The female athlete triad and abnormal pubertal development

Abstract

The female athlete triad is a medical condition that occurs in exercising adolescent females and consists of three factors: energy availability, menstrual function, and bone health. These interrelated factors exist on spectrums from optimal health to dysfunction. Underlying the triad is low energy availability which can be the result of inadvertent undereating, purposeful undereating, or an eating disorder. The resulting low energy availability directly impacts bone health as well as menstrual function. Menstrual irregularity or amenorrhea also has a direct impact on bone health and should not be viewed as a normal consequence of exercise, but instead a pathologic response to low energy availability. In combination, the female athlete triad can lead to long-term health consequences such as poor bone health, infertility, and endothelial dysfunction as well as more immediate health consequences such as stress fractures and musculoskeletal injury. Awareness of the components and health consequences of the female athlete triad is low among athletes and coaches and education may improve early identification of adolescents at risk for the condition and its associated health consequences. A non-pharmacologic approach to restoration of optimal energy availability is the key to treatment of the female athlete triad and a multidisciplinary team including the athlete, coach, dietician, health care provider, and mental health professional, if needed, should be utilized in any treatment plan.