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Monday, December 22, 2014

The Female Athlete Triad, Part 2

Posted by William on May 24, 2012

How is The Female Athlete Triad Diagnosed?
There is no single test to diagnose the Female Athlete Triad. Instead, the diagnosis rests on uncovering the different features of the triad.

The signs and symptoms may be subtle at first. Initially, athletes may not consciously over-exercise or restrict their calories. Eventually they may start to perform disordered eating behaviors, often in secret, and intensify their physical training. With time, their periods may cease and any of the multiple signs and symptoms of disordered eating may set in, such as fatigue. Stress fractures may occur.

One of the most important opportunities to diagnose the triad is during your pre-participation sports physical examinations. That’s when your doctor should be asking you questions designed to find out if you have any features of the triad. It pays to be honest so you can either prevent the disorder early on or, if it already exists, quickly decide on a treatment plan for you. Your doctor may order a DEXA scan to check for osteoporosis.

If you are a female athlete, chances are you know by now if the female athlete triad applies to you. That means it’s up to you to get help.

How Is the Female Athlete Triad Treated?
With this disorder an ounce of prevention is worth 10 pounds of cure. The female athlete triad is preventable — it does not have to happen. All it takes is knowing about it and making sure you work with your coach, your trainer, your doctor, a nutritionist and your parents to:

Design a proper exercise and training program.
Engage in healthy eating.
Decide on a reasonable weight for your chosen sport.
Get regular medical checkups.
Once the triad has developed, treatment becomes more difficult. A team approach — involving a nutritionist, a physician and a mental health professional — is recommended. Sports coaches and trainers must also be involved.

Treatment focuses on several key areas:

Identifying and eliminating disordered eating behaviors. This treatment can include dietary instruction from a nutritionist including calcium and vitamin D supplementation; doctor visits to monitor for medical complications of disordered eating; and mental health counseling for the psychological problems that can accompany disordered eating.

Agreeing on a more reasonable goal weight with consideration of the weight requirement for a particular sport. This means cutting back on the intensity of physical training and exercise.

Hormone replacement therapy. The goal of hormone replacement therapy is to reverse the low estrogen state that leads to osteoporosis.
Unfortunately, there are no published long-term studies on the benefits of hormone replacement therapy in slowing or reversing the loss of bone mineral density in female athletes Hormone replacement therapy can be done with birth control pills (which contain both estrogen and progesterone), or with separate estrogen and progesterone pills.

Experts vary in their recommendation for when to start hormone replacement therapy. Some recommend it after six months of amenorrhea or if there is evidence of loss of BMD on DEXA scanning. The athlete and her doctor should carefully discuss this decision.

While hormone therapy will treat and reverse the amenorrhea, the ultimate goal, of course, is the return of regular periods through a combination of better nutrition, revised physical training and maintenance of a reasonable body weight.

Who Should Get Involved?
Everyone involved in the sports career of a young female athlete should be involved — most importantly the athlete herself.

Each should be educated about this disorder and each should carefully put that knowledge into perspective and practice. The very health, happiness and well-being of the female athlete depend on it.

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