The Female Athlete Triad - Disordered Eating, Amenorrhoea, and Osteoporosis

Being an athlete, besides being downright fun, can help offset the development of many medical problems. However, taken to an extreme, a young woman's desire to excel at sport can push her to develop significant medical problems.

It seems that everywhere you turn these days there is something about eating disorders. Unfortunately, it cannot even be avoided in sports magazines and websites. The sad thing is that sport can often put a lot of pressure on women. Who has not heard of the female runner trying to lose just a few pounds to improve her race time. Or of the wrestler trying to somehow melt off one or two more pounds in order to not exceed her weight category. Or of the woman who gets into sport for the sole reason of losing weight, due to pressure from our ridiculous "Thin is Beautiful for Women" society. When women start to focus on losing weight, they can often start a dangerous process. What begins as a dietary improvement can lead to extreme calorie reduction, skipping meals, and even throwing up (purging) or taking laxatives to get rid of unwanted food, and starvation.The weight will come off, the woman will look thin, but after a certain point her training and performance are going to suffer.

Once women have shed too much weight, their bodies will let them know something is wrong. Besides feeling unwell and low in energy, women will often stop their periods. Although this may seem like a little bonus (who wants a period anyway, right?), it is actually the body's way of letting women know that something bad is going on. The hypothalamus is an area of the brain that is involved with periods and fertility. When women exercise they expend more energy. If they restrict the number of calories they are consuming, their body enters a state of constant energy depletion. The hypothalamus senses something is wrong and is unable to function properly. It responds by making the ovaries produce less hormones, estrogen in particular.Amenorrhoea, the medical term for no periods, then develops. When estrogen is low, the body loses its ability to absorb calcium and to use it for bone growth or maintenance. These women are then at high risk for developing weak bones and even a disease called osteoporosis if their bones get thin enough.

Young athletes with thinning bones often start to suffer from stress fractures which are painful and a real hindrance to a training program (talk to anyone who has had to run in a pool because of stress fractures). Stress fractures are an obvious result of too little estrogen and weakening bones. Some will actually break a bone from a relatively non-traumatic injury. A less obvious effect is the more long-term damage done to bones that are still gaining strength. In women, this continues into the 20's. If the process of bones developing is interrupted while women are still teens, bones may never reach their maximum density and, consequently, these women have a higher risk of developingosteoporosislater on. Even if estrogen levels come back up, bone loss can be halted and actually re-built although there is some concern that bones may never regain their full strength.

The eating disorder part of the female athlete triad can itself cause a lot of trouble. No athlete can perform if she is dehydrated or suffering from muscle weakness due to poor nutrition. Nor can she perform if she is so anorexic that her heart is starting to develop irregular rhythms because of starvation.

The good thing is that the Female Athlete Triad can be treated.A team that includes a doctor, nutritionist and psychologist can best treat the disordered eating. The goal is to get the young woman up to a weight that improves her health and teaches her how to be happy with her body at this healthy weight. Starting the birth control pill is often recommended. The pill provides a daily dose of estrogen that will help bones start to thicken up again. This is NOT to be used in place of a proper diet which will improve a woman's own estrogen stores. However, once a woman has become amenorrheic, she is at immediate risk for fractures and at long term risk for osteoporosis. The decrease in bone density can be seen within one year by special x-ray called bone densitometry. Therefore, the problem needs to be identified and treated early. Women also need to get enough calcium and vitamin D to promote bone growth (see Ask the Nutritionist for information on this).

The Female Athlete Triad is a significant medical syndrome.Because the consequences can be so significant, if you think you have any of the symptoms, see your doctor. On the other hand, be on the look-out for a friend that is training more than usual and losing a lot of weight. You could do her a big favour by helping her identify an eating disorder if that is what she is suffering from.

The bottom line is "that too much of a good thing" is not necessarily a "good thing". This goes for pursuing excellence in sport at the risk of your health.