What is female triad syndrome?

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The female athlete triad is a syndrome which contains three related conditions which are generally seen in teens or adult female athletes who aren’t meeting their energy requirements. This ultimately leaves them undernourished. The female triad syndrome, though more common in the athletic population, can also occur in non-athletes.

The three components of the female athlete triad include the following:

  1. Energy deficits or disordered eating
  2. Menstrual irregularities or amenorrhea
  3. Decreased bone density or osteoporosis

Who is at risk for developing the female athlete triad syndrome?

Those at highest risk for developing the triad include female athletes participating in sports that promote or emphasize being thin and lean. Long-distance runners, cyclists, gymnasts, figure skaters and dancers are often susceptible to the perceived and sometimes blatant pressure to lose weight.

The most common risk factors for female triad syndrome include:

  • Participating in sports that require weigh-ins
  • Social isolation during sports
  • Perfectionism in the athlete
  • Excessive training and exercise – particularly endurance exercise
  • Hearing negative comments about the athlete’s weight, weight gain or body shape
  • Controlling parents or coaches who emphasize winning

Common indications and symptoms of the female athlete triad syndrome

The warning signs and symptoms of the triad should be recognised as warning signs that something is wrong and should not be ignored. The most common of these include:

  • Irregular or absent menstrual cycles
  • Chronic fatigue
  • Insomnia and sleep disturbance
  • Recurrent stress fractures
  • Frequent or recurring injuries or illness
  • Routinely restricting calories
  • Obsession with thinness and body image
  • Cold hands and feet

Often difficult to recognise the female athlete tri-ad can have a significant impact on morbidity and even mortality in a fairly young segment of the population. In fact, the full impact of this syndrome may not be realised until these women get to menopause when bone loss is accelerated.

Considerable research of the triad has been constant and emergent data may increase the female athlete triad to a tetrad. This additional research has been looking at the relationship of the triad to endothelial dysfunction in addition to the possible increased cardiac risk.

Complications of the female athlete triad

Athletes who strive to reduce body fat by using excessive exercise or calorie restriction often think that being thin will help their sports performance. Infect, too little body fat in an athlete significantly reduces sports performance. However, more significantly, too little body fat increases the risk of developing serious and severe health complications.

Nutritional deficiencies, along with fluid and electrolyte imbalances, set up a cascade of effects that involve nearly every system of the body:

  • Cardiovascular
  • Endocrine
  • Reproductive
  • Skeletal
  • Gastrointestinal
  • Renal
  • Central nervous system

Inadequate calorie intake leads to a loss of body fat, an irregular or lack of menses (amenorrhea) and a reduction in oestrogen levels that eventually leads to bone loss. Decreased bone density then results in increased risk of stress fractures and even osteoporosis, as we’ve alluded to before.

The most serious complications of the triad include irreversible bone loss, starvation, decreased oestrogen production and sudden death. Research points to energy deficiency as the cause of the cascade of problems. A woman with this triad doesn’t eat enough to meet her energy demands which put a tremendous strain on every system of the body.

Although an eating disorder is often an underlying component of the triad some athletes experience energy deficits even without consciously restricting calories. For this reason, it’s important to monitor calories needs and to watch for warning signs of a calorie deficit.

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