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The danger of a too-lean physique for female athletes

Information provided on the blog is for educational purposes only and is not intended to diagnose or offer treatment plans.

The positive effects of sport participation in females are numerous and include both mental and physical health benefits.  However, with the increasing number of adolescent females participating in sports, a unique health concern arises.  The Female Athlete Triad, a syndrome characterized by low energy availability, menstrual dysfunction, and poor bone health.  This needs to be recognized as a serious health condition that can result in serious long-term consequences if left untreated.

Females most at risk are those participating in sports that emphasize a lean physique (gymnastics, ballet, long-distance running) and can occur in athletes at any age or competitive level.  The “triad” includes:

Low energy availability:

To maintain a lean figure, athletes will often restrict calorie consumption or exercise for prolonged periods of time without consuming adequate nutrition.  The severity can range from generalized disordered eating to defined eating disorders such as anorexia nervosa or bulimia nervosa.

Menstrual dysfunction:

Hormone imbalances in athletes can disrupt the normal menstrual cycle.  Females may experience irregular menstruation or complete lack of menstruation.  Prolonged, strenuous exercise and inadequate dietary consumption can lead to hormone imbalances that cause irregular menses.

Poor bone health:

Athletes that do not consume proper vitamins and nutrients or exhibit hormone imbalances can have decreased bone production. The consequences of poor bone health include increase risk of fractures and osteoporosis.  Most individuals will meet their maximum bone mass between the ages of 25 and 30.  Proper dietary intake and hormone balance is important for adolescent and young adult athletes to build strong, healthy bone.

Signs and symptoms include:

  • fractures
  • decline in sport performance
  • mood shifts
  • frequent injuries
  • dissatisfaction with appearance
  •  irregular menses

Health care professionals, coaches, teammates, and family members can play an important role in recognizing and preventing the Female Athlete Triad. Pre-participation physicals are effective screening tools and can aid in identifying those at risk.  Proper management of the female athlete triad involves modification in exercise program, restoration of proper nutrition, and supportive counseling from specialists and family.

Understanding the risks and consequences associated with the Female Athlete Triad can help ensure that active females are participating safely and maximizing a healthy lifestyle.

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Carly Jackson, PA-C

Carly is a Physician Assistant for OrthoIllinois. She's always had an interest in orthopedics (specifically female athletes, skiing and snowboarding injuries, and ACL surgery) while dealing with her own injuries and staying active in many different sports while growing up.


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