Recognize the female athlete triad
Recognize the female athlete triad: Excerpt from Avoiding Common Pediatric Errors
Author:
Nailah Coleman, MD
What to Do - Gather Appropriate Data
In the athletic world, as in other parts of general society, there are certain
sports (e.g., cheerleading, figure skating, and rowing) where a slim build is
notonlydesirablebutbeneficialtoanathlete'sperformanceorplacementina
certain sporting category. Unfortunately, the attainment of a slim build often
results in a trio of signs and symptoms known as the female athlete triad,
comprised of disordered eating, menstrual dysfunction, and osteoporosis.
Disordered eating can take many forms, ranging from restricting food
intake (e.g., anorexia) to binging or purging (e.g., bulimia) to taking medications to promote weight loss (e.g., laxatives, diuretics). Athletes will also
partake in excessive exercising or wear rubber suits while exercising to increase their weight loss. All of these disordered eating practices can help
contribute to the two remaining parts of the triad.
In general, menstrual dysfunction more commonly exists among female
athletes, as opposed to nonathletic females. This menstrual dysfunction can
take various forms, including amenorrhea, both primary and secondary;
oligomenorrhea; and luteal phase deficiency. Primary amenorrhea is diagnosed when a female has had no menses by the age of 16 or has had no menses
within 4.5 years of breast development. After having begun to menstruate,
a female that has 3 to 6 consecutive months without a menses is said to have
secondary amenorrhea. Oligomenorrhea denotes a cycle that exists >35 days
induration.Luteinizinghormone(LH)pulsatilityisdependentonafemale's
energy reserve. If a female has increased expenditure with decreased energy
intake, the energy deficiency causes abnormal LH pulsatility suppression
and, menstrual irregularity.
Osteoporosis is defined as decreased bone mass due to premature bone
loss or poor bone formation. In female athletes, this decreased bone mass is
related to low estrogen levels. Ironically, certain sports that cause increased
stress to certain bone groups may cause increased bone density in only those
bone groups. For example, female gymnasts—at risk for the female athlete
triad, due to the emphasis the sport puts on size and physique—may have
increased lower extremity bone density, from the stress placed on the lower
skeleton.
Early recognition of the female athlete triad is critical to prevention
of injury and short-and long-term sequelae. In the short term, using laxatives, diuretics, and rubber suits can result in dehydration and decreased
performance. Long-term consequences of the female athlete triad can be
functional, including decreased speed, endurance, and strength; and physiological, including electrolyte disturbances and end-organ dysfunction (e.g.,
cardiac and endocrine).
The preparticipation physical is the ideal time to probe for signs of the
female athlete triad. In addition to obtaining a good history from the athlete, it is also important to listen to any concerns expressed by the athlete's
parents, friends, and coaches. A thorough evaluation of the patient's menstrual dysfunction should include a pregnancy test and evaluation for other
pathologic conditions, including hypothyroidism (thyroid-stimulating hormone), pituitary tumor (prolactin), or polycystic ovarian syndrome (pelvic
exam, testosterone, LH, dehydroepiandrosterone sulfate [DHEA-S], and
17-hydroxyprogesterone). In addition, an evaluation of the patient's bone
mineral density may be warranted.
After diagnosis, treatment of the female athlete triad often involves a
multidisciplinaryteamofphysicians,nutritionists,andmentalhealthspecialists. On occasion, however, an unaware female athlete may only need dietary
education on her body's energy needs while playing her sport. Estrogen
supplementation may be helpful for those with hypothalamic amenorrhea,
restoring menstrual function and improving bone mineral density.
Suggested Readings
AmericanAcademyofPediatrics.CommitteeonSportsMedicineandFitness.Medicalconcerns
in the female athlete. Pediatrics. 2000;106:610–613.
American Academy of Pediatrics. Committee on Sports Medicine and Fitness. Promotion of
healthy weight-control practices in young athletes. Pediatrics. 1996;97:752–753.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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