Female Athlete Triad
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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 source]
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Characteristics/Clinical Presentation[edit source]
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Medications[edit source]
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Etiology/Causes[edit source]
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Original Editor <a href="User:Aarti Sareen">Aarti Sareen</a>
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
Introduction
One of the major medical concerns for women in sports is that of the female athlete triad which was initially defined at the Traid Consensus Conference in 1992Yeager KK,Agostini R, Nattiv A, Drinkwater BL.The female athlete traid: disordered eating,amenorrhea,osteoporosis. [Commentary].Med. Sci Sports Exer 25:775-7,1993..Also known simply as the Triad, this condition is seen in females participating in sports that emphasize leanness or low body weightTorstveit et al. 2005. ‘The Female Athlete Triad: Are Elite Athletes at Increased Risk?’ Medicine and Science in Sports and Exercise. vol. 37, no. 2. p. 184-93..This behavious may lead to fatal consequencesHobart, Julie A. and Douglas R. Smucker. 2000. ‘The Female Athlete Triad.’ The American Academy of Family Physicians. &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; http://www.aafp.org/afp/20000601/3357.html&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; Retrieved on 2007-10-11. It is a syndrome which involve 3 distinct and interrelated conditions:
- Disordered Eating (a range of poor nutritional behaviour)
- Amenorrhea (irregular or absent menstural periods)
- Osteoporosis (low bone mass and microarchitectural deterioration, which leads to weak bones and risk of fractures)
The problem of the of the female athlete traid collectively, as well as its indiviual components, have since been recognized as potentially serious problems for girls and women in sports worldwide.Nattive A,Agostini R,Drinkwater BL,Yeager KK; The female athlete traid: the inter-relatedness of disordered eating, amenorrhea and osteoporosis.Clin Sports Med 13:405-18,1994.Otis CL,Drinkwater B, Johnson MD,et al:American College of Sports Medicine Position Stand on the Female Athlete Traid.Med Sci Sports Exer 29:i-ix,1997.A study by Burrows et al has suggested that the current triad components do not identify all at-risk women; rather, the authors suggest that criteria such as exercise-related menstrual alterations, disordered eating, and osteopenia may be more appropriateBurrows M, Shepherd H, Bird S, MacLeod K, Ward B. The components of the female athlete triad do not identify all physically active females at risk. J Sports Sci. Oct 2007;25(12):1289-97..It is said to be interrelated as if an athlete is suffering from one element of the Triad, it is likely that they are suffering from the other two components of the triad as well"What is the Triad?". Female Athlete Triad Coalition. Retrieved 14 March 2012.. A Norwegian study of the prevalence of the triad found that fewer than 5% of elite female athletes met all the triad criteria and that this prevalence was comparable to that seen in normally active girls and young womenTorstvcit MK, Sundgot-Borgen J. The female athlete traid exist in both elite athlets and controls;Med Sci Sports Exer.2005; 37(9) 1149 59..When evaluating the presence of two of the components of the triad, prevalence ranged from 5.4% to 26.9% in the athletes. This implies that a Significant proportion of female athletes suffer from components of the triad rather than the triad itself and that this is not just confined to elite athletes, It has also been suggested that osteopenia is the likely effect of disordered eating on bone; osteoporosis is rare in this group of active womenKhan KM,Liu-Ambrose T,Sran MM,Ashe MC,Donaldson MG,Wark JD.New criteria for 'female athlete traid'syndrome? Br J Sports Med 2002; 36; 10-13..
Etiology
There are basically 3 main reason purposed for female athlete triad:
1. Low energy availability: This syndrome is caused by an energy drain or caloric deficit (ie, the athlete’s energy expenditure exceeds her dietary energy intake).This low energy availability, whether subconscious or conscious, disrupts the hypothalamic-pituitary-ovarian axis, resulting in decreased gonadotropin-releasing hormone (GnRH) pulsatility and low luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levelsLoucks AB. Effects of exercise training on the menstrual cycle: existence and mechanisms. Med Sci Sports Exerc. Jun 1990;22(3):275-80.These changes eventually lead to decreased estrogen production, causing menstrual dysfunction. The decreased estrogen levels, in turn, affect calcium resorption and bone accretion, causing decreased bone health.
2. Leptin Hormone: The hormone leptin, which is secreted by adipocytes, has also garnered increased interest. Leptin appears to influence the metabolic rate, and levels are proportional to body mass index (BMI). It may be a significant mediator of reproductive function, and many studies have demonstrated that low levels of leptin correlate positively with amenorrhea and infertility. Furthermore, leptin receptors have been found on hypothalamic neurons involved in the control of GnRH pulsatility and in bone, which may also affect osteoblastic function.
3. Emotional stressors can also often be identified as inciting factors in athletes with the triad. The death of a coach or a family member, growth spurts, an illness that prevents training, and other events that an athlete cannot control often lead to disordered eating and excessive training—areas of life that the athlete can control.For many, moving to a university setting initiates the triad cascade. Some young women move far away from family and friends, and they may carry the added responsibilities of a sports scholarship and a demanding academic workload.
Epidemiology
The female athlete triad, though more common in the athletic population, can also occur in the nonathletic population.All female athletes are at risk for the female athlete triad or any of its components, sports that have an aesthetic component e.g.in ballet, figure skating, or gymnastics or are tied to a weight class (eg, tae kwon do, judo, or wrestling) have a higher prevalence of affected female athletesNattiv A, Loucks AB, Manore MM, et al. American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc. Oct 2007;39(10):1867-82.Rosen LW, Hough DO. Pathogenic weight-control behavior of female college gymnasts. Phys Sportsmed. 1988;16(9):141-6.Kiernan M, Rodin J, Brownell KD, Wilmore JH, Crandall C. Relation of level of exercise, age, and weight-cycling history to weight and eating concerns in male and female runners. Health Psychol. 1992;11(6):418-21..Weight class sports associated with disordered eating, in athlets including males are,wresting,rowing.
Pathophysiology
The pathophysiology behind every triad is as follows:
Disordered eating
Eating disorders are characterized by a serious disturbance in eating, such as restriction of intake or bingeing, as well as excessive concern about body shape or weight. The term disordered eating itself was coined to include pathologic eating behaviors that do not meet the strict Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) requirements for anorexia or bulimia; thus, it includes, but is not limited to, anorexia nervosa and bulimia nervosa.These eating behaviours lead to negative energy balance and reduce energy avalibility. For more information on Anorexia nervosa <a href="http://www.physio-pedia.com/Anorexia_Nervosa">click here</a> and for Bulimia Nervosa<a href="http://www.physio-pedia.com/Bulimia_Nervosa">click here</a>
Menstrual Dysfunction
This includes includes luteal suppression, anovulation, oligomenorrhea, secondary amenorrhea and delayed menarche.
In luteal suppression have luteal phase and a prolonged follicular phase in which estradiol levels decrease. The cycle length usually does not change; the athlete will continue to ovulate—although it may be later in the cycle—and usually has regular menstruation.Anovulation is marked by low levels of estradiol and progesterone, which deter follicular development, as well as by an absence of ovulation.Amenorrhea usually refers to secondary amenorrhea, though delayed menarche/primary amenorrhea can occur in young athletes. By consensus, secondary amenorrhea is defined as the “absence of menstrual cycles lasting more than 3 months after menarche has occurred.”Oligomenorrhea is defined as “greater than 35 days between cycles.”
Osteoporosis
Bone quality refers to factors related to bone turnover rates (eg, resorption versus formation, microarchitecture or trabeculae, time for maturation of the new bone matrix, and bone geometry and size).The WHO has established diagnostic criteria for postmenopausal osteoporosis using bone density measurements, however, there is no similar diagnostic crietria that have been established for girls or young women using bone density criterioa. The consequences of ostepenia and osteoporosis in the female athlete are great.Menstruating athletes gain approximately 2-4% of bone mass per year, whereas amenorrheic athletes tend to lose 2% of BMD per year. Thus, it is easy to see why athletes who are involved in high-impact sports can still be more susceptible to fractures than their nonathletic and menstruating athletic counterparts. These include a possible increase in risk for stress fractures, as well as the potential for hip, vertebral and wrist fractures later in life.Rencken M, Chesnut CH, Drinkwater BL:Decreased bone density at multiple skeletal sites in amenorrheic athletes.JAMA 276:238-40,1996.Ireland M, Nattiv A. The Female Athlete. Saunders publication.
For more information on osteoporosis<a href="http://www.physio-pedia.com/Osteoporosis">click here</a>
Signs & Symptoms
If a girl has risk factors for female athlete triad, she may already be experiencing some symptoms and signs of the disorder, such as:
- weight loss
- no periods or irregular periods
- fatigue and decreased ability to concentrate
- stress fractures (fractures that occur even if a person hasn't had a significant injury)
- other injuries
Girls with female athlete triad often have signs and symptoms of eating disorders, such as:
- continued dieting in spite of weight loss
- preoccupation with food and weight
- frequent trips to the bathroom during and after meals
- using laxatives
- brittle hair or nails
- dental cavities because in girls with bulimia tooth enamel is worn away by frequent vomiting
- sensitivity to cold
- low heart rate and blood pressure
- heart irregularities and chest pain
Diagnosis
Resources
http://www.femaleathletetriad.org/
Recent Related Research (from Pubmed)
References
<a _fcknotitle="true" href="Category:Womens_Health">Womens_Health</a> <a _fcknotitle="true" href="Category:Sports_Medicine">Sports_Medicine</a>
