2.27.08 Female Athlete Triad

2007 Position Statement

Also read osteoporosis. Active, not necessarily athletes.

3 Interrelated Syndromes:

Disordered Eating- not eating disorders necessarily (those are clinical, medical diagnosis)
Will lead to amenorrhea (irregular menstrual cycle). As few as three missed periods will damage bones. Osteoporosis is a bone mineral density that is below normal.

If a woman has disordered eating, if affects her energy needs. Negative caloric balance- chronic negative calorie diet will cause amenorrhea. Normal cycle is 28 days.

Causes- pressure associated w/competition, emotionally vulnerable women, self image, cultural association w/ thinness, media/family/friends, mother's obsession with her own weight (#1 reason for poor body image).

Women w/ 1 component of the triad should be screened for the other two.

If a young woman exercising twists her ankle and fractures it, she should be screened for osteoporosis.

Much more prevalent than one would think. General population, not just athletes.

Energy Availability problems pg. 1869
Dietary intake-exercise output = +/-

Woman may have normal body fat level and her calorie intake may still be inadequate. May be intentional, inadvertent, or psychopathalogical.

Disordered Eating: low calorie intake significant enough to lead to problems with menstrual cycle.

May purge: laxatives, purging, diet pills, excessive exercise, diuretics.

Eating Disorders: Anorexia Nervosa, bulimia nervosa, ED-NOS (eating disorder, not otherwise specified)

Anorexia Nervosa-
Mortality rate is high: 10-18%
slow suicide-years

1. Starvation
2. Electrolyte imbalance
3. Low bp
4. Low HR
5. Arrythmia
6. orthostatic hypotension
7. low RBC and WBC count that lead to increased infections
8. Constipation
9. abdominal pain
10. high blood cholesterol
11. underweight <18% BMI- body comp as over fat
12. fine light hair growth

Bulimia-
Binge.purge cycles

1. Electrolyte imbalance
2. GI complications from stomach acid
3. Tooth decay from stomach acid
4. Russel's sign (knuckle scaring from finger down the throat)
5. hypertrophy of salivary glands
6. normal body weight/normal % body fat

General Disordered Eating
see nutrition book

1. Are you happy with your present weight? Why or why not?

2. What would you like to weight?

Prevalence of Disordered Eating
as young as 7 years old
40% of 9-10 year old females are trying to lose weight- major factor is mother's obsession with her own weight.80% of women dislike their body by age 18.

least like body- Caucasian
most comfortable with body- African American

40% of female body builders have disordered eating

15-62% of athletes depending on sport

Get professional help- team approach. Never overstep or contradict medical professional working with your client.
Appendix G- be careful of what you say and how you say it. Emphasize health, not weight.

Different Amenorrheas

Primary Amenorrhea- absence by age 15. 1st menses is the end of puberty usually.

Secondary amenorrhea- absence for more than 90 days in someone who has an established cycle.

Amenorrhea is never a natural cause from intense exercise.

Oligo: between 35-90 days without period

Eumenoria- normal period of 28 days

Cause- significant weight loss or low body fat. not alone responsible.
And in very obese women.
loss of specific body fat stores
excessive exercise accompanied by weight loss
nutritional deficiency- a lot of vegans.

Health Consequences:

directly related to osteoporosis. 3 months without a period with affect bone mineral density. 6 months will cause an irreversible bmd deficiency.

Decrease training 10-20% and increase calorie intake, and resistance. 1000-1300 mg of Ca and avoid fiber supplements.

Osteoporosis: generalized throughout whole skeleton but manifests in thoracic bones, wrist, hips.

pg. 223-225 ACSM