Female Athlete Triad Flashcards
What was the study performed by Erdelyi 1962?
Large cross sectional study of female athletes, showed that 84% found no change in their menstrual cycle, 11% found unfavourable changes, 5% found favourable changes.
What did Malina et al 1973, 1978 find about the age of menarche in athletes?
Age of menarche is much later in athletes than non athletes. Also later at more elite levels.
What did Feicht et al 1978 find about the effect of training load and bodyweight on
athletes’ menstrual cycles?
As training mileage increases, amenorrhea incidence increases. No difference found in weight between these groups.
What did Drinkwater et al 1984 find about differences between amenorrheic and eumenorrheic athletes?
Bone mineral density in vertebrae was 13% less in amenorrheic athletes
What did Marcus et al 1985 find about amenorrhea in distance runners?
Running related fractures were more frequent in amenorrheic runners
What did Rosen et al 1986 find about college athletes and eating disorders?
32% of college female athletes displayed pathogenic weight control behaviours such as self induced vomiting, laxitives, diet pills, diuretics, etc.
What did Rosen and Hough 1988 find about eating disorders in gymnasts?
All interviewed athletes were dieting, 62% of them were using pathogenic weight control methods
What did Pasman and Thompson 1988 find about eating disorders in different sports?
Greater drive for thinness in runners and weightlifters than controls
What is the ‘female athlete triad’? Give reference where the term was first used
- Disordered Eating (anorexia, bulimia)
- Amenorrhea (delayed menarche and more than 3 missed cycles)
- Osteoporosis (premature bone loss/inadequate formation)
Yeager et al 1993
What did Bullen et al 1985 find about the effect of exercise on menstrual cylce function?
8 weeks of daily 3.5hr exercise resulted in a higher percentage of menstrual abnormalities after the protocol. After 6 months all back to normal cycle
What is energy balance?
Energy Intake - Total energy expenditure
what is energy availability
Energy intake - Exercise energy expenditure
How do you put energy availability into the right unit of measurement?
Divide energy availability in kcal by fat free mass
What is the appropriate unit of measurement for energy availability?
Kcal per kg of fat free mass per day
What is the target energy availability for physically active women? Reference
45kcal/kgFFM/day (Loucks 2011)
Why does energy availability below 30kcal/kgFFM/day start to cause problems?
Below that and you don’t have enough energy to sustain your BMR (Loucks 2011)
In terms of energy balance, why is amenorrhea a response to excessive training load?
Energy Balance = Energy Intake - (Exercise Expenditure + Other Expenditure). If Exercise expenditure is too high, Other expenditure, including menstrual cycle, will decrease to maintain balance to keep the body working.
What are the 3 main causes of low energy availability?
- Eating disorders
- Intentional efforts to reduce body size/fatness
- Inadvertent failure to increase energy intake to compensate for exercise energy expenditure
What did Loucks et al 1989 find about hormonal balance in athletic amenorrheic women?
Disruption of pulsatile secretion of LH in athletic amenorrheic women relative to matched controls
What did Williams et al 1995 find about Exercise vs Low Energy Availability on LH pulse frequency?
LH Pulse frequency reduced in eucaloric exercise and caloric restriction exercise group.
What did Loucks et al 1994 find out about the impact of exercise vs low energy availability on LH pulse frequency?
- Low Energy Availability (LEA) lead to 23% reduction in LH pulse frequency during waking hours compared to.High (HEA)
- Adding exercise but increasing intake to match availability to diet restriction trial, DR had 10% lower LEA than HEA
- No difference between HEA with and without exercise
What did Loucks and Thuma 2003 find about the energy avilability threshold for LH pusle frequency disruption ?
Below 30kcal/kgFFM/d reduced LH pulse frequency. However the longer the luteal phase, the less effect this has, so older athletes may be less affected than younger.
How does bone mineral density get affected by amenorrhea and energy availability?
-Low oestrogen from amenorrhea decreases osteoblast activity
-Low energy availability decreases bone remodelling and increases bone breakdown
(Ihle and Loucks 2004)
What did De Souza et al 2008 find out about bone denstiy and amenorrhea and low energy availability?
THose with low oestrogen AND low energy availability had the lowest bone density
What is the female athlete triad ACCORDING TO Nattiv et al 2007?
- Low Energy Availability with or without an Eating Disorder
- Functional Hypothalamic Amnorrhea
- Osteoporosis
It is also a spectrum. The above 3 points are the END of the spectrum
What does Gibbs et al 2013 meta analysis say about the prevalence of the female athlete triad?
16-60% of female athletes display any one, 3-27% display any two, 1-16% display all three
In simple terms, how do you treat the triad?
Increase energy availability to 45kcal/kgFFM/d or until menstrual function increases
What did Vogt et al 2005 determine to be the average energy availability of elite male cyclists?
8kcal/kgFFM/day
What did Dolan et al 2012 find about Jockets?
10% lower bone mineral density and greater bone breakdown markers in jockeys compared to matched controls
What did Sudgot-Borgen et al 2004 find about eating disorders in males in sport?
25% higher in males in leanness sports than in general population
What does Mountjoy et al 2014 prefer to call the female athlete triad?
Relative Energy Deficiency in Sport (RED-S)
What is the rationale behind the Mountjoy et al 2014 decision to call female athlete triad the RED-S instead?
- Acronym doesnt spell FAT
- Can occur in non-athletes
- Many more consequences than the two emphasised in the triad and not everyone has all three
- Includes men too
- The key feature is energy deficiency
