Download - Female athlete triad
FEMALE ATHLETE TRIAD
Female Athlete Triad Overview
Case PresentationDefine TriadRisk factorsEpidemiologyMichigan State AthletesScreening toolsTreatment optionsTake home points
Case
18 year old female cross country runnerPre-participation physical for MSUPre-med major, A’s in High SchoolTreated for anorexia at 14 y/o, now “better”Menarche at 15 y/o, menses 2X/year Iron supplements for anemiaNow having problems with foot pain
Female Athlete Triad Overview
Women in sports has increased since the passage of Title IX legislation in 1972.
Athletics can promote healthy lifestyle behaviors and decrease the risk for health problems.
Female athlete triad recognized in the 90sHealth consequences may be irreversible
Female Athlete Triad
Menstrual DysfunctionDisordered EatingDecreased Bone Mineral Density
Menstrual Dysfunction
Primary Amenorrhea– Absence of menarche by 16 y/o
Secondary Amenorrhea– After normal menarche – Absence of menses for 3-12 mo
Oligomenorrhea– Cycles greater than 36 days
Luteal phase dysfunction
Menstrual Dysfunction- Athletic Amenorrhea
Diagnosis of exclusionRule out pregnancyPoor nutritionDecreased GnRH from hypothalamus
– Cortisol, endorphins, androgensLeads to decreased LH and FSH pulses
from anterior pituitary
Disordered Eating- a Spectrum
Caloric restrictionPathogenic weight control behaviorsAnorexia
– Refusal to maintain <85% ideal body weight– Intense fear of gaining weight– Amenorrhea
Bulimia – Binge eating, lack of control– Inappropriate compensatory behavior
Eating disorders NOS
Decreased Bone Mineral Density
Trabecular (axial) and cortical (appendicular)– Trabecular bone more metabolically active
Adequate calcium and estrogen requiredOsteopenia
– Z score 1.0 to 2.5Osteoporosis
– Z score greater than 2.5Duration of amenorrhea correlates linearly with
decreases in bone mineral density
Female Athlete Triad- interrelated components
Low body weight/fatNutritional deficienciesHigh emotional stressChronic intense training
Female Athlete Triad Risk Factors
High risk sportsPerfectionist personalityLow self esteemDistorted body imageSocial isolizationOver controlling coach/parent
Female Athlete Triad Epidemiology
True prevalence is unknownPreparticipation physical exam
– 60% reported irregular menses– 45% not happy with their current weight– 16% suffered a stress fracture
Eating disorder incidence from 15-62%
Michigan State University- Female Athlete Body Composition
103 Female AthletesAll varsity sports recruitedBody composition with DEXAAnthropometric dataMenstrual histories
– 10-12 menses/year- eumenorrheic– 6-9 menses/year- oligomenorrhea– 0-6 menses/year- amenorrhea
No nutritional data
ATHLETES NAge (yrs) Ht (cm) Wt (kg) BMI % Fat FFM (kg)
Total 103 20.2 167.2 63.72 22.7 20.30 50.62
Gymnastics 8 19.7 157.9# 58.64# 23.4 19.71 47.00
Softball 14 20.1 169.4*# 65.69$ 22.8 21.26$ 51.55
Running 25 20.4 165.1# 57.24# 21.0 17.95 46.88
Track 8 20.1 166.3# 63.25 22.8 18.24 51.60
Field Hockey 10 19.8 165.7# 63.19 22.9 20.90 49.93
Soccer 10 19.8 168.2*# 65.92 23.2 21.82$ 51.49
Crew 15 20.5 171.1* 71.48*$ 24.4$ 22.35$ 55.43*$
Swim/Dive 9 20.4 166.0# 64.21 23.3 21.79$ 50.10
Volleyball 4 19.6 182.3* 73.95*$ 22.3 20.57 50.10*$
Menstrual Function
Menarche (yrs)
# EM # OM # AM % Abnormal
Yes OCPs
Total 13.5 (1.4) 79 18 6 30.4 34
Gymnastics 14.4 (0.6) 5 2 1 60.0 5
Softball 13.6 (1.7) 12 1 1 16.7 4
Running 13.8 (1.6) 15 6 4 66.7 5
Track 13.4 (1.0) 6 2 0 33.3 3
Field Hockey 12.9 (1.3) 9 1 0 11.1 4
Soccer 12.9 (1.4) 8 2 0 25.0 3
Crew 13.3 (0.9) 13 2 0 15.4 4
Swim/Dive 13.4 (2.0) 8 1 0 12.5 5
Volleyball 14.1 (0.9) 3 1 0 33.3 1
Total and Site-specific BMD
N Total Body
L Spine Pelvis Avg Leg
Total103 1.129 0.905 1.129 1.230
Normal Menstruation
79 1.137* 0.917 1.141* 1.234
Abnormal Menstruation
24 1.105 0.865 1.089 1.216
* p<0.05 comparing normal and abnormal menstruation groups
Volleybal
Swimming/Diving
Crew
Soccer
Field Hockey
Track
Running
Softball
Gymnastics
Sport Categories
1.200
1.100
1.000
0.900
0.800
Mean B
MD
TO
TA
L B
OD
Y
Volleybal
Swimming/Diving
Crew
Soccer
Field Hockey
Track
Running
Softball
Gymnastics
Sport Categories
1.200
1.100
1.000
0.900
0.800
Mean B
MD
L S
PIN
E
Volleybal
Swimming/Diving
Crew
Soccer
Field Hockey
Track
Running
Softball
Gymnastics
Sport Categories
1.200
1.100
1.000
0.900
0.800
Mean B
MD
PELV
IS
Volleybal
Swimming/Diving
Crew
Soccer
Field Hockey
Track
Running
Softball
Gymnastics
Sport Categories
1.30
1.20
1.10
1.00
0.90
0.80
Mean B
MD
AVG
LEG
30.028.026.024.022.020.018.016.0
BMI
1.300
1.200
1.100
1.000
BM
D T
OT
AL
Fit line for Total
AbnormalMenstruation
Normal MenstruationMenstrual Function
R Sq Linear = 0.165
Conclusions for MSU Athletes
No athletes met the criteria for osteopenia, regardless of menstrual function
Non-weight bearing activity for the swimmers resulted in lower leg BMDs
Runners low at lumbar spine but leg BMD was normal
More menstrual dysfunction for runners and gymnasts
Screening Tools for Female Athlete Triad
Low body weight and/or BMIHigher risk sports
– Cross-country, swimming, gymnasticsPreparticipation Physical
– Menstrual history– Body image satisfaction– Past illnesses and injuries
Female Athlete Triad Treatment
Treatment Team– Athlete– Parents– Coaches– Athletic trainer/physician– Mental health providers– Dietician
Female Athlete Triad Treatment
Prevention is bestTreatment of eating disorder is multi-
disciplinaryAthletic participation may be discontinuedSlow increase in caloric intakeEstrogen replacement for menstrual
disturbances
TAKE HOME POINTS
PREVENTION is KEYEducation for athletes/coaches/medical
professionalsTreatment requires a multi-disciplinary
approachLifestyle modifications