This website is designed to help debunk some of the myths surrounding changes to the body that can occur in female athletes and exercising women. We believe education to dispel such myths is the first step in promoting lifelong health and well-being:
The Female Athlete Triad only affects athletes involved in ‘lean-build’ sports
Numerous researchers have suggested that the type of sport may play a role in predisposing an individual to the three separate but interrelated spectrums of the Female Athlete Triad. That is, low energy availability/energy deficit (with or without the presence of disordered eating behaviours), amenorrhea (loss of menstrual cycles) and bone mineral loss. Research since the 1970s has shown that female athletes who participate in lean-build sports, where a sport-specific body weight may confer a performance advantage (e.g. distance running, cycling, swimming and weight-class sports such as rowing) or where performance is judged on body shape and movement (e.g. ballet, gymnastics, figure skating and diving), may be at particular risk for developing low energy availability and the Triad. However, recent studies reveal a high prevalence of body image disturbances in female athletes who participate in sports where leanness may not be as important for sport performance (e.g. basketball, softball, volleyball, soccer, tennis and ice hockey). Therefore, symptoms of the Female Athlete Triad are NOT limited to women in ‘lean-build’ sports. As girls and women continue to pursue their sporting dreams on the national and international stage, the prevalence of low energy availability, menstrual disturbances and low bone mineral density seems to be growing across a wide variety of sports.
The Female Athlete Triad only affects elite female athletes
Young, up-and-coming female athletes are a group at particular risk for low energy availability and the Triad. The adolescent and teenage years are a particularly important time for optimising bone mass and strength. If a young female athlete is in an energy deficit, whether it be inadvertent or through some form of disordered eating behaviour, such that she either does not commense her menstrual cycle before the age of 15 years (primary amenorrhea) or loses her menstrual cycle for more than 90 days (secondary amenorrhea), it could compromise her long-term bone health and expose her to heightened risks for stress fractures, osteoporosis, and other bone health concerns.
Non-competitive exercising women are also at-risk for low energy availability and the Triad. Although this health issue has yet to receive much mainstream attention, recent research suggests it is much more common than previously thought. Researchers have long focused on the metabolic, reproductive and bone health concerns for elite female athletes, but physiologists and endocrinologists now recognise that everyday women engaging in regular exercise for health and fitness face similar risks. Indeed, recent research suggests that four out of five women who perform regular, purposeful exercise (i.e. >55% of maximal heart-rate for more than two hours per week) experience mild energy-related reproductive abnormalities and up to 46% of ‘recreational female runners’ may develop amenorrhea.
Not menstruating is ‘normal’ for competitive female athletes
It may be common among female athletes and normalized within many high performance sporting cultures, but irregular or absent menstrual cycles in ANY exercising pre-menopausal girl or women is not ‘normal’! Exercise-related menstrual disturbances are a sign that insufficient energy is available for all systems in the body to function optimally. That is, during an energy deficit, processes that are not essential for immediate survival (e.g. reproduction, growth, deposition and mobilisation of body fat stores) are compromised in favour of those essential for life (e.g. movement, breathing and keeping the body warm and heart pumping!). While such energy conservation may preserve life, low energy availability and the low estrogen levels characteristic of energy-related menstrual disturbances also compromise skeletal and cardiovascular function and thus long-term health.
Only very thin female athletes and exercising women lose their menstrual cycles
Early observations in patients with anorexia nervosa led to a hypothesis that menarche (i.e. when a female first begins to menstruate) and secondary amenorrhoea (i.e. amenorrhea that develops sometime after menarche) occurs at a “critical threshold” of 17% and 22% body fat, respectively. However, this hypothesis has consistently been refuted as similar levels of body fat, both above and below the proposed body fat “thresholds”, are seen in both amenorrheic and regularly menstruating exercising women. Further, some exercising amenorrheic women increase body weight and body fat above the suggested “threshold” but do not resume menstruating. So, factors other than body weight and fat, per se, mediate the development of menstrual disturbances in exercising women. The key point here is that there is much individual variation between women. Thus, any and all female athletes and exercising women should be aware of their own unique energy requirements and avoid comparing themselves to others.
Moving on from the myths:
In the section ‘Get Educated!’ and throughout this website we provide more detailed information on the social, psychological and physiological aspects of low energy availability and the Female Athlete Triad. So don’t stop here. Keep reading and educate yourself about the risks of energy deficiency so that you can ensure the long term health of your reproductive, skeletal and cardiovascular systems for many years to come.