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The Female Athlete

The Triad of Disordered Eating, Amenorrhoea and Osteoporosis

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Abstract

Over the last few decades, the number of women participating in organised sports has grown dramatically. Participation in sports has led to significant health benefits for these women; however, several medical disorders have become more prevalent as the number of female athletes has increased. In response to the increase in the number of female athletes and potential medical disorders, the American College of Sports Medicine coined the term ‘the female athlete triad’ in 1992. The female athlete triad is a serious syndrome comprising 3 interrelated components: (i) disordered eating; (ii) amenorrhoea; and (iii) osteoporosis.

The female athlete triad is a syndrome that can be prevented. Medical management of the female athlete triad requires a multidisciplinary approach, with early diagnosis and treatment being key factors. More studies are required to determine its causes, prevalence and consequences and to develop an optimal treatment strategy. All individuals, including coaches and parents, who are working with physically active girls and women should be educated about these disorders, and they should develop strategies to prevent, recognise and treat the female athlete triad.

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References

  1. Beim G, Stone DA. Issues in the female athlete. Orthop Clin North Am 1995; 26: 443–51

    PubMed  CAS  Google Scholar 

  2. Wiggins DL, Wiggins ME. The female athlete. Clin Sports Med 1997; 17: 593–603

    Article  Google Scholar 

  3. Otis CL, Drinkwater B, Johnson M, et al., American College of Sports Medicine. Position stand: the female athlete triad. Med Sci Sports Exerc 1997; 29 (5): i–ix

    Article  PubMed  CAS  Google Scholar 

  4. Skolnick AA. ’Female athlete triad’ risk for women. JAMA 1993; 270: 921–3

    Article  PubMed  CAS  Google Scholar 

  5. Rosen LW, McKeag B, Hough DO, et al. Pathogenic weightcontrol behaviour in female athletes. Phys Sportsmed 1986; 14: 79–86

    Google Scholar 

  6. Rosen LW, Hough DO. Pathogenic weight-control behaviours of female college gymnasts. Phys Sportsmed 1988; 16: 141–6

    Google Scholar 

  7. Dummer GM, Rosen LW, Heusner WW, et al. Pathogenic weight-control behaviours of young competitive swimmers. Phys Sportsmed 1987; 15: 75–86

    Google Scholar 

  8. Ratnasuriya RH, Eisler I, Szmukler GI, et al. Anorexia nervosa: Outcome an prognostic factors after 20 years. Br J Psychiatry 1991; 158: 495–502

    Article  PubMed  CAS  Google Scholar 

  9. Marshall LA. Clinical evaluation of amenorrhoea in active and athletic women. Clin Sports Med 1994; 13: 371–87

    PubMed  CAS  Google Scholar 

  10. Shangold MM, Rebar RW, Wentz AC, et al. Evaluation and management of menstrual dysfunction in athletes. JAMA 1990; 263: 1665–9

    Article  PubMed  CAS  Google Scholar 

  11. Lindberg JS, Powell MR, Hunt MM, et al. Increased vertebral bone mineral in response to reduced exercise in amenorrheic women. West J Med 1987; 146: 39–42

    PubMed  CAS  Google Scholar 

  12. Loucks AB, Horvath SM. Athletic amenorrhoea: a review. Med Sci Sports Exerc 1985; 17: 54–72

    Google Scholar 

  13. Otis CL. Exercise-associated amenorrhoea. Clin Sports Med 1992; 11: 351–62

    PubMed  CAS  Google Scholar 

  14. DeSouza MJ, Metzger DA. Reproductive dysfunction in amenorrheic athletes and anorexic patients: a review. Med Sci Sports Exerc 1991; 23: 995–1000

    CAS  Google Scholar 

  15. Frisch RE, Gotz-Welbergen AV, McArthur JW, et al. Delayed menarche and amenorrhoea of college athletes in relation to age of onset of training. JAMA 1981; 246: 1559–63

    Article  PubMed  CAS  Google Scholar 

  16. Bullen BA, Skrinar GS, Beitins IZ, et al. Induction of menstrual disorders in untrained women by strenuous exercise. N Engl J Med 1985; 312: 1349–53

    Article  PubMed  CAS  Google Scholar 

  17. Yurth E. Epitomes, female athlete triad. West J Med 1995; 162: 149–50

    PubMed  CAS  Google Scholar 

  18. Snow-Harter CM. Bone health and prevention of osteoporosis in active and athletic women. Clin Sports Med 1994; 13: 389–404

    PubMed  CAS  Google Scholar 

  19. Eriksen EF, Colvard DS, Berg NJ, et al. Evidence of estrogen receptors in normal human osteoblasts. Science 1988; 241: 84–6

    Article  PubMed  CAS  Google Scholar 

  20. Drinkwater BL, Bruemmer B, Chesnut III CH. Menstrual history as a determinant of current bone density in young athletes. JAMA 1990; 263: 545–8

    Article  PubMed  CAS  Google Scholar 

  21. Marcus R, Cann C, Madvig P, et al. Menstrual function and bone mass in elite women distance runners: endocrine metabolic features. Ann Intern Med 1985; 102: 158–63

    PubMed  CAS  Google Scholar 

  22. Drinkwater BL Nilson K, Chesnut III CH, et al. Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med 1984; 311: 277–81

    Article  PubMed  CAS  Google Scholar 

  23. Myburgh K, Bachrach LK, Lewis B, et al. Low bone mineral density at axial and appendicular sites in amenorrheic athletes. Med Sci Sport Exerc 1993; 25: 1197–202

    CAS  Google Scholar 

  24. Myerson M, Gutin B, Warren MP, et al. Total body bone density in amenorrheic runners. Obstet Gynecol 1992; 79: 973–8

    PubMed  CAS  Google Scholar 

  25. Rencken ML, Chesnut III CH, Drinkwater BL. Bone density at multiple skeletal sites in amenorrheic athletes. JAMA 1996; 276: 238–40

    Article  PubMed  CAS  Google Scholar 

  26. Robinson TL, Snow-Harter C, Taaffe DR, et al. Gymnasts exhibit higher bone mass than runners despite similar prevalence of amenorrhoea and oligomenorrhoea. J Bone Min Res 1995; 10: 26–35

    Article  CAS  Google Scholar 

  27. Snow-Harter C, Bouxsein M, Lewis B, et al. Effects of resistance and endurance exercise on bone mineral density in young women. J Bone Miner Res 1990; 5: 589–95

    Article  PubMed  CAS  Google Scholar 

  28. Sowers MR, Kshirsager A, Crutchfield MM, et al. Joint influence of fat and lean body composition compartments on femoral bone mineral density in premenopausal women. Am J Epidmiol 1992; 136: 257–65

    CAS  Google Scholar 

  29. Cann CE, Martin MC, Genant HK, et al. Decreased spinal mineral content in amenorrheic women. JAMA 1984; 251: 626–9

    Article  PubMed  CAS  Google Scholar 

  30. Drinkwater BL, Nilson K, Ott S, et al. Bone mineral density after resumption of menses in amenorrheic athletes. JAMA 1986; 256: 380–2

    Article  PubMed  CAS  Google Scholar 

  31. Johnson MD. Tailoring the preparticipation exam to female athletes. Phys Sportsmed 1992; 20: 61–72

    Google Scholar 

  32. Committee on Sports Medicine, American Academy of Pediatrics. Amenorrhoea in adolescent athletes. Pediatrics 1989; 84: 394-5

    Google Scholar 

  33. Warren MP. The effect of exercise on pubertal progression and reproductive function in girls. J Clin Endocrinol Metab 1980; 51: 1150–7

    Article  PubMed  CAS  Google Scholar 

  34. Davies M, Hall M, Jacobs H. Bone mineral loss in young women with amenorrhoea. BMJ 1990; 301: 790–3

    Article  PubMed  CAS  Google Scholar 

  35. Emans SJ, Grace E, Hoffer FA, et al. Estrogen deficiency in adolescents and young adults; impact on bone mineral content and effects of estrogen replacement therapy. Obstet Gynecol 1990; 76: 585–92

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, George Washington University, Washington, DC, USA

    Robin Vereeke West

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  1. Robin Vereeke West
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Correspondence to Robin Vereeke West.

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West, R.V. The Female Athlete. Sports Med 26, 63–71 (1998). https://doi.org/10.2165/00007256-199826020-00001

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  • DOI: https://doi.org/10.2165/00007256-199826020-00001

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