Female Athlete Triad

Question 1

Define Female Athlete Triad?

Answer 1

A triad of disorders observed in adolescent and young adult female adults
- osteoporosis
- disordered eating
- amenorrhea
(Yeager et al, 1993)

Question 2

What is amenorrhea?

Answer 2

delayed menarche (>16) and/or > 3 missed periods in a row

Question 3

What is eumenorrhea?

Answer 3

regular menstruation

Question 4

What can female athlete triad be characterised by?

Answer 4

low energy availability
menstrual dysfunction
low bone mineral density

Question 5

What was some of the early evidence into the effect of nutrition on menstrual function?

Answer 5

amenorrhea observed frequently in starving populations of Eastern Europe during WW1
1930s some observations that insufficient food intake could affect reproductive cycles of animals

Question 6

Outline the findings of Bullen et al (1985) into the effect of weight loss couple with intense activity on menstruation

Answer 6

intense physical activity couple with intentions of weight loss (4kg in 8 weeks) leads to severely high rates of menstrual abnormalities
(Bullen et al, 1985)

Question 7

What is the effect of athletic performance level on incidence of amenorrhea?

Answer 7

Malina et al (1973, 1978) found higher level college athletes displayed delayed menarche on average

Question 8

How does training volume affect incidence of amenorrhea?

Answer 8

incidence increases within college track and field athletes as mileage increases
- (Feicht et al, 1978)

Question 9

How does sport type affect incidence of amenorrhea?

Answer 9

triad characteristics higher in lean sport athletes

- (Gibbs et al, 2013)

Question 10

What is the effect of amenorrhea on bone mineral density ?

Answer 10

Vertebral BMD ~13% lower in amenorrheic athletes than control
- (Drinkwater et al, 1984)

Question 11

Energy availability = ???

Answer 11

energy intake - exercise energy expenditure

Question 12

How is energy availability expressed?

Answer 12

normalised to fat free mass (FFM) in kg

Question 13

What is a target energy availability for active women?

give reference

Answer 13

45 kcal per kgFFM per day

- Loucks (2011)

Question 14

What energy availability is thought to only be enough to support sleeping metabolic rate?

Answer 14

30 kcal per kgFFM per day

Question 15

What are the 3 main causes of low energy availability?

Answer 15

1. eating disorders
2. intentional efforts to reduce body size / fatness
3. inadvertent failure to increase energy intake to compensate for exercise energy expenditure

Question 16

How is the menstrual cycle disrupted in amenorrheic athletes?

Answer 16

pulsatile secretion of LH is disrupted

Question 17

Is menstrual disruption as a result of exercise or low energy availability?

Answer 17

mixed reports,
Williams et al (1995) reported only disruption in exercise AND calorie restriction group
WHEREAS
Loucks et al (1994) reported diet restriction alone = 23% reduction in LH pulse frequency

Question 18

How does age influence the relationship of low energy availability on LH pulse frequency?

Answer 18

younger women (shorter luteal phase) results in pronounced effect of low energy availability on LH pulse frequency.
Therefore, young women impacted more than older women by a low energy availability

Question 19

How does low energy availability affect bone mineral density markers?

Answer 19

as energy availability drops, markers of bone breakdown increase and markers of bone formation drop
- (Ihle & Loucks, 2004)

Question 20

Does estrogen affect BMD along with energy availability?

Answer 20

yes,
estrogen deficiency + low energy availability results in largest recordings of markers of bone breakdown and lowest bone formation
- (De Souza et al, 2008)

Question 21

Who created the most commonly used screening tool for the triad?

Answer 21

De Souza et al (2014)

Question 22

What kind of questions does the De Souza et al (2014) screening tool ask?

Answer 22

> do you restrict your diet?
> BMI?
> delayed menarche?
> stress fractures?
> Amenorrhea?

Question 23

What are some methods of triad treatment?

Answer 23

> focus on energy availability of 45 kcal per kgFFM per day.
nutritional education

Question 24

Provide the best course of treatment in reference to the 3 causes of low energy availability

Answer 24

> eating disordes (referral to doctor/mental health practitioner)
intentional effort to reduce body size/fatness (nutritional education)
inadvertent failure to increase energy intake to compensate for exercise energy expenditure (nutritional education)

Question 25

Can triad characteristics occur within men?

Answer 25

yeah

Question 26

Provide some research supporting that men can present some triad characteristics

Answer 26

Energy availability during training of 8 kcal per kgFFM per day in elite cyclists
- (Vogt et al, 2005)

Question 27

What does RED-S stand for?

Answer 27

Relative Energy Deficiency in Sport

Question 28

Why do the RED-S camp believe it’s a better descriptive than female athlete triad?

Answer 28

> highlights energy deficiency as a key feature
removal of female as it can occur in men
not everyone presents with all 3 triad symptoms
can occur in non-athletes
broadens the consequences to other than 2 emphasised in female athlete triad
DOESN’T SPELL FAT!