The female athlete triad: special considerations for adolescent female athletes

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.

Download Full-text

Stress Fractures And The Reproductive System In The Female Athlete

10.2310/fm.1513 ◽

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

Download Full-text

Stress Fractures And The Reproductive System In The Female Athlete

10.2310/obg.1513 ◽

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

Download Full-text

The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad

British Journal of Sports Medicine ◽

10.1136/bjsports-2013-093240 ◽

2014 ◽

Vol 48 (7) ◽

pp. 540-545 ◽

Cited By ~ 78

Author(s):

Anna Melin ◽

Åsa B Tornberg ◽

Sven Skouby ◽

Jens Faber ◽

Christian Ritz ◽

...

Keyword(s):

At Risk ◽

Female Athlete ◽

Screening Tool ◽

Female Athletes ◽

Female Athlete Triad

Download Full-text

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

International Journal of Sport Nutrition and Exercise Metabolism ◽

10.1123/ijsnem.22.2.131 ◽

2012 ◽

Vol 22 (2) ◽

pp. 131-138 ◽

Cited By ~ 16

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.

Download Full-text

FEMALE ATHLETE TRIAD PADA ATLET PUTRI DI PUSAT PENDIDIKAN LATIHAN (PUSDIKLAT) RAGUNAN JAKARTA

Journal of Nutrition College ◽

10.14710/jnc.v1i1.512 ◽

2012 ◽

Vol 1 (1) ◽

pp. 405-413

Author(s):

Gita Ayu Rosalinda Ratu Saputri ◽

Fillah Fithra Dieny

Keyword(s):

Eating Disorder ◽

Bone Density ◽

Nutritional Status ◽

Body Fat ◽

Female Athlete ◽

Female Athletes ◽

Education And Training ◽

Female Athlete Triad ◽

Menstrual Irregularity ◽

And Training

Background: Female athletes tend to consume improper for supporting their performance, so that can impact eating disorder. Eating disorder can lead menstrual irregularity and osteoporosis for them, so they have risk of female athlete triad. The aimed of this study to determine prevalence of female athlete triad in education and training centre (PUSDIKLAT) Ragunan Jakarta. Methods: Descriptive research with cross sectional design, and calculation of total subject used stratified proportional random sampling. The sample was composed of 65 female athletes in Education and Training Center (PUSDIKLAT) Ragunan Jakarta. Data include nutritional status, eating disorder, menstrual disorder, and bone density. Assessment of nutritional status used BMI/A percentile and percent body fat; measurement of percent body fat used body fat analyzer HBF 200; assessment of eating disorder used eating disorder diagnostic scale; measurement of menstrual irregularity used questionnaire including frequency, menstrual cycle, menarche, and menstruation on last 3 months; and measurement of bone density used quantitative ultrasound bone densitometry. Result: Female athlete triad not found on subjects, but 15 subjects (23.1%) had bulimia and 1 subject (1.5%) had menstrual irregularity, i.e oligoamenorrhea, whereas bone density of all subjects (100%) normal, so that only 1 subject (1.5%) had two symptom of female athlete triad (bulimia and oligoamenorrhea).fifty six subjects (86,2%) had normal nutritional status. Based on fat body percent, that was found 1 subject (1.5%) having underfat, 10 subjects (15.4%) overfat, and 2 subjects (3.1%) obese. Conclusion:Female athlete triad not found in Education and Training Center (PUSDIKLAT) Ragunan Jakarta

Download Full-text

POTENSI FEMALE ATHLETE TRIAD PADA ATLET REMAJA PUTRI DEFISIENSI BESI

GIZI INDONESIA ◽

10.36457/gizindo.v44i1.511 ◽

2021 ◽

Vol 44 (1) ◽

pp. 1-10

Author(s):

Fillah Fithra Dieny ◽

Deny Yudi Fitranti ◽

Firdananda Fikri Jauharany ◽

A Fahmy Arif Tsani

Keyword(s):

Bone Density ◽

Iron Deficiency ◽

Serum Ferritin ◽

Random Sampling ◽

Female Athlete ◽

Female Athletes ◽

Simple Random Sampling ◽

Female Athlete Triad ◽

Cross Sectional ◽

Cycle Disorders

The female athlete triad (FAT) is a syndrome that occurs in female athletes who have a combination of 3 related conditions and are associated with sports. The aimed of this study to analyze the relationship between iron deficiency and the state of the female athlete triad (FAT) in female athletes. The design of this study was cross sectional with 80 subjects of female athletes aged 12-18 years from various sports, who were taken by simple random sampling. The research was conducted at the Central Java Student Center for Education and Sports Training (BPPLOP). Bivariate analysis was performed using the Spearman test. Based on Ferritin, as many as 15 subjects (18.25%) had iron deficiency anemia, and FAT syndrome was not found in the subjects, however, when each sign was seen, 20 percent were classified as polimenorrhea and oligomenorrhea, and 37.5 percent experienced eating disorders. There were a significant relationship between iron deficiency based on serum ferritin (p = 0.015; r = 0.273) and Hb levels (p = 0.002; r = 0.337) with the component of athlete's bone density. However, iron deficiency (based on serum Ferritin and Hb levels) did not show a significant association with menstrual cycle disorders and eating disorders (p 0.05). Female Athlete Triad has not been found among subjects, but athletes have experienced eating behavior disorders, menstrual cycle disorders and the risk of low bone density. Iron deficiency is associated with decreased bone density in young female athletes. ABSTRAK Female athlete triad (FAT) merupakan suatu syndrom yang terjadi pada atlet wanita yang memiliki kombinasi dari 3 kondisi yang saling berkaitan, dan berhubungan dengan olahraga. Tujuan penelitian untuk menganalisis hubungan defisiensi besi dengan keadaan female athelete triad (FAT) pada atlet remaja putri. Desain penelitian ini adalah cross-sectional dengan 80 subjek atlet putri berusia 12-18 tahun dari berbagai cabang olahraga yang diambil secara simple random sampling. Penelitian dilakukan di Balai Pemusatan Pendidikan dan Latihan Olahraga Pelajar (BPPLOP) Jateng. Analisis univariat untuk mendeskripsikan data berupa distribusi dan persentase. Analisis bivariat dilakukan menggunakan uji Spearman. Berdasarkan data serum ferritin, sebanyak 15 subjek (18,25%) mengalami anemia defisiensi besi, namun belum ditemukan kejadian FAT pada subjek, tetapi bila dilihat masing masing tanda sebanyak 20 persen tergolong polimenorea dan oligomenorea, serta 37,5 persen mengalami gangguan perilaku makan. Ada hubungan yang signifikan antara defisiensi besi berdasarkan serum ferritin (p=0,015; r=0,273) dan kadar Hb (p=0,002; r=0,337) dengan komponen kepadatan tulang atlet. Namun defisiensi besi (bedasarkan serum Ferritin dan Kadar Hb) tidak menunjukkan hubungan yang signifikan dengan gangguan siklus menstruasi dan gangguan perilaku makan (p0,05). FAT belum ditemukan pada atlet remaja putri, namun atlet sudah ada yang mengalami gangguan perilaku makan, gangguan siklus menstruasi dan risiko kepadatan tulang rendah. Defisiensi besi berhubungan dengan menurunnya kepadatan tulang atlet remaja putri.Kata kunci: atlet; remaja putri; defisiensi besi; female athlete triad (FAT)

Download Full-text

Stress Fractures And The Reproductive System In The Female Athlete

10.2310/im.1513 ◽

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

Download Full-text

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

Journal of Sport Rehabilitation ◽

10.1123/jsr.2021-0121 ◽

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.

Download Full-text