Menstrual Abnormalities in Female Athletes
Gymnastics, dance, figure skating, and running are well-known competitive sports but they also have another thing in common; a higher prevalence for eating disorders among female athletes. The competitive sports culture is known to promote ideal body shape and body weight in athletes in order for them to perform at their best. When mixed with the fashion industry’s strong culture to be thinner and younger than previous generations, female athletes are under extreme pressure and eventually excessive dieting, exercise and weight checks can take a toll often resulting in bulimia nervosa and anorexia nervosa. Competitive athletics begins in childhood and it is common for eight-year old athletes to be pushed to their maximum potential by parents and coaches in the hopes of attaining a goal such as making it to the Olympics or preparing for a full-ride athletic collegiate scholarship. Additionally to menstrual abnormalities in female athletes these young women are at risk for developing low-self esteem and body image disturbances later in life in addition to pushing themselves to extremes in other aspects of their adult life.
The female athlete triad
The female athlete triad is a well-known interrelationship of amenorrhea (missed or lack of menstrual periods), osteoporosis, and disordered eating that was established in female athletes in 1997 by the American College of Sports Medicine. This condition still exists today however the criteria has changed in order to broaden the spectrum of this disorder and individuals no longer have to present with all three of these components. The new re-defined components of the female athlete triad are known as menstrual function (any disturbance in menstrual periods), BMD (bone mineral density), and energy availability (daily dietary energy intake minus daily exercise energy expenditure). Research has shown that female athletes are at risk for poor bone health and disordered eating and although osteoporosis and anorexia nervosa are common in this population; an overall decrease in bone health and the high drive for thinness and dietary restraint are more common overall than the former two particular disorders, according to a study from the American Academy of Pediatrics. Although male athletes are also commonly affected by eating disorders and body image disturbances, the statistics are more elusive in males than in females.
REFUEL trial in female athletes
Recent research presented at the 2017 American College of Sports Medicine Annual Meeting gave an insight into a treatment plan for female athletes who have experienced amenorrhea secondary to excessive exercise. The research has shown that when women consume more calories in their daily diet they can recover their menstrual cycles that have been suppressed by extreme exercise. Women athletes with the female athlete triad often exercise so much that their calories burned far outweigh their calories consumed resulting in an energy imbalance causing absent or irregular menstrual cycles. Abnormal menstrual cycles will lead to the decreased production of estrogen, a hormone that plays a major role in bone remodeling. With a decrease in estrogen, women are more prone to bone disorders such as osteoporosis. Specific findings in this controlled study showed that more than half the women diagnosed with female athlete triad began menstruating 12 months after they increased their caloric intake/energy consumption 20 to 30 percent above their baseline energy expenditure. Additionally they kept their exercise routine proving that a decrease in exercise was not necessary in order to regain menstruation. For many women, increasing their caloric/energy consumption by 20-30 percent above their baseline energy expenditure may be nearly impossible to obtain with regular meals and therefore meal substitutes in the form of energy bars and shakes are highly recommended and were used in this study, known as the REFUEL trial.
According to an article in Medscape Medical News, “For a long time, researchers thought exercise itself was the cause of the female athlete triad. So it comes as good news that athletes with this problem can continue to exercise as long as they increase their energy consumption.”
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