What is the Female Athlete Triad?
Female Athlete Triad
Being a pro dancer brought with it a world of benefits that I never imagined. The experiences, the thrill, the empowerment… things that will stay with me for a lifetime. It also brought with it a number of physical, mental and emotional challenges that I didn’t anticipate: injury, chronic pain, complete and utter exhaustion, altered hormones and menstrual cycle dysregulation, unchecked stress and anxiety, unintended disordered eating, and insomnia.
I was completely oblivious to a phenomenon known as the “female athlete triad,” which is more common in athletes who participate in sports that generally desire a leaner body physique and low body weight (dancers, gymnasts and runners). The female athlete triad is a group of medical conditions that show up more commonly in female athletes, and they may occur alone or all together. These things are not always completely reversible, but natural medicine can be pretty powerful in addressing them when caught early.
The components of the “triad” are laid out below:
1: “Low Energy Availability”
Due to an athlete’s increased activity, insufficient calories, or deficient nutrient intake, female athletes are more likely than the general population to experience a low body mass index (BMI)* rating. Nutrients are essential for proper cell function – requiring adequate vitamins, minerals, and macros (including carbohydrates, proteins and fats). Without enough nutrition, our body pulls nutrients from “storage” areas to keep the most essential functions of your body going (for example, to keep your heart beating). Additionally, inadequate nutrition is known to decrease metabolism, making maintenance of your natural healthy body weight more challenging, both now and in the future. Low energy availability affects hypothalamic function (a part of your brain that controls several hormone pathways), which may lead to the 2nd and 3rd components of the female athlete triad.
2: Abnormal Periods
As a result of the malnutrition, our body may reserve its nutrition components to support the fundamental aspects of life (again, think keeping your heart beating) and inhibit the hormones that regulate your periods. Menstrual dysfunction may be an indication that your body’s hormones are out of balance or that your brain has instituted a fundamental survival mechanism by shutting down “extra credit” functions.
The American College of Obstetrics and Gynecology states that 69% of dancers experience a lack of a period for over 90 days compared to 2-5% of the general population. Low body fat and decreased estrogen are large contributing factors in irregular periods in athletes. On average, a woman requires a BMI of 18.5 to have a menstrual cycle, but women may experience reproductive challenges anywhere from a BMI of 18.5 to 21. Suppressing your body’s reproductive hormones now may lead to long-term suppression and sequelae of infertility or difficulty conceiving, painful periods, osteoporosis, and even cardiovascular disease.
3: Bone Loss
Healthy young women shouldn’t experience osteopenia or osteoporosis (bone loss). Female athletes, however, are at an increased risk of bone density changes. This happens for a couple of reasons: 1) inadequate vitamins and minerals for proper homeostasis; and 2) prematurely decreased estrogen, which mimics hormonal changes after menopause. With abnormal hormone profiles, female athletes are putting their bodies into pseudo-menopause, increasing their risk for premature bone loss during a time when its really, really important to build bone for the prevention of osteoporosis later in life.
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*BMI is an inherently flawed measurement. It is based on a 20-year old population and doesn’t properly account for individuals with more muscle mass. If you fall into this category, a “normal range” BMI may in fact be functionally “underweight” for you.