Irregular periods, for starters.
Sport & exercise is a great way for girls & women to stay fit, healthy, gain confidence and socialise with friends. Time & time again, research has proven that those who engage in regular physical activity are generally healthier, more confident and feel better physically & mentally than those who don’t.
Unfortunately, there is a serious medical condition that can effect females who train regularly. This condition is estimated to affect one in every four females involved in sport & regular training, and can cause stress fractures, iron-deficiency anaemia and weak bones.
Sadly, despite this condition effecting up to one quarter of girls and women in sport, it often goes unrecognised. It is not until it starts to impact upon a female’s sporting ability that something may be done. This condition is known as The Female Athlete Triad.
If you are a female involved sport and intense exercise, or if you are the coach or trainer of female athletes, or, if you have a daughter who plays sport, then you need to be aware of the ‘The Female Athlete Triad’. If you have a good knowledge of this condition and are able to recognise the signs, then it can either be prevented or managed successfully, allowing females to achieve their full athletic abilities.
What is the Female Athlete Triad?
The Female Athlete Triad is a combination of three medical conditions that are linked to each other:
- Low energy availability & disordered eating
- Menstrual problems
- Weak bones & stress fractures
Triad factor #1: Low energy availability and disordered eating
The first factor of The Female Athlete Triad is low energy availability. Energy availability is the amount of energy from food (calories eaten) that is available for your body after exercise. Some females may try to lose weight as a way to improve their athletic performance or to achieve a certain look. Other times, girls simply may not realise how much energy they expend during workouts and they don’t eat enough to maintain a healthy weight.
Some girls with the Triad may also show disordered eating (including anorexia or bulimia), meaning they go to extremes and restrict or eliminate certain foods or food groups and skip meals. Basically they do not provide their body with sufficient energy.
In the short term, if you don’t fuel your body with enough energy from the food, you won’t be able to perform at your best. This will mean less power, muscle strength and stamina. However, in the long-term, if this energy deficit is too large, your body will not have enough energy to maintain normal bodily functioning, like developing healthy bones, regulating your body temperature or having a menstrual period every month.
Triad factor #2: Menstrual problems
The second factor of The Female Athlete Triad is menstrual problems. Exercising intensely and not eating enough food (i.e. low energy availability) can affect a female’s hormone levels. Decreases in estrogen, the hormone that helps to regulate the menstrual cycle, can occur. As a result, females with the triad may have irregular or missed periods, or they may stop altogether, which has serious reproductive health complications.
Triad factor #3: Weak bones and stress fractures
Bone problems resulting from The Female Athlete Triad include stress fractures and reduced bone density for your age. When you are in a negative energy balance, your body is not able to replace old bone cells with new healthy cells. This can lead to stress fractures and low bone mass. Usually, the teen years are a time when girls should be building up their bone mass to their highest levels — called peak bone mass. However, minimal energy intake will affect hormones, leading to stress fractures and other bone problems like osteoporosis, which are detrimental to athletic performance.
What are the signs and symptoms?
Are you a female in sport or train regularly? Have you experienced any of the following:
- weight loss
- irregular periods or loss of periods
- fatigue & decreased ability to concentrate
- stress fractures
- muscle injuries
- brittle hair or nails
- dental cavities
- sensitivity to cold
- low heart rate and blood pressure
- heart irregularities & chest pain
- preoccupation or obsession with weight, appearance, food & exercise
If you have experienced any of these signs or symptoms, it is important to talk to someone about it. Remember, with proper help, you can manage this condition, stay healthy, prevent serious health complications and keep performing at your best.
As a female involved in sport & fitness:
- Focus on healthy, nutritious eating for optimal performance
- Avoid restrictive eating practices or cutting out specific foods/food groups
- Don't avoid carbohydrates-rich foods – carbohydrates are essential for optimal fitness training as they are your body's primary fuel source. Choose healthy carbohydrate options like sweet potato, oats, brown rice, yoghurt & fruit.
- Eat regular meals and snacks to fuel you for training – don't skip meals or snacks, especially pre & post workout snacks
- Monitor your menstrual cycle by using a diary or calendar
- Consult your doctor if you have irregular/missed periods or recurrent injuries and stress fractures
- Seek the help of a Dietitian to design a healthy diet specific to your sport and to your body’s energy needs
- Talk with someone if you are concerned about your body image or weight
- Seek emotional support from parents, coaches, friends and teammates
Management & treatment
Managing and treating the Female Athlete Triad requires a team approach – the female athlete, parents, coach, Dietitian, G.P. and other health professionals.
The first aim of treatment for any Triad component is to increase energy availability. This may involve increasing energy intake from foods or reducing energy expenditure from exercise. Nutrition counselling from a Dietitian is essential to have energy needs assessed. Increasing energy availability should restore menstrual cycles and optimise bone mineral density. Ensuring adequate amounts of bone building nutrients including calcium, vitamin D & K, protein and other essential nutrients will aid bone recovery. Amounts can be determined by a Dietitian and dietary supplements may be necessary.
What if I think someone I know has it?
It is easy to ignore female athlete triad and hope it goes away. But successful treatment requires help from a doctor and other health professionals. If a friend, sister or teammate has signs and symptoms of female athlete triad, discuss your concerns with her and encourage her to seek treatment. If she refuses, you may need to mention your concern to a parent or coach.
Tips for female athletes:
- Keep track of your periods – keep a record on a calendar or in your phone of when your have your periods. That way, if you start missing periods, you'll know right away and you'll have accurate information to give to your doctor.
- Visit a dietitian – they will help you get your dietary game plan into gear and find out if you're getting enough key nutrients such as iron, calcium, and protein. And if you need supplements, a Dietitian can recommend the best choices.
- Don't skip meals or snacks – if you're constantly on the go, it can be easy to skip meals and snacks. But eating now will improve performance later, so stock up with healthy snacks like fruit, muesli bars, fruit muffins, yoghurt tubs to ensure you have something tasty and easy to eat on the go.
- Talk to someone – if you are concerned about your health or you have some of the signs and symptoms of the Female Athlete Triad, it is important to talk to someone about it. Talk to relative, friend, coach, and seek medical help. Talking to a doctor or dietitian will be confidential.
- Remember: It's your body and your life; you can stop unhealthy consequences of the Triad if you seek help and live healthy and compete at your best!
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