Female Triad Flashcards

1
Q

three interrelated components:

A

Low Energy Availability (with or without an Eating Disorder)

Menstrual Dysfunction

Decreased Bone Mineral Density (Osteoporosis or Osteopenia)

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2
Q

Low Energy Availability (with or without an Eating Disorder):

A

woman’s energy intake is insufficient to meet the demands of exercise and other daily activities

can result from an eating disorder (e.g., anorexia nervosa or bulimia) or from inadvertent undereating

Low energy availability affects the body’s normal physiological processes

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3
Q

Menstrual Dysfunction:

A

Energy deficiency can disrupt the normal release of hormones, leading to irregular menstrual cycles or amenorrhea (absence of menstruation)

This can have significant consequences on reproductive health and hormone regulation

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4
Q

Decreased Bone Mineral Density (Osteoporosis or Osteopenia):

A

Prolonged low energy availability and hormonal imbalances can lead to reduced bone density, increasing the risk of stress fractures and long-term bone health issues like osteopenia (low bone mass) and osteoporosis

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5
Q

Since 2007: Does not need to be all 3, now ____ is considered female triad

A

just 1

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6
Q

Optimal Energy Availability:

A

Energy intake is AT LEAST sufficient to cover energy expenditure and replenish stored energy

Maintained body weight

Maintained physiological processes

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7
Q

Low Energy Availability:

A

individual’s energy intake is insufficient to support both their exercise demands and the energy required for normal physiological processes

low calorie intake, excessive energy expenditure (from exercise or daily activities), or a combination of both

goal of managing low energy availability is to optimize energy availability, which typically involves increasing caloric intake, reducing energy expenditure, or both

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8
Q

Energy Availability Calculation:

A

difference between dietary energy intake and energy expenditure during exercise, divided by lean body mass

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9
Q

Optimal energy availability is around ___ of lean body mass per day

A

45 kcal/kg

When energy availability drops below 30 kcal/kg of lean body mass per day, it is associated with most of the negative effects on physiological processes, such as reproductive function and bone health

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10
Q

Body’s Response to Low Energy Availability:

A

prioritizes basic survival functions over non-essential processes

Menstrual Dysfunction

Decreased Bone Density

Reduced Metabolic Rate

Impaired Immune Function

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11
Q

Menstrual Dysfunction:

A

The brain suppresses the release of reproductive hormones, leading to irregular periods or amenorrhea (absence of menstruation)

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12
Q

Decreased Bone Density:

A

Reduced hormone levels, particularly estrogen, impair bone formation and increase the risk of osteoporosis and stress fractures

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13
Q

Reduced Metabolic Rate:

A

The body reduces its energy expenditure, leading to fatigue and impaired recovery

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13
Q

Impaired Immune Function:

A

The immune system may become compromised, leading to an increased risk of illness and injury

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13
Q

Bulimia Nervosa:

A

Involves cycles of binge eating followed by compensatory behaviors such as vomiting, excessive exercise, or use of laxatives.

Often accompanied by feelings of shame, guilt, and loss of control over eating.

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13
Q

Disordered Eating:

A

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

range of unhealthy eating behaviors and attitudes toward food, body image, and exercise

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13
Q

Binge Eating Disorder:

A

Characterized by recurrent episodes of eating large amounts of food in a short period, often when not physically hungry.

Unlike bulimia, binge eating episodes are not followed by purging behaviors.

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13
Q

Anorexia Nervosa:

A

Characterized by extreme food restriction, intense fear of gaining weight, and a distorted body image.

Leads to significant weight loss, malnutrition, and potential life-threatening health issues.

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13
Q

Exercise Binging:

A

Refers to the excessive and compulsive need to exercise, often in response to eating, in an attempt to burn off calories.

Can result in overtraining, fatigue, injury, and psychological stress.

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14
Q

Individuals exhibiting signs of disordered eating should be referred to qualified specialists, including:

A

Registered dietitians experienced in sports nutrition.

Mental health professionals who specialize in eating disorders and body image concerns.

Medical professionals (e.g., primary care physicians, endocrinologists) to monitor and manage the physical health consequences.

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15
Q

Eumenorrhea

A

Regular menstruation every 28 days

If abnormal:
Diagnosis by exclusion (thyroid, pregnancy, polycystic ovary)

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16
Q

Amenorrhea:

A

Absence of menstruation for 3 or more months.

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17
Q

Oligomenorrhea:

A

Infrequent or irregular menstrual periods (longer than 35 days apart).

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18
Q

Luteal Phase Defects:

A

Shortened luteal phase, leading to difficulty with fertility or irregular cycles.

19
Q

Thyroid Dysfunction:

A

Hypothyroidism or hyperthyroidism can disrupt the menstrual cycle.

Blood tests for TSH (thyroid-stimulating hormone) and other thyroid hormones can identify abnormalities.

20
Q

Pregnancy:

A

Amenorrhea can be caused by pregnancy, so a pregnancy test should be conducted if this is a possibility.

21
Q

Polycystic Ovary Syndrome (PCOS):

A

PCOS is a hormonal disorder that can cause irregular periods, weight gain, and other symptoms.

It is typically diagnosed through clinical signs, ultrasound, and blood tests to evaluate hormone levels.

22
Q

Subclinical Menstrual Disorders:

A

Luteal phase defect- fertility issues, low progesterone

Anovulation

23
Q

Luteal Phase Defect:

A

time between ovulation and the start of menstruation, typically lasting about 12-14 days

phase is shorter than normal or characterized by insufficient production of progesterone, a hormone critical for preparing the uterine lining for pregnancy

LPD is often seen in athletes with low energy availability or stress, both of which can affect hormonal balance

24
Q

Anovulation:

A

menstrual cycle in which ovulation does not occur, meaning an egg is not released from the ovary

Menstruation may still occur, but without ovulation, fertility is impaired

can result from disruptions in the hypothalamic-pituitary-ovarian axis, often caused by low energy availability, stress, excessive exercise, or certain medical conditions

25
Q

Amenorrhea:

A

Primary- absence after age 15

Secondary- 3 consecutive missed cycles

Oligomenorrhea- every 35 days or fewer than 9 per year

26
Q

Functional hypothalamic Amenorrhea-

A

Gonadotropin releasing hormone due to prolonged exertion and weight loss, impacts luteinizing and follicle stimulating hormone, which impacts release of estrogen

27
Q

Optimal Bone Mass

A

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

28
Q

Calcium:

A

Essential for bone mineralization and overall bone strength.

Adolescents require 1,300 mg/day to support bone growth.

29
Q

Vitamin D:

A

Facilitates calcium absorption and helps maintain proper bone structure.

Vitamin D is obtained through sunlight exposure and dietary sources (e.g., fortified foods), with a recommended intake of 600-800 IU/day

30
Q

T-Score:

A

T-score of 0 or higher indicates normal bone density.

Negative T-scores indicate lower bone density

T-score between -1 and -2.5 classified as osteopenia

T-score below -2.5 indicating osteoporosis.

31
Q

Z-Score:

A

Compares an individual’s BMD to the average for their age, sex, and ethnicity.

A Z-score of 0 is normal, meaning the person’s bone density is typical for their age and sex.

Low Z-scores (below -2.0) may suggest a condition affecting bone health other than aging, such as nutritional deficiencies, hormonal imbalances, or chronic illness.

32
Q

Low Bone Mineral Density

A

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

33
Q

Osteoporosis:

A

typically associated with loss of estrogen in menopause

Happens earlier if in a chronic state of reduced estrogen

Normal: -1.0 and above

Osteopenia (low bone mass): Between -1.0 and -2.5

Osteoporosis: -2.5 or lower

Severe osteoporosis: -2.5 or lower with a history of one or more fractures.

34
Q

High school athletes:

A

Overall prevalence of all three Triad conditions: 1.0–1.3%.

Prevalence of any two conditions: 4.0–18.0%.

Prevalence of any one condition: 16.0–54.0%.

35
Q

Premenopausal exercising and athletic women:

A

Overall prevalence of all three Triad conditions: 0.0–4.3%.

Prevalence of any two conditions: 9.0–27.0%.

Prevalence of any one condition: 22.0–60.0%.

36
Q

Among high school athletes, the prevalence of ___ was quite high ____

A

any one condition

(16.0–54.0%)

37
Q

___ showed a much higher prevalence of all three conditions ___

A

Elite female endurance athletes

(15.9%)

38
Q

Triathlon team members had a 0% prevalence of ___ but a high percentage of ____

A

all three conditions

at least one condition (60.0%)

39
Q

The prevalence of Female Athlete Triad conditions varies based on the athletic level and sport type, with ____ showing more severe conditions.

A

elite endurance athletes

40
Q

Lean sport athletes vs non lean sport:

Prevalence of all three Triad conditions:

A

Lean sport athletes: 1.5–6.7%.

Non-lean sport athletes: 0.0–2.0%.

41
Q

Lean sport athletes vs non lean sport:

Prevalence of any two Triad conditions:

A

Lean sport athletes: 6.8–57.8%.

Non-lean sport athletes: 5.4–13.5%.

42
Q

Lean sport athletes vs non lean sport:

Menstrual disturbances (MD):

A

Lean sport athletes: Secondary amenorrhea (1.4–27.7%), Primary amenorrhea (0.7–9.5%), Oligomenorrhea (22.3–24.7%).

Non-lean sport athletes: Secondary amenorrhea (0.0–12.8%), Primary amenorrhea (0.0–0.4%), Oligomenorrhea (14.3–16.5%).

43
Q

Lean sport athletes vs non lean sport:

Disordered Eating (DE):

A

Lean sport athletes: Clinical DE (1.5–28.1%), Subclinical DE (6.0–89.2%).

Non-lean sport athletes: Clinical DE (0.0–15.1%), Subclinical DE (2.9–89.2%).

44
Q

Lean sport athletes vs non lean sport:

Low Bone Mineral Density (BMD):

A

Lean sport athletes: Low BMD (Z-score ≤ -2.0: 3.1%, Z-score < -1.0: 15.4%).

Non-lean sport athletes: Low BMD (Z-score ≤ -2.0: 0.0%, Z-score < -1.0: 0.0%).

45
Q

Lean sport athletes show a higher prevalence of all three conditions and a significantly higher rate of :

A

menstrual disturbances and eating disorders, which are central to the Female Athlete Triad.

46
Q

Non-lean sport athletes have a lower prevalence of these conditions, particularly:

A

low bone density and primary amenorrhea

47
Q

Female Triad
Risk factors:

A

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

48
Q

Medical Management

A

Multidisciplinary Approach- Physician, Dietitian, Mental Health, Rehab Professional (PT, ATC, Ex Phys), Coach

49
Q

Pharmacological Interventions

A

Limited use due to poor evidence

Potential Drugs: Oral Contraceptives, Hormone replacement therapy, Recombinant Parathyroid Hormone, Antidepressants

50
Q

Non-Pharmacological Interventions

A

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

51
Q

Prevention

A

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)

52
Q

Management of Injury secondary to female triad

A

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