Female athlete triad and relative energy deficiency in sport – endocrine changes and treatment in women

Abstract

Introduction: Female athlete triad (FAT) it is a syndrome of three tightly inter related components: amenorrhea, eating disorder, and osteoporosis. FAT syndrome has been re-evaluated and re-defined and the International Olympic Committee introduced a new relative energy deficiency in sport (RED-S) syndrome. Aim: The aim of the study was to review the knowledge on the issues of endo crine changes occurring in FAT and RED-S, and treatment of those conditions on a basis of available literature. Material and methods: This article was based on a review of the literature search in the electronic databases Medline (PubMed), EBSCO, ClinicalKey, and Willey Online Library, using the terms: ‘female athlete triad,’ ‘relative energy deficiency in sport,’ ‘FAT and RED-S and endocrine changes,’ ‘low energy availability (LEA) and endocrine changes,’ ‘FAT and RED-S and treatment and women’. Results and discussion: LEALE inuencesin abnormal secretion of gonadotro-pin-releasing hormone (GnRH) and this leads to the disrupted follicle-stimula ting hormone (FSH) and luteinising hormone (LH) secretion. Higher ghrelin levels inhibit secretion of GnRH and of adrenocorticotropic hormone (ACTH), growth hormone (GH), FSH and LH. A high peptide YY (PYY) results in a significant suppression of GnRH secretion. Hypercortisolemia occurring in athletes may directly affect reproductive functions. Lack of estrogen contributes both to disrupted mineralization of bones and to endothelial dysfunction. Conclusions: Low energy levels found in female athletes diagnosed with FAT or RED-S syndrome significantly inuence hormonal pathways, disrupting the function of their reproductive system, and this noticeably affects the overall health of sportswomen, inuencing endothelial dysfunctions and bone mineral density.