Female Athlete Triad

Definition (ACOG 2017): “The female athlete triad is a medical condition observed in physically active females involving three components:
1) Low energy availability with or without disordered eating,
2) Menstrual dysfunction, and
3) Low bone density.”

Diagnosis
Assess all active females for the components of the triad. If one or more of the components are found, do further evaluation for the rest.

Diagnostic tests
DEXA scan (Bone Mineral density test).

Treatment
“The female athlete triad is a result of energy imbalance; thus, adjusting energy expenditure and energy availability is the main intervention.
Pharmacologic treatment may be considered when nonpharmacologic treatment has failed.
“A team approach involving the patient, obstetrician-gynecologist, sports nutritionist, coaches, parents, and mental health care provider, if indicated, is optimal.” ACOG

“The goal of treatment for those diagnosed with female athlete triad is restoration of regular menses as a clinical marker of reestablishment of energy balance and enhancement of bone mineral density. The female athlete triad is a result of energy imbalance; thus, adjusting the energy expenditure and energy availability is the main intervention. Nonpharmacologic interventions, including family-based therapy and cognitive behavioral therapy, also have been shown to be effective interventions for disordered eating . Not all athletes with female athlete triad have disordered eating. Some athletes are not aware of their energy needs or do not have the appetite to drive adequate consumption. A sports nutritionist can help the athlete and her family determine the quantity and quality of food consumption and dietary supplementation required to meet her bodily functions, replace energy output due to athletic training, and enhance bone health. Daily intake of 1000–1300 mg of calcium and 600 units of Vitamin D is recommended; however, evidence is lacking regarding whether vitamin supplementation improves BMD. In some cases, in addition to increasing quality and quantity of energy consumption, working with coaches to decrease athletic activity level may be required to regain a positive energy balance. Additionally, weight gain may be necessary to increase BMD. The strongest predictor of recovery to normal menstrual function in collegiate athletes is weight gain (4).” ACOG 2017

Background
“The female athlete triad is a result of energy imbalance; thus, adjusting energy expenditure and energy availability is the main intervention. Low energy availability is associated with hypothalamic dysfunction and, subsequently, will negatively affect menstrual function and bone health. Consequences of these clinical conditions may not be completely reversible, so prevention, early diagnosis, and intervention are critical.” ACOG

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