Are you, or is someone you know an “exercise junkie”? Do you worry about your weight, restrict your food and fluid intake, diet constantly, or exercise excessively to avoid gaining weight? Has your menstrual cycle been disrupted, is it erratic, or has it stopped altogether? Do you feel stressed or depressed? Have you resorted to taking diet pills and laxatives? Do you ever force yourself to vomit after eating?
These are a few of the questions health professionals may ask if they suspect someone may be a victim of the female athlete triad, which includes 1) disordered eating, 2) amenorrhea, and 3) osteoporosis. Women and girls with this condition exhibit signs of pathogenic weight control, and are at high risk for many medical problems.
Disordered eating may span the spectrum between restrictive eating or avoiding certain foods, to anorexia or bulimia. It results in a negative energy balance, where more calories are being expended than are coming into the body. An electrolyte imbalance can occur, which can lead to dehydration, decreased thermal regulation, cardiovascular problems, poor healing, and even sudden death.
Most people have heard of anorexia nervosa, which is an eating disorder characterized by an intense fear of fatness, an abnormal body image, absent or disrupted periods, and weight loss to less than 85 % of normal. There may also be associated signs like low blood pressure, slow heart rate, dry skin and nails, hair loss or thinning, and excessive fine hair on the sides of the face and arms. Bulimia nervosa is a related condition characterized by recurrent bingeing and purging, two times per week or more. Associated signs may include enlarged salivary glands, periodontal disease, conjunctival bleeding, and scars on the back of the hand from repetitive, forced vomiting. Statistics show that about one in every hundred women binges and purges to lose weight.
Menstrual dysfunction often occurs in women and girls with disordered eating. Primary amenorrhea is a condition in which girls do not start their periods by age 16 when the usual sex characteristics are present, or by age 14 if no other sex characteristics are present. Secondary amenorrhea is a condition in which your period is absent or irregular, and is diagnosed in previously menstruating women when there is an absence of three consecutive periods, or less than two cycles per year. Athletic amenorrhea is a condition that falls under this secondary category, and occurs usually when there is a combination of caloric restriction, excessive exercise, emotional stress, and low body fat.
Some of the health consequences that may result from disordered eating and amenorrhea include osteoporosis, stress fractures, scoliosis, infertility, and cardiovascular disease. Osteoporosis, in this instance, is a premature loss of bone in pre-menopausal women, an inadequate formation of bone, or a combination of both. People at high risk of osteoporosis are likely to include women of slender build, those with low calcium intake, those with a family history, and those of Caucasian and Asian heritage.
When the conditions of disordered eating, amenorrhea, and osteoporosis exist together, it may be diagnosed as the female athlete triad. It occurs more frequently in athletic women, but can also affect non-athletic women and girls. The true prevalence is not known because it is very often unreported or under diagnosed. Prevention and treatment should include a multidisciplinary approach by physicians, dietitians, psychologists, physical therapists, nurses, coaches, athletic trainers, dentists, and family. Appropriate history taking and education is the key to recognition of the problem and prevention. Counseling and family support may help a great deal in determining the underlying cause, promoting a healthy body image, promoting healthy eating habits, and addressing issues such as stress, anxiety, and depression.
The ultimate message is that proper exercise should be in an appropriate balance with the fuel consumed in order to achieve and maintain a healthy body and lifestyle. For further information regarding diet, nutrition, and exercise, please consult your physician, a nutritionist, and a women’s health physical therapist.
Ann Sundgren, PT
Palmer Physical Therapy for Women