Time to get a little bit serious. With the holidays around many fitness professionals are taking writing about how to stay trim with Holiday parties and guides to New Year resolutions. I on the other hand wanted to take a different approach and take my time off school to really get into some deeper issues that surround fitness. One common problem that comes up time and time again with females in the fitness industry is amenorrhoea and energy deficiencies. Sounds strange doesn’t it?
The Female Athlete Triad is the combination of amenorrhoea (missed periods), low energy (eating disorders) and osteoporosis.
For many of us, this seems unlikely, but there is far too much reality to the Female Triad.
Signs of the female athlete triad include:
- Weight loss
- Absent or irregular periods
- Fatigue
- Stress fractures
- Restrictive dieting
- Binge eating
- Induced vomiting
- Excessive exercise
Symptom 1: Amenorrhoea
Amenorrhoea is the absence of menstruation, one or more missed periods. Primary amenorrhea is common in young athletes with no menstruation by the age of 16. Secondary amenorrhea occurs when you have previously menstruated but stopped having periods. When women shed too much weight, eat a low calorie diet and train hard, their bodies sense something is wrong. Commonly what occurs is the body will go into fight or flight mode, with menstruation being the first thing to go. Who needs to make babies when your body is in survival mode? A lot of women see this as a bonus, not getting a period but really this is not a good thing. The hypothalamus (part of the brain that is involved in periods and fertility) senses something is wrong and is unable to function properly. It responds by making the ovaries produce less hormones, particularly estrogen. Why is this a problem? With low estrogen, the body losses the ability to absorb calcium and therefore it cannot be uses for bone growth and maintenance. This brings us to symptom 2, osteoporosis.
The Menstruation Pathway
I want to make it clear that low body fat DOES NOT lead to amenorrhea. It was thought for many years that low body fat levels and exercise related chemicals (such as beta endorphins and catecholamines) disrupt the interplay of the sex hormones estrogen and progesterone, but recent research has disproven this theory. It has been found that there are no differences in the body composition, or hormonal levels in amenorrheic athletes. Amenorrhea has been shown to be directly attributable to a low energy availability. Many women who exercise at a high level do not take in enough calories to expend on their exercise as well as to maintain their normal menstrual cycles.
Symptom 2: Osteoporosis
Osteoporosis is a disease of the bone leading to an increased risk of fractures. The bone mineral density is reduced, causing the amount and variety proteins in the bone to be altered and disrupted. Although when many people think of Osteoporosis they think of postmenopausal Osteoporosis, which is all too common in older women, but as noted earlier female athletes are also at a great risk of developing weak bones. Additionally as active women, many of us perceive that we are not at risk for osteoporosis because exercise is known to strengthen bones. When bones begin to thin, stress fractures occur- which as we all can assume really hinder training. Stress fractures can lead to breaks even from non-traumatic injuries. Low estrogen is a contributing agent to osteoporosis, as well as lack of calcium in diets. Irreversible bone loss starts within six months to two years of the loss of menses.
Symptom 3: Low Energy
In an attempt to reduce body fat can lead to nutrient deficiencies and fluid electrolyte imbalance from low food intakes. Low energy is caused by an imbalance between the amount of energy consumed and the amount of energy expended during exercise. This energy deficiency is the primary cause of the Female Athlete Triad. Often, this can involve a conscious restriction of food intake, problems with body image and a high drive for thinness. Sometimes, these conditions can lead to disordered eating, or more serious eating problems, like anorexia or bulimia. For the competitors out there, this can occur around contest prep time! The “must get lean” mentality, can lead to a restrictive diet, and excessive exercise which of course creates an energy imbalance.
What can you do? Yearly check-ups are key. Monitoring your menstrual regularity as part of basic screening, and people with a history of stress fractures may warrant special attention. Keep in mind that many health care providers are not familiar with the Female Triad, and might be dismissive of its signs and symptoms. Also not all symptoms are caused by energy deficit or dietary problems. Amenorrhea might also be caused by an anatomic defect, premature ovarian failure, a prolactin-secreting tumor, polycystic ovarian syndrome (PCOS), or pregnancy.
It is a fine line that can be crossed, especially when your sport requires high amounts of training, and leanness. One important thing to remember is that consequences might not be seen now, or even in the next few months but could occur in years to come- in which they will be too late to reverse. Train smart ladies. Let’s try to be healthy inside and out.
Check out the Female Traid Coalition at www.femaleathletetriad.org for more information
