Diseases & Conditions
Female Athlete Triad: Problems Caused by Extreme Exercise and Dieting
Sports and exercise are healthy activities for girls and women of all ages. Occasionally, a female athlete who focuses on being thin or lightweight may eat too little or exercise too much. Doing this can cause long-term damage to health, or even death. It can also hurt athletic performance or make it necessary to limit or stop exercise.
Three interrelated illnesses may develop when a girl or young woman goes to extremes in dieting or exercise. Together, these conditions are known as the "female athlete triad."
The three conditions are:
- Disordered eating. Abnormal eating habits (i.e., crash diets, binge eating) or excessive exercise keeps the body from getting enough nutrition.
- Menstrual dysfunction. Poor nutrition, low calorie intake, high-energy demands, physical and emotional stress, or low percentage of body fat can lead to hormonal changes that lead to irregular menses or stop menstrual periods altogether (amenorrhea).
- Low bone mineral density. Lack of periods disrupts the body's bone-building processes and weakens the skeleton, making bones more likely to break. In the most severe cases, young female athletes can develop osteoporosis as a result of disordered eating and menstrual dysfunction.
Females at Risk
Females in any sport can develop one or more components of the triad. At greatest risk are those in sports that reward being thin for appearance (such as figure skating or gymnastics) or improved performance (such as distance running or rowing).
Fashion trends and advertising often encourage women to try to reach unhealthy weight levels. Some female athletes suffer low self-esteem or depression, and may focus on weight loss because they think they are heavier than they actually are. Others feel pressure to lose weight from athletic coaches or parents.
Female athletes should consider these questions:
- Are you dissatisfied with your body?
- Do you strive to be thin?
- Do you continuously focus on your weight?
If the answer to any of these questions is yes, you may be at risk for developing abnormal patterns of eating (disordered eating), which can lead to menstrual dysfunction and early osteoporosis.
Female Athlete Triad
Although they usually do not realize or admit that they are ill, people with disordered eating have serious and complex disturbances in eating behaviors. They are preoccupied with body shape and weight and have poor nutritional habits.
Disordered eating can take many forms. Some people starve themselves (anorexia nervosa) or engage in cycles of overeating and purging (bulimia).
Others severely restrict the amount of food they eat, fast for prolonged periods of time or misuse diet pills, diuretics, or laxatives. People with disordered eating may also exercise excessively to keep their weight down.
Females are more likely than males to have disordered eating. The illness can cause many problems, including dehydration, muscle fatigue and weakness, an erratic heartbeat, kidney damage, and other serious conditions. Not taking in enough calcium can lead to bone loss. It is especially bad to lose bone when you are a child or teenager because that is when your body should be building bone. Hormone imbalances can lead to more bone loss through menstrual dysfunction.
Missing three or more periods in a row is cause for concern. With normal menstruation, the body produces estrogen, a hormone that helps to keep bones strong. Without a menstrual cycle (amenorrhea), the level of estrogen may be lowered, causing a loss of bone density and strength (premature osteoporosis).
If this happens during youth, it may become a serious problem later in life when the natural process of bone mineral loss begins after menopause. Amenorrhea may also cause stress fractures. Normal menstruation is necessary for pregnancy.
Premature Osteoporosis (Low Bone Density for Age)
Bone tissue wears away, making your skeleton fragile. Low bone mass puts you at increased risk for fractures.
Recognizing the female athlete triad is the first step toward treating it. See your doctor right away if you miss several menstrual periods, get a stress fracture in sports, or think you might have disordered eating.
Give the doctor your complete medical history, including:
- What you do for physical activity and what you eat for nutrition.
- How old you were when you began to menstruate and whether you usually have regular periods.
- If you are sexually active, use birth control pills, or have ever been pregnant.
- If you have ever had stress fractures or other injuries.
- Any changes (up or down) in your weight.
- Any medications you are taking or symptoms of other medical problems.
- Family history of diseases (i.e., thyroid disease, osteoporosis).
- Factors that cause stress in your life.
Your doctor will give you a complete physical examination and may use laboratory tests to check for pregnancy, thyroid disease, and other medical conditions. In some cases, a bone density test will be recommended.
Treatment for female athlete triad often requires help from a team of medical professionals including your doctor (orthopaedic surgeon, pediatrician, gynecologist, family physician), your athletic trainer, a nutritionist, and a counselor or psychologist.
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AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.