Guidelines for Parents, Coaches, and Athletes

Female Athlete Triad

July 2002 American Academy of Pediatrics, section in Sports Medicine & Fitness

The combination of 3 medical conditions – eating problems, menstrual problems, and weak bones – can cause female athletes to lose strength and endurance and develop season-ending injuries (such as stress fractures). It may even force young athletes to quit their sport. More importantly, these conditions can put young women at risk for lifelong problems with weak bones.

 

Eating Problems

Taking in fewer calories than your body requires.

This can lead to:

Menstrual (period) Problems

Periods that:

Start at a late age or do not start by 16 years of age;

Start, then stop for longer than 3 to 6 months; or

Occur irregularly – longer than 35 days without periods or fewer than 9 per year.

This can lead to:

Problems with weak bones

Moderately weakened bone (osteopenia) can affect young women and can cause them to have the bone strength of a 50- to 60 year-old woman! This weakness may not be completely reversible.

Severely weakened bone (osteoporosis) causes increased risk of stress fractures (breaks in bones from playing sports or performing arts) and trauma fractures (from falls of collisions).

GUIDELINES FOR PREVENTION

Diet

          Fad diets and food supplementation do not help you perform better and do not replace good balanced eating habits.

It is important to eat enough food (calories) to build bone strength and muscle mass that will help you to perform your best.

Calcium

Young female athletes need calcium for bone strength. About 1300 mg per day is needed and is best obtained through a fortified diet:

(1 cup) skim milk 300 mg

(1 oz.) Swiss cheese 270 mg

(8 oz.) yogurt 410 mg

(1 cup) broccoli 150 mg

(1 glass) calcium fortified orange juice 200-250 mg

(1 cup) cottage cheese 200 mg

Excess intake of carbonated or caffeinated drinks (soda/pop or coffee) can lead to calcium loss and weaken bones. Instead, drink milk or calcium–fortified orange juice.

Menstrual Periods

Skipping periods is NOT NORMAL. This is NOT a sign of good or advanced sports training.

Tell your doctor or trainer about missed periods as soon as it occurs or at the time of your preseason physical.

Skipping periods does not mean that you are not fertile or cannot get pregnant. In fact, it could be a sign that you are pregnant.

Keep a calendar of your menstrual periods. LISTEN to your body.

Stress Fractures

Nagging, aching pain that occurs with activity and doesn’t improve over time may signal a broken bone or crack known as a stress fracture.

Stress fractures heal slowly with rest. They heal even more slowly when bones are weak, and you may need to stay away from your sport for a long time.

Prevention

Athletes need to follow a healthy diet with adequate intake of calories and calcium to maintain and improve performance.

Female athletes need to be aware of changes in their menstrual periods and report these to their physician.

Worsening or persistent bone or joint pain that affect athletes in daily activities needs to be evaluated for the possibility of stress fractures.

 

To learn more about the potential health risks of performance enhancing substances visit

The Healthy Competition Foundation