Exercise is part of a balanced, healthy lifestyle and sports can be an excellent form of exercise. Kids and teens who play sports are healthier; get better grades; and are less likely to experience depression, use alcohol and drugs. But some young girls who play sports or exercise intensely are at risk for developing a health problem called female athlete triad. Female athlete triad is characterized by having one or more of a combination of three conditions:

• Disordered eating: Teen athletes may try to lose weight as a way to improve their athletic performance. Disordered eating includes not consuming enough calories to meet energy demands, avoiding certain types of food (such as foods containing fat), and serious eating disorders like anorexia or bulimia nervosa.
• Amenorrhea: Exercising intensely and not eating enough calories can both lead to decreases in the hormones that help regulate the menstrual cycle. As a result, a girl’s periods may never start, become irregular or stop altogether.
• Osteoporosis (loss of bone density): Teens should be building up their bone mass to their highest levels — called peak bone mass – during their teenage years. Osteoporosis for a teen is particularly bad because it can ruin an athlete’s career and cause lifelong repercussions.

What are the signs and symptoms?

• Weight loss
• No periods or irregular periods
• Fatigue and decreased ability to concentrate
• Stress fractures (fractures that occur even if a person hasn’t had a significant injury)
• Other injuries, particularly to the bones or joints

Other signs and symptoms include common signs of eating disorders, such as:

• Continued dieting in spite of weight loss
• Preoccupation with food and weight
• Frequent trips to the bathroom during and after meals
• Using laxatives
• Brittle hair or nails
• Dental cavities
• Sensitivity to cold
• Low heart rate and blood pressure
• Heart irregularities and chest pain

Diagnosis and treatment of female athlete triad

Doctors can perform a physical examination to help diagnose female athlete triad. They will ask questions about periods, nutrition, medications and exercise habits. Your doctor might request or suggest:

• Blood tests
• Bone density tests
• Other tests to rule out other potential medical problems
• An appointment with a psychologist to help with the emotional aspects of female athlete triad
• Hormone, calcium or vitamin D supplements

Once it has been diagnosed, female athlete triad can be treated with help from coaches and trainers, parents, physical therapists, pediatricians, adolescent or sports medicine specialists, nutritionists and dietitians and mental health specialists.

What if I think I have it or a friend has it?

It might be tempting to shrug off several months of missed periods, but getting help right away is important. Female athlete triad may lead to reduced physical performance, stress fractures, other injuries, long-term bone weakness, permanent effects on the reproductive system and heart problems.

You might worry about seeming nosy when you ask questions about a friend’s health, but you’re not: your concern is a sign that you’re a caring friend. If a friend, sister or teammate has signs and symptoms of female athlete triad, discuss your concerns with her and encourage her to seek treatment. If she refuses, you may need to mention your concern to a parent, coach, teacher or school nurse.

Tips for female athletes

• Keep track of your periods. And talk to your doctor if you miss any.
• Don’t skip meals or snacks. Eating now will improve performance later.
• Visit a dietitian or nutritionist who works with teen athletes to make a dietary game plan.

It’s your body and your life. 

Pressure from teammates, parents, or coaches can turn a fun activity into a nightmare. You — not your coach or teammates — will have to live with any damage you do to your body now.

First published on the HCA Midwest Health website here.