scholarly journals Energy Deficiency, Menstrual Disturbances, and Low Bone Mass: What Do Exercising Australian Women Know About the Female Athlete Triad?

2012 ◽  
Vol 22 (2) ◽  
pp. 131-138 ◽  
Author(s):  
Stephanie M. Miller ◽  
Sonja Kukuljan ◽  
Anne I. Turner ◽  
Paige van der Pligt ◽  
Gaele Ducher
Keyword(s):  
Stress Fracture ◽  
Bone Health ◽  
Female Athlete ◽  
Female Athletes ◽  
Adult Women ◽  
Female Athlete Triad ◽  
Sports History ◽  
Menstrual Dysfunction ◽  
Energy Deficiency ◽  
History Of

Purpose:Prevention of the female athlete triad is essential to protect female athletes’ health. The aim of this study was to investigate the knowledge, attitudes, and behaviors of regularly exercising adult women in Australia toward eating patterns, menstrual cycles, and bone health.Methods:A total of 191 female exercisers, age 18–40 yr, engaging in ≥2 hr/wk of strenuous activity, completed a survey. After 11 surveys were excluded (due to incomplete answers), the 180 participants were categorized into lean-build sports (n = 82; running/athletics, triathlon, swimming, cycling, dancing, rowing), non-lean-build sports (n = 94; basketball, netball, soccer, hockey, volleyball, tennis, trampoline, squash, Australian football), or gym/fitness activities (n = 4).Results:Mean (± SD) training volume was 9.0 ± 5.5 hr/wk, with participants competing from local up to international level. Only 10% of respondents could name the 3 components of the female athlete triad. Regardless of reported history of stress fracture, 45% of the respondents did not think that amenorrhea (absence of menses for ≥3 months) could affect bone health, and 22% of those involved in lean-build sports would do nothing if experiencing amenorrhea (vs. 3.2% in non-lean-build sports, p = .005). Lean-build sports, history of amenorrhea, and history of stress fracture were all significantly associated with not taking action in the presence of amenorrhea (all p < .005).Conclusions:Few active Australian women are aware of the detrimental effects of menstrual dysfunction on bone health. Education programs are needed to prevent the female athlete triad and ensure that appropriate actions are taken by athletes when experiencing amenorrhea.

scholarly journals Collegiate Athletic Trainers' Knowledge of the Female Athlete Triad and Relative Energy Deficiency in Sport

2018 ◽  
Vol 53 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Emily Kroshus ◽  
J. D. DeFreese ◽  
Zachary Y. Kerr
Keyword(s):  
Athletic Training ◽  
Female Athlete ◽  
National Collegiate Athletic Association ◽  
Female Athletes ◽  
Athletic Trainers ◽  
Relative Energy ◽  
Female Athlete Triad ◽  
Stress Injury ◽  
Menstrual Dysfunction ◽  
Energy Deficiency

Context:  The female athlete triad (Triad) and relative energy deficiency in sport (RED-S) specify the consequences of energy imbalance. Athletic trainers (ATs) are positioned to identify athletes who are fueling themselves inadequately and experiencing related health and performance consequences. Objective:  To assess the knowledge of collegiate ATs about the Triad and RED-S and to examine variability in related screening and referral behaviors among National Collegiate Athletic Association divisions. Design:  Cross-sectional study. Setting:  Collegiate athletic training departments. Patients or Other Participants:  Head ATs at National Collegiate Athletic Association member institutions (n = 285, response rate = 33%). Main Outcome Measure(s):  An electronic survey was administered. The number of Triad components that were correctly identified and screening and referral behaviors related to Triad components were measured. Results:  Nearly all respondents (98.61% [n = 281]) had heard of the Triad; a smaller proportion (32.98% [n = 94]) had heard of RED-S. On average, respondents correctly identified 2 components of the Triad. We observed differences by sex, with women correctly identifying more components than men (U = 12.426, P = .003). More than half (59.93% [n = 163]) indicated that athletes at their institutions were screened for eating disorders. Nearly three-quarters (70.55% [n = 115]) of respondents indicated that all female athletes at their institutions were screened annually for menstrual dysfunction. More comprehensive referral behaviors for athletes identified as experiencing menstrual dysfunction or a bone injury (eg, athlete referred to a nutritionist, dietitian, or counselor) occurred at Division I institutions than at Division II and III institutions. Conclusions:  Continuing education for ATs about the Triad and RED-S may encourage a more comprehensive approach to referral and screening after a diagnosis of menstrual dysfunction or bone-stress injury. Using institutional opportunities, such as preparticipation screening, for identifying components of the Triad or RED-S and specifying protocols for referring athletes who screen positive for 1 of these components should also be explored.

Does Supplemental Estrogen Improve Bone-Related Symptoms of Female Athlete Triad in Female Athletes? A Critically Appraised Topic

2021 ◽  
pp. 1-5
Author(s):  
Elizabeth Hollenczer ◽  
Angelica Esposito ◽  
Erin M. Moore
Keyword(s):  
Oral Contraceptive ◽  
Bone Health ◽  
Female Athlete ◽  
Female Athletes ◽  
Energy Levels ◽  
Female Athlete Triad ◽  
Mineral Density ◽  
Bottom Line ◽  
Oral Contraceptive Pills ◽  
Contraceptive Pills

Clinical Scenario: Due to the Female Athlete Triad (Triad) being a 3-pronged syndrome, treatments can vary depending on the symptoms that clinicians focus on. With reproductive and bone health compromised, assessment and recovery methods include monitoring menstrual regularity and dual-energy X-ray absorptiometry scans. Low levels of estrogen have demonstrated negative effects on bone mineral density (BMD). Clinical Question: Does supplemental estrogen improve BMD in athletes with Female Athlete Triad symptoms? Summary of Key Findings: Supplemental estrogen does improve BMD with estrogen patches demonstrating increased improvement compared with oral contraceptive pills. Clinical Bottom Line: Restoration of regular menstruation, improvement of BMD, and ensuring optimal energy levels is the best approach for treating Triad symptoms. Transdermal patches are a new treatment option that address both menstrual function and BMD but still require further research. Strength of Recommendation: Available studies demonstrated a level 2 evidence for supplemental estrogen (oral contraceptive pills and estrogen patches) providing improvements for bone health related to the Triad.

scholarly journals DOES THE FEMALE ATHLETE TRIAD REALLY EXIST?

2020 ◽  
pp. 037
Author(s):  
Ivana Petrović
Keyword(s):  
Female Athlete ◽  
Female Athletes ◽  
Medical Condition ◽  
Future Research ◽  
Female Athlete Triad ◽  
Mineral Density ◽  
Physically Active ◽  
Menstrual Dysfunction ◽  
High Level ◽  
Three Components

The Female Athlete Triad (Triad) is a medical condition of female athletes consisting of three components: low energy availability (EA), menstrual dysfunction (MD), and low bone mineral density (BMD). The prevalence of all three components of the Triad ranges from 1-14%. In last ten years, it has ranged from 1.3% up to 23% with 78% of female athletes having at least one of the three components of the Triad. The aim of this systematic review is to collect and analyze recent studies of the Female Athlete Triad. Based on an analysis of electronic databases and the inclusion criteria set, 20 studies were included in the analysis. The following conclusions are proposed based on their analysis: MD was the most prevalent among endurance athletes with ranges from 35.5% to 60.7%, with the presence of secondary amenorrhea and oligomenorrhea, 30% to 64.0% and 18% to 27.0% and with a very high level of cases with irregular menorrhea, 72.3%. Low/negative EA ranges from 19.8% among non-leanness athletes and up to 77%. The greatest proportion of athletes in moderate- and high-risk categories for expressing the Triad participated in sports that emphasize leanness, including cross-country, gymnastics running, and lacrosse. A recommendation for future research is that they should focus on enhanced monitoring of physically active women, and the prevention of the Triad, stress fractures and osteoporosis.

The Female Athlete Triad: Is the Triad a Problem Among Division I Female Athletes?

2007 ◽  
Vol 1 (4) ◽  
pp. 358-370 ◽  
Author(s):  
Justine J. Reel ◽  
Sonya SooHoo ◽  
Holly Doetsch ◽  
Jennifer E. Carter ◽  
Trent A. Petrie
Keyword(s):  
Eating Disorders ◽  
Disordered Eating ◽  
Female Athlete ◽  
Female Athletes ◽  
Division I ◽  
Female Athlete Triad ◽  
Muscle Injuries ◽  
Menstrual Dysfunction ◽  
Eating Disordered ◽  
Menstrual History

The purpose of the study was to determine prevalence rates of the female athlete triad (Triad), differences by sport category (aesthetic, endurance, and team/anaerobic), and the relationship between each of the components of the Triad. Female athletes (N= 451) from three Division I universities with an average age of 20 years completed the Menstrual History Questionnaire, Injury Assessment Questionnaire, and the Questionnaire for Eating Disorder Diagnoses (Q-EDD; Mintz, O’Halloran, Mulholland, & Schneider, 1997). Almost 7% of female athletes reported clinical eating disorders, and 19.2% reported subclinical disordered eating. Disordered eating was prevalent in all three sport categories with no significant differences between groups. Muscle injuries were more prevalent in team/anaerobic sports (77.4%) than the aesthetic (68.1%) and endurance groups (58.1%). Furthermore, those athletes with menstrual dysfunction more frequently reported clinical eating disorders (1.4%) and sustained more skeletal injuries (51%) during their athletic career than athletes with regular menstrual function. Clinical implications and further research directions are addressed.

Body Mass-Related Predictors of the Female Athlete Triad Among Adolescent Athletes

2016 ◽  
Vol 26 (1) ◽  
pp. 17-25 ◽  
Author(s):  
Katie J. Thralls ◽  
Jeanne F. Nichols ◽  
Michelle T. Barrack ◽  
Mark Kern ◽  
Mitchell J. Rauh
Keyword(s):  
Body Mass ◽  
Female Athlete ◽  
Female Athletes ◽  
Ideal Body Weight ◽  
Adolescent Female ◽  
Female Athlete Triad ◽  
Fat Percentage ◽  
Mineral Density ◽  
Anthropometric Measures ◽  
Menstrual Dysfunction

Early detection of the female athlete triad is essential for the long-term health of adolescent female athletes. The purpose of this study was to assess relationships between common anthropometric markers (ideal body weight [IBW] via the Hamwi formula, youth-percentile body mass index [BMI], adult BMI categories, and body fat percentage [BF%]) and triad components, (low energy availability [EA], measured by dietary restraint [DR], menstrual dysfunction [MD], low bone mineral density [BMD]). In the sample (n = 320) of adolescent female athletes (age 15.9± 1.2 y), Spearman’s rho correlations and multiple logistic regression analyses evaluated associations between anthropometric clinical cutoffs and triad components. All underweight categories for the anthropometric measures predicted greater likelihood of MD and low BMD. Athletes with an IBW ≤85% were nearly 4 times more likely to report MD (OR = 3.7, 95% CI [1.8, 7.9]) and had low BMD (OR = 4.1, 95% CI [1.2, 14.2]). Those in <5th percentile for their age-specific BMI were 9 times more likely to report MD (OR 9.1, 95% CI [1.8, 46.9]) and had low BMD than those in the 50th to 85th percentile. Athletes with a high BF% were almost 3 times more likely to report DR (OR = 2.8, 95% CI [1.4, 6.1]). Our study indicates that low age-adjusted BMI and low IBW may serve as evidence-based clinical indicators that may be practically evaluated in the field, predicting MD and low BMD in adolescents. These measures should be tested for their ability as tools to minimize the risk for the triad.

scholarly journals Knowledge of Low Energy Availability, Relative Energy Deficiency in Sport and the Female Athlete Triad Amongst Female Athletes and Active Individuals

Proceedings ◽  
2019 ◽  
Vol 37 (1) ◽  
pp. 24
Author(s):  
Winter ◽  
Black ◽  
Brown
Keyword(s):  
Female Athlete ◽  
Female Athletes ◽  
Relative Energy ◽  
Low Energy ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Energy Deficiency ◽  
Exercise Energy Expenditure ◽  
Low Energy Availability ◽  
Normal Physiological Function

Background: Low Energy Availability (LEA), Relative Energy Deficiency in Sport (RED-S) and the Female Athlete Triad (Triad) are generally related to the negative health effects of consuming insufficient energy to meet exercise energy expenditure and maintain normal physiological function. [...]

scholarly journals The Role of Energy Availability in Reproductive Function in the Female Athlete Triad and Extension of its Effects to Men: An Initial Working Model of a Similar Syndrome in Male Athletes

2019 ◽  
Vol 49 (S2) ◽  
pp. 125-137 ◽  
Author(s):  
Mary Jane De Souza ◽  
Kristen J. Koltun ◽  
Nancy I. Williams
Keyword(s):  
Bone Health ◽  
Female Athlete ◽  
Reproductive Function ◽  
Low Energy ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Male Athlete ◽  
Menstrual Dysfunction ◽  
Working Model ◽  
Low Energy Availability

Abstract The Female Athlete Triad represents three interrelated conditions of (i) low energy availability (energy deficiency), presenting with or without disordered eating, (ii) menstrual dysfunction, and (iii) poor bone health, each of which can exist along a continuum of severity ranging from mild and moderate subclinical health concerns to severe clinical outcomes, including eating disorders, amenorrhea, and osteoporosis. This review provides a brief overview of the Female Athlete Triad, including updating the current thinking regarding energy availability and how it relates to reproductive function, and sets the stage for an initial working model of a similar syndrome in males that will be based on currently available evidence and will later be defined and referred to as a Male Athlete Triad by the newly re-named Female and Male Athlete Triad Coalition. A primary focus of this paper will be on the physiology of each Triad model with an emphasis on low energy availability and its role in reproductive function, with a brief introduction on its effects on bone health in men. From the data reviewed, (i) a specific threshold of energy availability below which menstrual disturbances are induced is not supported; (ii) it appears that the energetic, reproductive, and bone systems in men are more resilient to the effects of low energy availability compared to those of women, requiring more severe energetic perturbations before alterations are observed; and (iii) it appears that recovery of the hypothalamic pituitary gonadal axis can be observed more quickly in men than in women.

Stress Fractures And The Reproductive System In The Female Athlete

2018 ◽  
Author(s):  
Irfan M Asif ◽  
Kimberly Harmon ◽  
Mallory Shasteen
Keyword(s):  
Femoral Neck ◽  
Disordered Eating ◽  
Reproductive System ◽  
Female Athlete ◽  
Female Athletes ◽  
Stress Fractures ◽  
Female Athlete Triad ◽  
Low Back ◽  
Mineral Density ◽  
Pubic Ramus

Stress fractures are more common in the female athlete. Stress fractures of the pubic ramus and femoral neck are particularly more common in females than in males. Rib stress fractures are an important injury to consider in the female rower, whereas spondylolysis is a common cause of low back pain in female athletes who hyperextend their spines. The higher incidence of stress fractures in females is mainly due to the higher prevalence of disordered eating and subsequent energy imbalance, which leads to detrimental effects on bone. This review discusses stress fractures and unique issues related to exercise and the female reproductive system. This review contains 6 figures, 5 tables and 49 references Key words: amenorrhea, bone mineral density, disordered eating, female athlete triad, femoral neck, pregnancy, pubic ramus, rib, spondylolysis, stress fracture

scholarly journals Bone-Mineral Density and Other Features of the Female Athlete Triad in Elite Endurance Runners: A Longitudinal and Cross-Sectional Observational Study

2010 ◽  
Vol 20 (5) ◽  
pp. 418-426 ◽  
Author(s):  
Noel Pollock ◽  
Claire Grogan ◽  
Mark Perry ◽  
Charles Pedlar ◽  
Karl Cooke ◽  
...  
Keyword(s):  
Female Athlete ◽  
Negative Energy ◽  
Endurance Athletes ◽  
Female Athlete Triad ◽  
Training Volume ◽  
Mineral Density ◽  
Cross Sectional ◽  
Menstrual Dysfunction ◽  
Endurance Runners ◽  
And Training

Low bone-mineral density (BMD) is associated with menstrual dysfunction and negative energy balance in the female athlete triad. This study determines BMD in elite female endurance runners and the associations between BMD, menstrual status, disordered eating, and training volume. Forty-four elite endurance runners participated in the cross-sectional study, and 7 provided longitudinal data. Low BMD was noted in 34.2% of the athletes at the lumbar spine, and osteoporosis in 33% at the radius. In cross-sectional analysis, there were no significant relationships between BMD and the possible associations. Menstrual dysfunction, disordered eating, and low BMD were coexistent in 15.9% of athletes. Longitudinal analysis identified a positive association between the BMD reduction at the lumbar spine and training volume (p = .026). This study confirms the presence of aspects of the female athlete triad in elite female endurance athletes and notes a substantial prevalence of low BMD and osteoporosis. Normal menstrual status was not significantly associated with normal BMD, and it is the authors’ practice that all elite female endurance athletes undergo dual-X-ray absorptiometry screening. The association between increased training volume, trend for menstrual dysfunction, and increased loss of lumbar BMD may support the concept that negative energy balance contributes to bone loss in athletes.

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