WOMEN’S HEALTH: Female Athlete Triad
Filed under: Exercise Science
"The cinder track was strewn with wretched damsels in agonizing distress."
From article published in New York Times following female 800 meter race in 1928 Olympics.
FEMALE ATHLETE TRIAD
Female participation in all sports has grown considerably over the last several decades. For some female athletes, the pressure to keep body weight low and training heavy has lead to disordered eating, loss of menstrual cycle (amenorrhea), and bone loss (osteoporosis). These three symptoms grouped together are often referred to a condition known as Female Athlete Triad (FAT).
Women were first allowed to participate in the Olympics in 1912 and some events like the women's marathon were only added in 1984. Today, more and more sports are available to women, and there is a push to ensure equity for women in sports. Women are proving that they are capable of feats once thought impossible for the "weaker sex." At the 1984 Olympic in Los Angeles, Joan Benoit won the gold medal in the first ever Olympic marathon event for women. Her time was 2 hours and 24 minutes, a standard that would have won 11 of the previous 20 men's Olympic marathon races. In 1988, Paula Newby-Fraser completed the Hawaiian Ironman Triathlon in 9 hours and 1 minute, just 30 minutes or 6% slower than the male winner. Only 10 men were ahead of her that year. The gap between the best men and women athletes has shrunk sharply during the last 25 years. In the Boston Marathon, the difference in winning times for men and women has diminished from 54 minutes in 1972 to about 14 minutes during recent years.
Under these stresses to compete and be successful in sports, women may push themselves to extreme levels in training and at the same time ignore proper dieting, putting themselves at risk to develop health issues. Under these conditions, some women may lose their menstrual periods. If amenorrhea is experienced long enough, estrogen levels may decrease, leading to loss of bone mineral mass and early osteoporosis. Other symptoms of FAT are fatigue, anemia, depression, cold intolerance, and eroded teeth enamel from frequent vomiting.
Typically, only 2 to 5% of the female population has amenorrhea. This proportion, however, can climb to 50% in some athletic groups, especially female runners. Close to half of female runners who train 80 or more miles a week are amenorrheic, compared with only 5 to 10% of runners who are moderate in their training. In female athletes with amenorrhea, the density of their bones is 20 to 30% lower than normal and the risk of stress fracture in the bones of the legs and feet is high.
It appears that the heavy amounts of exercise can actually disrupt the release of certain hormones from the brain that are needed by the ovaries to go through a normal and full cycle. Also, when the female athlete does not eat enough, the body goes into semi-starvation mode, interrupting the normal release of hormones that drive the menstrual cycle.
Although the percentage of athletic women who eat poorly is not known, estimates from experts range from 30 to 65%. With the disruption of menstrual periods, estrogen levels drop to levels experienced by women after menopause, leading to a rapid loss of bone mass.
All women who stop menstruating or menstruate irregularly because of an exercise program are urged to see a doctor. A multi-disciplined approach should address these issues and involving a dietitian and psychologist may also be helpful. The female athlete should attempt to start eating by consuming a well-rounded, high carbohydrate diet while exercising less, increase calcium intake to 1,500 mg/day, increase lean body mass, and, in some cases, receive estrogen replacement therapy. With these changes, the menstrual period often returns, and bone mass is built back up to near normal levels for many but not all female athletes.
1. Nieman, DC. ACSM Health & Fitness Journal, Vol. 9, No. 4, July/August 2005, pg. 6-7.
2. Smith, AD. The Female Athlete Triad: Causes, Diagnosis & Treatment, The Physician & Sportsmedicine, Vol. 24, No. 7, July 1996.