of low energy availability (disordered eating), irregular menstrual cycle (amenorrhea of any type), and low bone mineral density (osteoporosis).

The triad normally begins with an eating disorder, which then leads to both amenorrhea (irregular or absent periods), and later osteoporosis. Eating disorders are generally classified into anorexia nervosa (AN), bulimia nervosa (BN), or a combination of the two.

Breaking Down the Eating Disorders

When it comes to athletes and eating disorders, frequent underreporting has been determined (Hildebrant, T., 2005). It’s also been shown that 15-62% of all athletes battle an eating disorder of some sort, which is quite a high number, especially when compared against the .5% to 3% average of the general population (Hinton, P.S., & Kubas, K.L., 2005).

While aneroxia or bulemia are usually the most studied of the eating disorders, it was estimated in one study that approximately 50% of all eating disorders are neither anorexia nor bulemia (Thompson, S., 2007). Other eating disorders – labeled “Eating Disorders Not Otherwise Specified” (EDNOS) are more common than the ones many of us often hear about.

A myriad of unhealthy eating patterns fall under this category, and many of them, you just may find yourself identifying with as a female athlete. One such disorder is the cognitive dietary restraint, or CDR; it manifests itself in an individual limiting her caloric intake in an effort to maintain a lean physique. Sound familiar?

Why do They Exist?

There has been considerable speculation as to why eating disorders even exist, and how to prevent them. Sports in which leanness is a factor (i.e. figure competitions) have been hypothesized to lead to increased eating disorders, and in turn, menstrual dysfunction (Hinton, P.S., & Kubas, K.L., 2005).

Now, it should be noted that eating disorders among athletes are not considered psychologically the same as those among non-athletes. Rather, their fear of weight gain or obsession with food may be linked solely to their sport (H Hinton, P.S., & Kubas, K.L., 2005).

This energy deficit the women athletes purposely create has an impact on the female body and will often lead to irregular menstruation, which, of course, is the second component of the triad.

Amenorrhea

Amenorrhea is the most severe of female menstrual dysfunctions and is defined as the lack of a menstrual cycle for three consecutive months. This symptom of disordered eating is often experienced by female athletes, though it isn’t linked to one particular subtype of an eating disorder. (Pinheiro Et Al, 2005).

The hormones required for menstruation are linked to the calcium production in the body, so the lack of a period results in insufficient calcium production, which leads us right into the last piece of the triad: osteoporosis.

Osteoporosis

Without the proper amounts of calcium, osteoporosis can easily form. Osteoporosis is a decline in Bone Mineral Density (BMD), which has actually been shown to be lower in athletes in lean build sports (Mudd, L.M., Fornetti, W., & Pivarnik, J.M., 2007). For more information on osteoporosis, check out Osteoporosis: The Silent Epidemic.

Summary

I realize that this article is pretty scientific, so let’s recap:

• Eating disorders, including aneroxia nervosa, bulemia nervosa, and other eating disorders (EDNOS), or cognitive dietary restraint, all create low energy availability.
• Low energy availability may result in the female body being unable produce the hormones necessary for regular menstruation. The most severe of irregular menstruation is the absence of a menstrual cycle for more than three months.
• The absence of a menstrual cycle proposes problems with calcium production. Calcium is necessary for building strong bones; its deficiency, combined with the other two symptoms of the triad, can lead to stress fractures and even osteoporosis.

Female Athlete Triad: The Silent Killer

The female athlete triad is more than dangerous; it’s deadly! What’s worse is that there’s currently no specific medical treatment standard for a woman diagnosed with this condition.

Young girls, lean build sport athletes, and even recreational female athletes are specifically at risk. If you consider yourself to be in one of the risk categories or believe you may be experiencing some or all of the sympoms mentioned in this article, I urge you to take your health into your own hands before it’s too late!

Contact the Female Athlete Triad Coalition for more information and educational materials

References

Hildebrant, T. (2005). A Review of Eating Disorders in Athletes: Recommendations for
Secondary School Prevention and Intervention Programs. Journal of Applied School Psychology, 21(2), 145-167. Retrieved September 7, 2008 from: http://www.haworthpress.com/web/JAPPS

Hinton, P.S., & Kubas, K.L. (2005). Psychosocial Correlates of Disordered Eating in Female
Collegiate Athletes: Validation of the ATHLETE Questionnaire. Journal of American College Health, 54(3), 149-156. Retrieved September 7, 2008, from: http://web.ebscohost.com.ezproxy.apollolibrary.com/ehost/pdf?vid=6&hid=112&sid=3cac0659-4473-4315-9aff-3e9de91b1886%40sessionmgr103

Mudd, L.M., Fornetti, W., & Pivarnik, J.M. (2007). Bone Mineral Density in Collegiate Athletes:
Comparison Among Sports. Journal of Athletic Training, 42(3), 403–408. Retrieved September 18, 2008, from: http://web.ebscohost.com.libproxy.utsystem.edu/ehost/pdf?vid=7&hid=12&sid=90d4d038-25be-4e40-a05b-44b8ed24b362%40sessionmgr8

Pinheiro, A.P., Thornton, L.M., Plotonicov, K.H., Tozzi, F., Klump, K.L., Berrettini, W.H.,
Brandt, H., Crawford, S., Crow, S., Fichter, M.M, Goldman, D., Halmi, K.A., Jonhson, C., Kaplan, A.S., Keep, P., LaVia, M., Mitchell, J., Rotondo, A., Strober, M., Treasure, J., Woodside, D.B., Holle, A.V., Hamer, R., Kaye, W.H., & Bulik, C.M. (2007). Patterns of Menstrual Disturbance in Eating Disorders. International Journal of Eating Disorders, 40, 424-434. Retrieved on September 18, 2008 from: http://web.ebscohost.com.libproxy.utsystem.edu/ehost/pdf?vid=7&hid=12&sid=90d4d038-25be-4e40-a05b-44b8ed24b362%40sessionmgr8

Thompson, Sharon H. (2007). Characteristics of the Female Athlete Triad in Collegiate Cross
Country Runners. Journal of American College Health, 56(2), 129-136. Retrieved September 18, 2008 from: http://web.ebscohost.com.libproxy.utsystem.edu/ehost/pdf?vid=7&hid=12&sid=90d4d038-25be-4e40-a05b-44b8ed24b362%40sessionmgr8