II. Definitions
- Female Athlete Triad
- Disordered Eating (Anorexia Nervosa)
- Secondary Amenorrhea
- Osteoporosis (Stress Fractures)
III. Epidemiology
- Eating Disorder Incidence in female athletes: 15-62%
-
Amenorrhea
Incidence
- Female Athletes: as high as 66%
- Women in general population: 2-5%
IV. Etiology: Pressure of competition and Society
- Winning
- Weight control
- Performance
- Thinness
V. Diagnosis
- Eating Disorder
-
Amenorrhea
- Menarche delayed 5 months per year athletic training
- Nutrition is lowest common denominator
-
Osteoporosis
- Old bones at a young age is associated with triad
- Osteoblasts are Estrogen dependent
- Athlete triad is Estrogen deficient state
VI. Risk Factors
- College age
- Appearance sports
- Gymnastics
- Figure skating
- Diving
- Dancing
- Endurance sports
- Long distance Running
- Cross Country Skiing
- Swimming
- Rowing
- Weight limits
- Wrestling
- Martial arts
- Rowing
- Enablers
- Judges
- Coaches
- Parents
- Athlete characteristics
- Perfectionist
- Goal oriented
- Highly dependent on external approval
- Win at all cost
VII. Signs
- See Anorexia Nervosa
VIII. Prevention
- Keep high index of suspicion
- Recognize triad early
-
Secondary Amenorrhea
- Increase body weight by 2 kilograms
- Decrease Exercise activity by 10%
IX. Treatment
- Multidisciplinary team
- Primary Physician, Psychologist, and Nutritionist
- Trainer and Coach
- Parents
- Threshold for intervention
- Menstrual periods missed
- Pounds lost
- Excessive Exercise
-
Pre-participation Exam
- Weight range history and Ideal Weight over last year
- Menstrual history
- Education
- Nutrition for peak performance
- Proper training (No Overtraining)
- Safe weight loss (less than 2 pounds per week)
- Decrease activity intensity part of year
- Oral Contraceptive cycling
- Nutrition
X. Radiology: Wrist and Hand XRay for Bone Health
- Premarin 0.625 mg qd for bone Growth Delayed by 2 years
XI. Prognosis
-
Eating Disorder
- See Anorexia Nervosa
- Amenorrhea associated morbidity
-
Osteoporosis associated morbidity
- Female athlete at age 20 may have 70 year old bone
- Increased Stress Fractures
- Increased Vertebral Fracture
- Increased Hip Fractures