Unformatted text preview: Module 3 --- Article 5 TREATMENT HIGHLIGHTS FEMALE ATHLETE TRIAD In a research review, the female athlete triad is described, and treatment strategies are discussed. The female athlete triad is defined as the combination of disordered eating, amenorrhea, and osteoporosis. While many athletes do not meet strict criteria for an eating disorder, they may engage in a wide range of disordered eating behaviors (eg, food restriction, binge eating, purging) to maintain their physique. The exact number of women with female athlete triad is not known, but studies have shown that between 15% and 62% of female college athletes engage in disordered eating behavior. In addition to societal perpetuation of the ideal body image, other factors can contribute to the development of a poor self-image and pathogenic weight control in female athletes, such as frequent weigh-ins, punitive consequences for weight gain, pressure to win, an overly controlling parent or coach, and social isolation caused by intensive involvement in a sport. The authors suggest that athletic pursuits that emphasize low body weight and a lean physique can increase the risk of developing the female athlete triad. Early recognition of the female athlete triad can be done through a health screening that includes: (a) menstrual history1 (including information about current and previous hormonal therapy), (b) diet history (including information about perceived ideal weight and about disordered eating practices), and (c) exercise history (including information about additional exercise outside of required training, history of previous fractures, and history of overuse injuries). The presence of fatigue, anemia, electrolyte abnormalities, or depression may also be indicative of the presence of the female athlete triad. The authors recommend that treatment involve a physician, a mental health specialist, and a dietitian. Treatment includes helping the patient make several lifestyle changes, such as receiving adequate nutrition, attaining a reasonable weight, and decreasing exercise activity. Hormone replacement therapy may be recommended to treat amenorrhea, and may help increase bone density. Calcium and vitamin D may be needed to strengthen bones. If applicable, treatment for depression and/or an eating disorder may be needed. The involvement of trainers and coaches as well as family members may be crucial. The authors note that, because there may initially be some concern that treatment may interfere with the athlete’s career, education of all those involved regarding the potentially life-threatening health risks of the female athlete triad is important.
1 In a position paper published by the American College of Sports Medicine, short-term amenorrhea is noted as a warning symptom of the female athlete triad. The paper suggests that a medical evaluation be conducted within the first 3 months of the appearance of amenorrhea. During the examination, the practitioner should inform the patient about the risks of irreplaceable bone loss that can occur after only 3 years of amenorrhea. Documentation of any loss of bone density in the patient may encourage the patient to comply with the recommended changes in eating behaviors and training regimens, and may also convince the patient to start estrogen replacement therapy. Hobart JA & Smucker DR. The female athlete triad. American Family Physician, 61:3357-3364, 2000. A patient handout providing information about the female athlete triad can be accessed at the American Academy of Family Physicians Web site (http://www.aafp.org/afp/20000601/3367ph.html). © Copyright 2011 MWK Publishing LLC; from The Complete Practitioner: Mental Health Applications (Vol. 3, No. 10 -- October 2000) For next article, go to next page. ...
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