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S PORT S M E D I C IN E Constellation of Conditions Can Negatively Affect Female Athletes “Through education about proper nutrition, female athletes can restore a positive energy balance, often without having to decrease their exercise.” Female athlete triad is a syndrome of three interrelated conditions that can affect physically active girls and women and requires early detection and treatment to prevent serious complications. The condition is most common in girls and women who engage in endurance sports or in sports in which being lean is considered an advantage. It involves three components: energy deficiency with or without disordered eating, menstrual dysfunction and low bone-mineral density. “This is a more common problem than many people realize,” says Aurelia Nattiv, MD, a UCLA family and sports-medicine physician and director of the UCLA Metabolic Bone and Osteoporosis Center in Santa Monica. “Often, inadequate nutrition is the triggering factor, and it can set off a metabolic cascade resulting in menstrual problems, such as amenorrhea, and ultimately poor bone health if the problem is not identified and treated early in the process.” UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) In some cases, the athlete’s unhealthy obsession with being thin to better compete in her sport may require psychological treatment if she shows signs of developing a clinical eating disorder or disordered eating, says Dr. Nattiv, who recently helped to develop national treatment guidelines for the syndrome. Although the triad was once associated with disordered eating, it has become apparent that many female athletes with the condition simply aren’t eating properly for the amount of exercise they are undertaking. These athletes can be in chronic energy deficit, but may not have the psychological concerns. They are more likely to change their behavior if given proper education. For such athletes, Dr. Nattiv notes, treatment focuses on education and guidance on how to replenish energy stores with a healthy diet and bone-building nutrients. “Through education about proper nutrition, female athletes can restore a positive energy balance, often without having to decrease their exercise,” Dr. Nattiv says. “This can usually be done without prescription medications.” For many female athletes, Dr. Nattiv adds, the improved nutrition and often increased caloric intake may restore normal menstrual cycles and prevent declines in bone-mineral density that can lead to osteoporosis and injury risk, such as stress fractures. In rare cases, medication may be needed. Dr. Nattiv has urged physicians to be more vigilant in asking female athletes about their menstrual cycles and nutrition when seeing them for a stress fracture or other bone injury. For young female athletes and their parents, she emphasizes the connection between nutrition and bone health, especially among adolescents and young adults. “Younger athletes are still forming bone, which is why this is such a critical time,” Dr. Nattiv explains. “If they aren’t getting adequate nutrition for energy, it can affect their attainment of peak bone mass for the rest of their life.” In addition to stress fractures, triggers for further evaluation in female athletes include weight loss, disordered eating, obsession with being thin and irregular menses, Dr. Nattiv notes.