An athletic woman is not an unusual sight in the '90s; however, it has only been in the last 20 years that so many women have become active and competitive. The passage of Title IX in 1972 opened the athletic fields to women who choose to participate in competitive athletics by prohibiting discrimination on the basis of sex in educational institutions that receive federal funds. Because more women have been participating in sports, an increasing number of women's health issues have been brought to the forefront. Most women have reported overall health benefits from athletic participation, but risks do exist. Three of these risks appear to have some relation to one another and are collectively referred to as the female athlete triad.
The female athlete triad consists of disordered eating, amenorrhea, and osteoporosis. In the hopes of improving her athletic ability, the female athlete may fall into a trap of disordered eating. This disordered eating pattern along with stringent training regime may lead to amenorrhea, which means the menstrual cycle is irregular or has stopped. Amenorrhea may lead to premature osteoporosis. These components interact to create significant health problems for the female athlete.
The first component of the female athlete triad is disordered eating. This problem is common in women who participate in appearance sports, such as ballet, gymnastics, figure skating, diving, and equestrian events. Two types of extreme disordered eating behaviors are bulimia nervosa and anorexia nervosa. Bulimia nervosa is characterized by binge eating 2 times a week for at least 3 months. A person with bulimia nervosa may also practice self-induced vomiting (purging) and may use laxatives.
Anorexia nervosa is characterized by a body weight that is 15% below the normal weight range for a given age and height. A person who has this disease has an abnormal body image; she always feels fat even when dangerously underweight. Some women who have anorexia nervosa may binge and purge like women who have bulimia nervosa. Disordered eating, however, is not just a problem in women who are bulimic or anorexic. Numerous patterns of disordered eating that are not this extreme but are problematic also exist.
Often when a female athlete falls into extreme patterns of disordered eating, she does not have menstrual periods. This condition - amenorrhea- is the second component of the triad. A girl who has not begun menstruation by age 16 has primary amenorrhea. A woman who has skipped three to six menstrual periods in a row or more than three menstrual periods in 1 year has secondary amenorrhea. Although other medical problems, such as thyroid disorder or pregnancy, can cause a women to stop menstruating, the training regime and eating patterns of the female athlete must be considered as causes.
Disordered eating and amenorrhea seem to be associated with the development of premature osteoporosis - the third component of the triad. Osteoporosis means that the bones are losing mass and becoming porous, thin, and weak. Sixty percent to 70% of a woman's peak bone mass develops during her adolescent growth spurt, which occurs between the ages of 15 and 19. Women normally begin to lose bone mass after the age of 35. If a female athlete is not taking in enough calcium - the building block for bones - when bone mass is developing, she may have an abnormally low amount of bone mass before any normal loss of bone mass occurs, or she may lose bone mass prematurely. This premature loss of bone may be associated with a greater risk of injury and stress fractures for the female athlete who is putting stress on her musculoskeletal system during athletic participation.
What does all this mean? As health care professionals, parents, and coaches, we must be on the lookout for the disorders of this triad in female athletes. Prevention is the key to decreasing the occurrence of these disorders. Normal body images and weights must be promoted; optimal body weight for performance and general health, not necessarily appearance, must be stressed. Athletes must adhere to adequate diets in order to optimize the "fuel content" needed for improved health and performance. In addition to these factors, a good look at the training schedule is imperative. Overtraining leads to increased risk of injury and decreased sports performance, neither of which is the goal of any sports program. A healthy body image, a sufficient diet, and the right amount of training can help prevent the female athlete triad and can help the female athlete excel in an athletic career.
Teresa A. Lynch, P.T., A.T.,C.
Jackson, Wyoming
Turner A. Blackburn, Jr., P.T., M.Ed., A.T.,C.
Wyomissing, Pennsylvania