female athlete

Question 1

3 parts of the female triad

Answer 1

low energy availability w/wout ED –> osteoporosis–>functional hypthalamic amenorrhea

subclinical menstrual disorders–> reduced energy availability with or wout ED - low BMD

optimal energy availability –> eumenorrhea –> optimal bone health

basically energy availability, menstraul dysfunction, bone mass

Question 2

does the triad need all 3

Answer 2

no it can be just one to be considered female triad

Question 3

optimal energy availability

Answer 3

Energy intake is AT LEAST sufficient to cover energy expenditure and replenish stored energy
Maintained body weight
Maintained physiological processes

Question 4

low energy availability

Answer 4

Can be due to intake, stored, or expenditure
Low energy availability is determined to be .45 kcal/kg of lean-body mass per day; however, energy availability .30 kcal/kg of lean-body mass is associated with most of the negative effects
When energy availability is low, the brain/body has to make some tough decisions
Goal: optimize energy availability to normalize menstruation and/or bone health

Question 5

disordered eating

Answer 5

Anorexia, Bulimia, Binging, Exercise Binging, etc
Refer to specialists

Question 6

eumenorrhea

Answer 6

Regular menstruation every 28 days
If abnormal:
Diagnosis by exclusion (thyroid, pregnancy, polycystic ovary)

Question 8

subclinical menstrual disorders

Answer 8

Luteal phase defect- fertility issues, low progesterone
Anovulation

Question 9

amenorrhea

Answer 9

Primary- absence after age 15
Secondary- 3 consecutive missed cycles
Oligomenorrhea- every 35 days or fewer than 9 per year
Functional hypothalamic Amenorrhea- Gonadotropin releasing hormone due to prolonged exertion and weight loss, impacts luteinizing and follicle stimulating hormone, which impacts release of estrogen

Question 10

optimal bone mass

Answer 10

90% peak BMD achieved by 18 and greatest from 11-14 yrs old
Needs: Calcium, Vitamin D, loading
DEXA: Normal Z score: 0 and above
T score: match peak bone mass
Z score: Match to age/sex

Question 11

low BMD

Answer 11

Estrogen inhibits bone remodeling and resorption
Decreased estrogen = decreased BMD
Decreased BMD = increased fracture risk
Increasing BMI is associated with menses
Z-score: -1 to -2 is abnormal and requires exploration in WB athlete

Question 12

osteoporosis

Answer 12

Typically associated with loss of estrogen in menopause
Happens earlier if in a chronic state of reduced estrogen

Question 13

risk factors

Answer 13

1st menstrual period after age 15
< 9 periods per year
< 18.5 kg/m2 (BMI) for adults
Disordered eating
Family Hx of bone disease or DE
Vegetarianism (indirectly)
Lactose intolerance
Low Vit D
Hx of bone stress injury
Anxiety, OCD, other metal health disorders

Question 14

medical management pharmacologic interventions

Answer 14

Limited use due to poor evidence
Potential Drugs: Oral Contraceptives, Hormone replacement therapy, Recombinant Parathyroid Hormone, Antidepressants

Question 15

medical management non pharm interventions

Answer 15

Low energy availability is addressed first- naturally increase luteinizing and follicle stimulating hormone
Sports dietitian for nutritional counseling
Mental Health if DE suspected
Can reduce activity to relatively raise energy availability
Vitamin D and Calcium

Question 16

rehab preventions considerations

Answer 16

Screening and prompt referral (pre-participation and monitoring of those at risk)
Education, especially in those with risk factors
Pay close attention during transition from high school to college level sports
Gymnastics, Ballet, Diving, Figure Skating, Aerobics, Running, Weight Class Sports
Resistance training
High impact exercise (caution)

Question 17

management of injury secondary to female triad

Answer 17

Make sure underlying cause is addressed first (via referral)
Follow fracture/bone stress injury management principles
May need to adjust depending on where the patient is in fixing underlying causes