Female Athlete Triad

Female athlete triad is a disease process due to energy imbalances that affects females. It is a triad of menstrual dysfunction, low energy bioavailability (with or without an eating disorder) and decreased bone mineral density. The type of menstrual dysfunction due to changes in energy bioavailability is called functional hypothalamic amenorrhea. 

Energy bioavailability refers to the amount of dietary energy available to perform necessary functions after exercise. 

This is more prevalent in sports that have an emphasis on aesthetics and leanness, such as ballet.

If anyone is found to have any of the components  of the female athlete triad they should be evaluated for the other 2. 

This diagnosis should be considered if a female has rapid weight loss, rapid decline in performance, changes in mood, or frequent injuries such as fractures.

Symptoms

The symptoms are based on the triad of menstrual dysfunction, low energy bioavailability and decreased bone mineral density

Women are usually deficient in estrogen and may therefore have sexual dysfunction, low bone density and infertility. There may be vaginal dryness which may cause sex to be painful. 

The low energy bioavailability is usually due to disordered eating, which may or may not meet the criteria for an underlying eating disorder such as anorexia or bulimia.  

The decreased bone mineral density may lead to an increased risk of fractures.

Diagnosis

When evaluating someone for female athlete triad a full history, physical examination and labs should be done. A DEXA scan is helpful in determining if there is low bone mineral density. Other causes of menstrual irregularities should be ruled out prior to the diagnosis of female athlete triad.

Treatment

Treatment focuses on increasing caloric intake and decreasing exercise to increase bone mineral density and regulate menses. Other therapies may be an option if symptoms are not improving. 

Calcium and vitamin D supplementation is encouraged for low bone density as an initial treatment option.

Recognition is very important as the earlier detection can help to prevent complications.