Detection and Management of the Female Athlete Triad

2020 ◽  
pp. 36-40
Author(s):  
Craig Coleman ◽  
Brett Spain Spain
Keyword(s):  
Female Athlete ◽  
Multidisciplinary Approach ◽  
Athletic Trainer ◽  
Health Practitioner ◽  
Net Energy ◽  
Female Athlete Triad ◽  
Mental Health Practitioner ◽  
Mineral Density ◽  
Physically Active ◽  
Exercise Physiologist

The female athlete triad is a disorder seen in physically active females that manifests as three interrelated syndromes that may or may not occur simultaneously.1,2,3 It is a multi-component disease initiated by an energy-deficient state (possibly from an eating disorder), bone mineral density abnormalities and menstrual changes.1,2,3 Prevention and early intervention are important in averting permanent debilitating damage. The cornerstone of treatment is creating a positive net energy availability, which requires a multidisciplinary approach comprised of a licensed physician, nutritionist, exercise physiologist, mental health practitioner, athletic trainer, coaches, the athlete and their parents.

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.

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.

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, rib pain and other features of the female athlete triad in elite lightweight rowers

BMJ Open ◽  
2014 ◽  
Vol 4 (2) ◽  
pp. e004369 ◽  
Author(s):  
Lygeri Dimitriou ◽  
Richard Weiler ◽  
Rebecca Lloyd-Smith ◽  
Antony Turner ◽  
Luke Heath ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Female Athlete ◽  
Female Athlete Triad ◽  
Mineral Density

Characterization of Risk Quantification Differences Using Female Athlete Triad Cumulative Risk Assessment and Relative Energy Deficiency in Sport Clinical Assessment Tool

2019 ◽  
Vol 29 (6) ◽  
pp. 569-575 ◽  
Author(s):  
Bryan Holtzman ◽  
Adam S. Tenforde ◽  
Allyson L. Parziale ◽  
Kathryn E. Ackerman
Keyword(s):  
Female Athlete ◽  
Assessment Tool ◽  
Cumulative Risk ◽  
Relative Energy ◽  
Risk Level ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Mineral Density ◽  
Energy Deficiency ◽  
Low Energy Availability

This study’s objective was to identify differences in risk for low energy availability and athletic clearance level by comparing scores on Female Athlete Triad Cumulative Risk Assessment (Triad CRA) and Relative Energy Deficiency in Sport Clinical Assessment Tool (RED-S CAT). A total of 1,000 female athletes aged 15–30 years participating in ≥4 hr of physical activity/week for the previous ≥6 months completed an extensive survey assessing health, athletic history, family disease history, and specific Triad/RED-S risk factors. Retrospective chart review ascertained laboratory and bone mineral density measures. Triad CRA and RED-S CAT were used to assign each athlete’s risk level (low, moderate, and high), and case-by-case comparison measured the level of agreement between the tools. We hypothesized that the tools would generally agree on low-risk athletes and that the tools would be less aligned in the specific elevated risk level (moderate or high). Most of the sample was assigned moderate or high risk for Triad CRA and RED-S CAT (Triad: 54.7% moderate and 7.9% high; RED-S: 63.2% moderate and 33.0% high). The tools agreed on risk for 55.5% of athletes. Agreement increased to 64.3% when only athletes with bone mineral density measurements were considered. In conclusion, Triad CRA and RED-S CAT provide consensus on the majority of athletes at elevated (moderate or high) risk for low energy availability, but have less agreement on the specific risk level assigned.

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

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.

The components of the female athlete triad do not identify all physically active females at risk

2007 ◽  
Vol 25 (12) ◽  
pp. 1289-1297 ◽  
Author(s):  
Melonie Burrows ◽  
Helen Shepherd ◽  
Stephen Bird ◽  
Kenneth Macleod ◽  
Bob Ward
Keyword(s):  
At Risk ◽  
Female Athlete ◽  
Female Athlete Triad ◽  
Physically Active

scholarly journals The female athlete triad: a current concepts review

2016 ◽  
Vol 23 (2) ◽  
Author(s):  
C George
Keyword(s):  
Bone Mineral Density ◽  
At Risk ◽  
Bone Mineral ◽  
Female Athlete ◽  
Well Being ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Mineral Density ◽  
Menstrual Function ◽  
Positive Effects

Female athletic participation continues to grow throughout the world. This has many positive effects on health and well-being, but it has also led to a unique set of health problems. The female athlete triad was first described in 1992 by the American College of Sports Medicine, consisting of disordered eating, amenorrhoea and osteoporosis. An updated position stand was released in 2007 that modified the components of the triad to energy availability, menstrual function and bone mineral density. This article reviews the current definitions of the triad components, epidemiology, pathophysiology, diagnosis and treatment. Each of the components of the triad exists on a continuum from healthy to pathological. Low energy availability, from either dietary restriction or increased expenditure, is the factor that leads to the pathological states of menstrual function and bone mineral density. Athletes especially at risk are those in sports requiring leanness or low body weight. Prevention and early recognition of triad disorders is crucial to ensure timely intervention and treatment. Treatment is centered on restoring energy availability to adequate levels (30 kcal.kg-1.d-1) to re-establish normal metabolic functioning. All those who work with female athletes must remain vigilant in the education, recognition and treatment of athletes at risk. Continued research and knowledge of the triad disorders aids the development of prevention and treatment strategies to allow women to continue to enjoy the benefits of regular exercise and physical activity throughout their lives.

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