Introduction- Female athlete triad comprise three condition-
Eating disorder
Menstrual disturbance
Osteoporosis / decreased bone density
The components of the female athlete triad are interconnected.
Eating disorders lead to inadequate nutrition which affects production of hormones(estrogen).
Estrogen has an important role in bone development. Decreases in estrogen levels weaken the bone and increase risk of injury.
Definition- Triad is combination of 3 health complication- energy deficit(eating disorder), menstrual disturbance(amenorrhoea, bone loss( osteoporosis)
Athletes suffering from one element are suffering from all 3 as well. Most athletes are not diagnosed with extreme cases but may display intermediate symptoms.
Risk factors-
Chronic dieting
low self esteem
Family dysfunction
Lack of nutrition.
physical abuse
Biological factor
Perfectionism
Trigger factors-
Emphasis on body weight for performance.
Pressure to lose weight.
Increase in training
Overtraining
Mechanisms of female athlete triad-
Low energy availability with/without eating disorder- low energy intake results in low energy available and less energy available for body function. Athletes use restrictive diets, laxatives and pills.Eating disorders causes (dehydration, muscle fatigue, erratic heartbeat, kidney damage, osteoporosis, hormone imbalance.
Menstrual dysfunction -include
primary amenorrhea - no menses by 16 age but develop secondary character without menarche.Eating disorder may be the cause.
Secondary amenorrhoea - menses cease for 3 month, who had normal menstrual cycle previously.
Oligomenorrhea - Menstrual cycle occurs at irregular intervals.
Low bone mineral density- Decrease level of estrogen in females causes decreased osteoblast activity and increases chances of fractures. Decreasing mineral density causes fragile bones.
Clinical features-
Weight loss
Irregular Menstrual cycle
Chronic fatigue
Fracture
Change in appetite
Increase infection / illness
Anxiety/ depression
Nutrition deficits
Constipation
Vaginal dryness
Impaired athletes performance
Decrease resting metabolic rate.
Examination-
Examine physical characteristics of eating disorder- fat and muscle loss, dry hair, skin,cold and discolored hand and feet, decrease body temperature, hypotension, bradycardia, face and extremity edema, knuckle scar, swollen parotid gland, periodontal caries, pharyngeal erythema .
Investigation
CBC, Electrolyte,Ca, Mg, P,Cholesterol, albumin, total protein, blood urea, nitrogen, creatinine, urinalysis, pregnancy test, TFT, FSH, estradiol, prolactin.
DEXA to evaluate bone density and triple phase bone scan to evaluate stress fracture.
Treatment -
Pharmacology - oral contraceptive ( estrogen, prostaglandin, testosterone)
Vitamine D, Ca.
Physiotherapy treatment-
Ultrasound
Manipulative therapy( stretching, strengthening)
Resistive training
Cold compression
Low level laser
Electric stimulation( strength trainning)
Taping