Female Athlete Triad: Difference between revisions

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== Definition/Description  ==
== Definition/Description  ==


Female Athlete Triad is a syndrome that evolves from the interrelationships among energy availability, bone mineral density, and menstrual function. The clinical manifestations include eating disorders, functional hypothalamic amenorrhea, and osteoporosis. Not all clinical signs must be present to diagnose Female Athlete Triad.<ref name="1">The Female Athlete Triad. Medicine &amp;amp;amp; Science In Sports &amp;amp;amp; Exercise [serial on the Internet]. (2007, Oct), [cited March 27, 2017]; 39(10): 1867-1882. Available from: Academic Search Complete.</ref>&nbsp;Female Athlete Triad commonly occurs in adolescent or highly competitive female athletes. This syndrome is most common in Adolescent athletes largely due to their skeletal immaturity and naturally low Bone Mineral Density (BMD) being more susceptible to physical and metabolic stressors. Along with health care providers, all coaching staff members of high level and high school women’s sports teams should be highly aware of signs of this disease in order to manage the health of their players.<ref name="2">Mukherjee S, Chand V, Wong X, Choong P, Lau V, Ng K, et al. Perceptions, awareness and knowledge of the Female Athlete Triad amongst coaches—Are we meeting the expectations for athlete safety?. International Journal Of Sports Science &amp;amp;amp; Coaching [serial on the Internet]. (2016, Aug), [cited March 27, 2017]; 11(4): 545-551. Available from: PsycINFO.</ref>&nbsp;It is also recommended that all female athletes are screened for Female Athlete Triad on a yearly basis.<ref name="3">Thein-Nissenbaum J. Long term consequences of the female athlete triad. Maturitas [serial on the Internet]. (2013, June), [cited March 27, 2017]; 75(2): 107-112. Available from: MEDLINE.</ref> Early signs of the Female Athlete Triad include weight changes, repeated fractures, and decreased energy.Longterm effects of Female Athlete Triad include low peak BMD, Osteoporosis, Thoughts of suicide during long term disease process, and kidney and liver dysfunction.<ref name="3" /><br>  
Female Athlete Triad is a syndrome that evolves from the interrelationships among energy availability, bone mineral density, and menstrual function. The clinical manifestations include eating disorders, functional hypothalamic amenorrhea, and osteoporosis. Not all clinical signs must be present to diagnose Female Athlete Triad.<ref name="1">The Female Athlete Triad. Medicine &amp;amp;amp;amp; Science In Sports &amp;amp;amp;amp; Exercise [serial on the Internet]. (2007, Oct), [cited March 27, 2017]; 39(10): 1867-1882. Available from: Academic Search Complete.</ref>&nbsp;Female Athlete Triad commonly occurs in adolescent or highly competitive female athletes. This syndrome is most common in Adolescent athletes largely due to their skeletal immaturity and naturally low Bone Mineral Density (BMD) being more susceptible to physical and metabolic stressors. Along with health care providers, all coaching staff members of high level and high school women’s sports teams should be highly aware of signs of this disease in order to manage the health of their players.<ref name="2">Mukherjee S, Chand V, Wong X, Choong P, Lau V, Ng K, et al. Perceptions, awareness and knowledge of the Female Athlete Triad amongst coaches—Are we meeting the expectations for athlete safety?. International Journal Of Sports Science &amp;amp;amp;amp; Coaching [serial on the Internet]. (2016, Aug), [cited March 27, 2017]; 11(4): 545-551. Available from: PsycINFO.</ref>&nbsp;It is also recommended that all female athletes are screened for Female Athlete Triad on a yearly basis.<ref name="3">Thein-Nissenbaum J. Long term consequences of the female athlete triad. Maturitas [serial on the Internet]. (2013, June), [cited March 27, 2017]; 75(2): 107-112. Available from: MEDLINE.</ref> Early signs of the Female Athlete Triad include weight changes, repeated fractures, and decreased energy.Longterm effects of Female Athlete Triad include low peak BMD, Osteoporosis, Thoughts of suicide during long term disease process, and kidney and liver dysfunction.<ref name="3" /><br>  


[[Image:Triad-diagram.jpg]]<ref name="1" /><ref name="4">Stickler L, Hoogenboom B, Smith L. THE FEMALE ATHLETE TRIAD-WHAT EVERY PHYSICAL THERAPIST SHOULD KNOW. International Journal Of Sports Physical Therapy [serial on the Internet]. (2015, Aug), [cited March 27, 2017]; 10(4): 563-571. Available from: MEDLINE.</ref>
[[Image:Triad-diagram.jpg]]<ref name="1" /><ref name="4">Stickler L, Hoogenboom B, Smith L. THE FEMALE ATHLETE TRIAD-WHAT EVERY PHYSICAL THERAPIST SHOULD KNOW. International Journal Of Sports Physical Therapy [serial on the Internet]. (2015, Aug), [cited March 27, 2017]; 10(4): 563-571. Available from: MEDLINE.</ref>  


== Prevalence  ==
== Prevalence  ==


Due to inconsistencies and limitations in criteria defining Female Athlete Triad, study methodology, and experimental design there is an evident discrepancy in the literature when determining the prevalence of the triad. The chances of all three conditions of the triad presenting simultaneously are low, ranging from 0% to 16%. The odds of two conditions presenting at the same time range from 3% to 27%. Generally, most common to just have one of the conditions present with the odds ranging from 16% to 60%.<ref name="5">Gibbs J, Williams N, De Souza M. Prevalence of individual and combined components of the female athlete triad. Medicine And Science In Sports And Exercise [serial on the Internet]. (2013, May), [cited March 27, 2017]; 45(5): 985-996. Available from: MEDLINE.</ref> Since a diagnosis for Female Athlete Triad is possible without having all three components of the triad, it is possible for sedentary and normally active females to be diagnosed with the syndrome at rates that are only slightly less than competitive female athletes.<ref name="6">Hoch A, Pajewski N, Moraski L, Carrera G, Wilson C, Gutterman D, et al. Prevalence of the female athlete triad in high school athletes and sedentary students. Clinical Journal Of Sport Medicine: Official Journal Of The Canadian Academy Of Sport Medicine [serial on the Internet]. (2009, Sep), [cited March 27, 2017]; 19(5): 421-428. Available from: MEDLINE.</ref><ref name="7">Torstveit M, Sundgot-Borgen J. The female athlete triad exists in both elite athletes and controls. Medicine And Science In Sports And Exercise [serial on the Internet]. (2005, Sep), [cited March 27, 2017]; 37(9): 1449-1459. Available from: MEDLINE.</ref><br><br>
Due to inconsistencies and limitations in criteria defining Female Athlete Triad, study methodology, and experimental design there is an evident discrepancy in the literature when determining the prevalence of the triad. The chances of all three conditions of the triad presenting simultaneously are low, ranging from 0% to 16%. The odds of two conditions presenting at the same time range from 3% to 27%. Generally, most common to just have one of the conditions present with the odds ranging from 16% to 60%.<ref name="5">Gibbs J, Williams N, De Souza M. Prevalence of individual and combined components of the female athlete triad. Medicine And Science In Sports And Exercise [serial on the Internet]. (2013, May), [cited March 27, 2017]; 45(5): 985-996. Available from: MEDLINE.</ref> Since a diagnosis for Female Athlete Triad is possible without having all three components of the triad, it is possible for sedentary and normally active females to be diagnosed with the syndrome at rates that are only slightly less than competitive female athletes.<ref name="6">Hoch A, Pajewski N, Moraski L, Carrera G, Wilson C, Gutterman D, et al. Prevalence of the female athlete triad in high school athletes and sedentary students. Clinical Journal Of Sport Medicine: Official Journal Of The Canadian Academy Of Sport Medicine [serial on the Internet]. (2009, Sep), [cited March 27, 2017]; 19(5): 421-428. Available from: MEDLINE.</ref><ref name="7">Torstveit M, Sundgot-Borgen J. The female athlete triad exists in both elite athletes and controls. Medicine And Science In Sports And Exercise [serial on the Internet]. (2005, Sep), [cited March 27, 2017]; 37(9): 1449-1459. Available from: MEDLINE.</ref><br><br>  


== Characteristics/Clinical Presentation  ==
== Characteristics/Clinical Presentation  ==


*Weight loss
*Weight loss  
*Absent or irregular periods
*Absent or irregular periods  
*Fatigue
*Fatigue  
*Stress fractures
*Stress fractures  
*Restrictive dieting
*Restrictive dieting  
*Binge eating
*Binge eating  
*Induced vomiting
*Induced vomiting  
*Excessive exercise<br>
*Excessive exercise<br>


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Due to the loss in bone mineral density the primary comorbidity associated with female athlete triad is osteoporosis. Female athlete triad generally occurs in the primary age range for storing and depositing calcium in the bones. Slowing or reversing this possess will result in the potential to increase the risk of fractures later in life even after resolving the issues leading to a diagnosis of female athlete triad.  
Due to the loss in bone mineral density the primary comorbidity associated with female athlete triad is osteoporosis. Female athlete triad generally occurs in the primary age range for storing and depositing calcium in the bones. Slowing or reversing this possess will result in the potential to increase the risk of fractures later in life even after resolving the issues leading to a diagnosis of female athlete triad.  


Systemically low Bone MIneral Density, low blood estrogen level, and menstrual dysfunction has been linked to Endothelial Dysfunction in endurance athletes. Endothelial Dysfunction is directly related to the bodies ability to constrict or dilate blood vessels. If Endothelial Dysfunction is present (indicated by Brachial Artery flow-mediated dilation) the risk for Cardiovascular Events, poor blood flow mediation, and athrosclerotic disease are all increased significantly.<ref name="8">Weiss Kelly A, Hecht S. The Female Athlete Triad. Pediatrics [serial on the Internet]. (2016, Aug), [cited March 27, 2017]; 138(2): e1-e10. Available from: Academic Search Complete.</ref><br>
Systemically low Bone MIneral Density, low blood estrogen level, and menstrual dysfunction has been linked to Endothelial Dysfunction in endurance athletes. Endothelial Dysfunction is directly related to the bodies ability to constrict or dilate blood vessels. If Endothelial Dysfunction is present (indicated by Brachial Artery flow-mediated dilation) the risk for Cardiovascular Events, poor blood flow mediation, and athrosclerotic disease are all increased significantly.<ref name="8">Weiss Kelly A, Hecht S. The Female Athlete Triad. Pediatrics [serial on the Internet]. (2016, Aug), [cited March 27, 2017]; 138(2): e1-e10. Available from: Academic Search Complete.</ref><br>  


== Medications  ==
== Medications  ==


Antidepressants are often used to treat associated concomitant depression and anxiety disorders. They are also used following weight restoration for bulimia nervosa and anorexia nervosa. Research has show mixed results for improving BMD or restoring menstrual cycles when using hormone replacement therapy (HRT) or oral contraceptive pill (OCP). While BMD may not be improved by using OCP, it may help to reduce further loss in BMD in athletes under the age of 16.Young women with functional hypothalamic amenorrhea should not use bisphosphonates that are approved for the treatment of postmenopausal osteoporosis due to their unproven efficacy in women of childbearing age. Also since the medication tend to linger in the bones for many years they have the potential to cause harm to a developing fetus is the patient becomes pregnant later in life.Ovulation inducing agents such as clomiphene citrate and exogenous gonadotropins are indicated if the aim of therapy is to restore fertility.<ref name="1" /> Nutritional therapy has the best evidence for successfully treating female athlete triad due to its ability to in increase energy availability.<ref name="9">Javed A, Tebben P, Fischer P, Lteif A. Female athlete triad and its components: toward improved screening and management. Mayo Clinic Proceedings [serial on the Internet]. (2013, Sep), [cited March 27, 2017]; 88(9): 996-1009. Available from: MEDLINE.</ref><br><br>
Antidepressants are often used to treat associated concomitant depression and anxiety disorders. They are also used following weight restoration for bulimia nervosa and anorexia nervosa. Research has show mixed results for improving BMD or restoring menstrual cycles when using hormone replacement therapy (HRT) or oral contraceptive pill (OCP). While BMD may not be improved by using OCP, it may help to reduce further loss in BMD in athletes under the age of 16.Young women with functional hypothalamic amenorrhea should not use bisphosphonates that are approved for the treatment of postmenopausal osteoporosis due to their unproven efficacy in women of childbearing age. Also since the medication tend to linger in the bones for many years they have the potential to cause harm to a developing fetus is the patient becomes pregnant later in life.Ovulation inducing agents such as clomiphene citrate and exogenous gonadotropins are indicated if the aim of therapy is to restore fertility.<ref name="1" /> Nutritional therapy has the best evidence for successfully treating female athlete triad due to its ability to in increase energy availability.<ref name="9">Javed A, Tebben P, Fischer P, Lteif A. Female athlete triad and its components: toward improved screening and management. Mayo Clinic Proceedings [serial on the Internet]. (2013, Sep), [cited March 27, 2017]; 88(9): 996-1009. Available from: MEDLINE.</ref><br><br>  


<h2> Diagnostic Tests/Lab Tests/Lab Values  </h2>
== Diagnostic Tests/Lab Tests/Lab Values  ==
<p>Athletes most commonly show signs of 1 or 2 components of Female Athlete Triad.&nbsp;If suspected due to pain, recurrent fractures, recurrent sprains, Low BMI (&lt;85% expected weight), poor eating habits, or other, use the following questions to see if there is cause for concern.<br />  
 
</p><p><img src="/images/thumb/6/60/Triad_Table1.png/3px-Triad_Table1.png" _fck_mw_filename="Triad Table1.png" _fck_mw_location="left" _fck_mw_width="3" _fck_mw_height="3" _fck_mw_type="thumb" alt="" class="fck_mw_frame fck_mw_left" /><br />  
Athletes most commonly show signs of 1 or 2 components of Female Athlete Triad.&nbsp;If suspected due to pain, recurrent fractures, recurrent sprains, Low BMI (&lt;85% expected weight), poor eating habits, or other, use the following questions to see if there is cause for concern.<br>  
</p><p><br />
 
</p><p>Table 1 from (10)  
<br>
</p><p>Table2 from (10)  
 
</p><p><u>Risk Factors</u>(8,10, 11,)<u></u>  
Table 1 from (10)  
</p><p>Non-Modifiable:  
 
</p>
Table2 from (10)  
<ul><li>Female Gender  
 
</li><li>Age 12-19 (10)
<u>Risk Factors</u>(8,10, 11,)<u></u>  
</li></ul>
 
<p>Modifiable:  
Non-Modifiable:  
</p>
 
<ul><li>Early age sport specialization  
*Female Gender  
</li><li>Low BMI (Z-score less than or equal to -1)  
*Age 12-19 (10)
</li><li>Overtraining  
 
</li><li>Engaging in sports with endurance, aesthetic, and weight class components  
Modifiable:  
</li><li>Severe Dieting  
 
</li><li>Family Dysfunction  
*Early age sport specialization  
</li><li>Abuse
*Low BMI (Z-score less than or equal to -1)  
</li></ul>
*Overtraining  
<p><u>Energy Availability (EA)</u>  
*Engaging in sports with endurance, aesthetic, and weight class components  
</p>
*Severe Dieting  
<ul><li>&nbsp;Energy Intake should be at least 45 kcal/kg of fat-free mass (FFM)<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="8" />
*Family Dysfunction  
</li><li>&lt; 30kcal/kg FFM disrupts bone mineralization and menstruation<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="8" />
*Abuse
</li><li>5 days or more of &lt; 30kcal/kg decreases luteinizing hormone availability in the body<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="8" />
 
</li></ul>
<u>Energy Availability (EA)</u>  
<p>Triggers for disordered eating may include: Prolonged dieting, weight fluctuations, changes in coaching, injury, and social attention to weight.  
 
</p><p><u>Bone Mineral Density</u><br />In women, about 90% of bone formation should be complete by 18 years old<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="3" />, with bone density peaking between 20-30 years old. Poor Bone Mineral density is correlated with being &lt;85% expected weight for height and age. A Z-score at or below -1.0 is cause for concern.&nbsp;Long Distance Running is a highest risk sport for negatively impacting BMD<br />BMD Screenings such as for celiacs disease<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref">8</span><br />Menstruation<br />Disorders in menstrual function can be as mild as anovulation and luteal dysfunction to Oligomenorrhea and Amenorrhea<br />Menstrual disturbances are common in all adolescents (~21%), but more common in adolescent athletes (~54%)<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="8" />
*&nbsp;Energy Intake should be at least 45 kcal/kg of fat-free mass (FFM)&lt;span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="8" /&gt;
</p>
*&lt; 30kcal/kg FFM disrupts bone mineralization and menstruation&lt;span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="8" /&gt;
<ul><li>-Anovulation - ovaries do not release an oocyte and ovulation doesn’t occur. (few overt symptoms)  
*5 days or more of &lt; 30kcal/kg decreases luteinizing hormone availability in the body&lt;span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="8" /&gt;
</li><li>-Luteal Deficiency - low concentration of blood progesterone and or Luteal phase lasting less than 11 days (few overt symptoms)  
 
</li><li>-Oligomenorrhea - menstrual cycles lasting longer than 35 days  
Triggers for disordered eating may include: Prolonged dieting, weight fluctuations, changes in coaching, injury, and social attention to weight.  
</li><li>-primary Amenorrhea is the “absence of menarche by the age of 15 years.”<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="8" />
 
</li><li>-secondary Amenorrhea is absence of menstruation for greater than or equal to 3 consecutive months after menarche<br /><br />
<u>Bone Mineral Density</u><br>In women, about 90% of bone formation should be complete by 18 years old&lt;span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="3" /&gt;, with bone density peaking between 20-30 years old. Poor Bone Mineral density is correlated with being &lt;85% expected weight for height and age. A Z-score at or below -1.0 is cause for concern.&nbsp;Long Distance Running is a highest risk sport for negatively impacting BMD<br>BMD Screenings such as for celiacs disease<ref>8</ref><br>Menstruation<br>Disorders in menstrual function can be as mild as anovulation and luteal dysfunction to Oligomenorrhea and Amenorrhea<br>Menstrual disturbances are common in all adolescents (~21%), but more common in adolescent athletes (~54%)&lt;span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="8" /&gt;
</li></ul>
 
*-Anovulation - ovaries do not release an oocyte and ovulation doesn’t occur. (few overt symptoms)  
*-Luteal Deficiency - low concentration of blood progesterone and or Luteal phase lasting less than 11 days (few overt symptoms)  
*-Oligomenorrhea - menstrual cycles lasting longer than 35 days  
*-primary Amenorrhea is the “absence of menarche by the age of 15 years.”&lt;span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="8" /&gt;
*-secondary Amenorrhea is absence of menstruation for greater than or equal to 3 consecutive months after menarche<br><br>


== Etiology/Causes  ==
== Etiology/Causes  ==
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<references />  
<references />  


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Revision as of 02:29, 4 April 2017

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - James Chad Cissell, Michelle Walsh, Ethan Adams, Aarti Sareen, Lucinda hampton, Wanda van Niekerk, Regan Haley, Kim Jackson, Nicole Hills, Elaine Lonnemann, WikiSysop, Adam Vallely Farrell, 127.0.0.1, Oyemi Sillo, Claire Knott and Rishika Babburu  

Definition/Description[edit | edit source]

Female Athlete Triad is a syndrome that evolves from the interrelationships among energy availability, bone mineral density, and menstrual function. The clinical manifestations include eating disorders, functional hypothalamic amenorrhea, and osteoporosis. Not all clinical signs must be present to diagnose Female Athlete Triad.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Female Athlete Triad commonly occurs in adolescent or highly competitive female athletes. This syndrome is most common in Adolescent athletes largely due to their skeletal immaturity and naturally low Bone Mineral Density (BMD) being more susceptible to physical and metabolic stressors. Along with health care providers, all coaching staff members of high level and high school women’s sports teams should be highly aware of signs of this disease in order to manage the health of their players.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title It is also recommended that all female athletes are screened for Female Athlete Triad on a yearly basis.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Early signs of the Female Athlete Triad include weight changes, repeated fractures, and decreased energy.Longterm effects of Female Athlete Triad include low peak BMD, Osteoporosis, Thoughts of suicide during long term disease process, and kidney and liver dysfunction.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Triad-diagram.jpgCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Prevalence[edit | edit source]

Due to inconsistencies and limitations in criteria defining Female Athlete Triad, study methodology, and experimental design there is an evident discrepancy in the literature when determining the prevalence of the triad. The chances of all three conditions of the triad presenting simultaneously are low, ranging from 0% to 16%. The odds of two conditions presenting at the same time range from 3% to 27%. Generally, most common to just have one of the conditions present with the odds ranging from 16% to 60%.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Since a diagnosis for Female Athlete Triad is possible without having all three components of the triad, it is possible for sedentary and normally active females to be diagnosed with the syndrome at rates that are only slightly less than competitive female athletes.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Characteristics/Clinical Presentation[edit | edit source]

  • Weight loss
  • Absent or irregular periods
  • Fatigue
  • Stress fractures
  • Restrictive dieting
  • Binge eating
  • Induced vomiting
  • Excessive exercise

Associated Co-morbidities[edit | edit source]

Due to the loss in bone mineral density the primary comorbidity associated with female athlete triad is osteoporosis. Female athlete triad generally occurs in the primary age range for storing and depositing calcium in the bones. Slowing or reversing this possess will result in the potential to increase the risk of fractures later in life even after resolving the issues leading to a diagnosis of female athlete triad.

Systemically low Bone MIneral Density, low blood estrogen level, and menstrual dysfunction has been linked to Endothelial Dysfunction in endurance athletes. Endothelial Dysfunction is directly related to the bodies ability to constrict or dilate blood vessels. If Endothelial Dysfunction is present (indicated by Brachial Artery flow-mediated dilation) the risk for Cardiovascular Events, poor blood flow mediation, and athrosclerotic disease are all increased significantly.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Medications[edit | edit source]

Antidepressants are often used to treat associated concomitant depression and anxiety disorders. They are also used following weight restoration for bulimia nervosa and anorexia nervosa. Research has show mixed results for improving BMD or restoring menstrual cycles when using hormone replacement therapy (HRT) or oral contraceptive pill (OCP). While BMD may not be improved by using OCP, it may help to reduce further loss in BMD in athletes under the age of 16.Young women with functional hypothalamic amenorrhea should not use bisphosphonates that are approved for the treatment of postmenopausal osteoporosis due to their unproven efficacy in women of childbearing age. Also since the medication tend to linger in the bones for many years they have the potential to cause harm to a developing fetus is the patient becomes pregnant later in life.Ovulation inducing agents such as clomiphene citrate and exogenous gonadotropins are indicated if the aim of therapy is to restore fertility.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Nutritional therapy has the best evidence for successfully treating female athlete triad due to its ability to in increase energy availability.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]

Athletes most commonly show signs of 1 or 2 components of Female Athlete Triad. If suspected due to pain, recurrent fractures, recurrent sprains, Low BMI (<85% expected weight), poor eating habits, or other, use the following questions to see if there is cause for concern.


Table 1 from (10)

Table2 from (10)

Risk Factors(8,10, 11,)

Non-Modifiable:

  • Female Gender
  • Age 12-19 (10)

Modifiable:

  • Early age sport specialization
  • Low BMI (Z-score less than or equal to -1)
  • Overtraining
  • Engaging in sports with endurance, aesthetic, and weight class components
  • Severe Dieting
  • Family Dysfunction
  • Abuse

Energy Availability (EA)

  •  Energy Intake should be at least 45 kcal/kg of fat-free mass (FFM)<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="8" />
  • < 30kcal/kg FFM disrupts bone mineralization and menstruation<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="8" />
  • 5 days or more of < 30kcal/kg decreases luteinizing hormone availability in the body<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="8" />

Triggers for disordered eating may include: Prolonged dieting, weight fluctuations, changes in coaching, injury, and social attention to weight.

Bone Mineral Density
In women, about 90% of bone formation should be complete by 18 years old<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="3" />, with bone density peaking between 20-30 years old. Poor Bone Mineral density is correlated with being <85% expected weight for height and age. A Z-score at or below -1.0 is cause for concern. Long Distance Running is a highest risk sport for negatively impacting BMD
BMD Screenings such as for celiacs disease[1]
Menstruation
Disorders in menstrual function can be as mild as anovulation and luteal dysfunction to Oligomenorrhea and Amenorrhea
Menstrual disturbances are common in all adolescents (~21%), but more common in adolescent athletes (~54%)<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="8" />

  • -Anovulation - ovaries do not release an oocyte and ovulation doesn’t occur. (few overt symptoms)
  • -Luteal Deficiency - low concentration of blood progesterone and or Luteal phase lasting less than 11 days (few overt symptoms)
  • -Oligomenorrhea - menstrual cycles lasting longer than 35 days
  • -primary Amenorrhea is the “absence of menarche by the age of 15 years.”<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="8" />
  • -secondary Amenorrhea is absence of menstruation for greater than or equal to 3 consecutive months after menarche

Etiology/Causes[edit | edit source]

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Systemic Involvement[edit | edit source]

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Medical Management (current best evidence)[edit | edit source]

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Physical Therapy Management (current best evidence)[edit | edit source]

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Differential Diagnosis[edit | edit source]

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Case Reports/ Case Studies[edit | edit source]

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Resources
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References[edit | edit source]

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  1. ↑ 8

Original Editor <a href="User:Aarti Sareen">Aarti Sareen</a>

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