Female Athlete Triad: An Unhealthy Condition

A small minority of girls who take part in sports face a threat unique to women: the female athlete triad.

The triad is made up of these factors: disordered eating, disrupted menstrual cycles (missing three or more periods in a row) and osteoporosis (low bone mass). The condition, while common, isn't healthy or normal.

It can start when an active girl cuts back on calories to lose weight or burns more calories exercising than she's taking in, says Anne Z. Hoch, D.O., director of the Women's Sports Medicine Program at the Froedtert & Medical College of Wisconsin in Milwaukee. Continued weight loss affects the reproductive system, leading to missed periods.

Just to get through the day, a girl needs 1,500 to 1,800 calories, Dr. Hoch says. "You need 100 calories more for every mile you run. So if you run five to 10 miles, you need to add another 500 to 1,000 calories. But instead of taking in 2,500 calories, some of these girls are only taking in 1,000 or 1,500 calories."

Females form most of their bone mass as teens, but these girls wind up with low levels of the estrogen. Adequate estrogen is needed to help the body use calcium, which builds and maintains bone density. Since just one in eight girls ages 11 to 14 gets enough calcium anyway, their risk of osteoporosis rises.

Any competitive female athlete is at risk for the triad. But Dr. Hoch says it's most common in runners, ballerinas, gymnasts and figure skaters, whose sports focus more on appearance and weight. According to the American Academy of Family Physicians, athletes who are also at risk include those who feel that sports take up all their free time, leaving no time for friends; those who exercise more than needed for their particular sport; and those who are pushed to win, no matter what.

Treatment often involves a team approach. A doctor, nutritionist and psychologist work with the athlete, her coach and her parents.

"Our studies on amenorrheic athletes have found that when girls improve their diets and fuel their bodies properly, they gain weight and body fat and their menstrual periods return," says Dr. Hoch.