The Female Athlete Triad is a syndrome occurring in physically active girls and women. Its interrelated components are disordered eating, amenorrhea, and osteoporosis. Pressure placed on young women to achieve or maintain unrealistically low body weight underlies development of the Triad. Adolescents and women training in sports in which low body weight is emphasized for athletic activity or appearance are at greatest risk. Girls and women with one component of the Triad should be screened for the others. Alone or in combination, Female Athlete Triad disorders can decrease physical performance and cause morbidity and mortality. More research is needed on its causes, prevalence, treatment, and consequences. All individuals working with physically active girls and women should be educated about the Female Athlete Triad and develop plans to prevent, recognize, treat, and reduce its risks.

Medicine convened a panel of experts and concerned individuals to address an area of growing concern in sports medicine: a triad of disorders observed in adolescent and young adult female athletes. This two-day workshop explored the medical and practical issues surrounding the Triad disorders in the setting of a comprehensive conference format which addressed prevention, screening, risk profiles, diagnostic parameters, training dynamics, treatment, educational gaps, and research needs.

This study was designed to determine whether the hypoestrogenic status of 14 amenorrheic athletes was associated with a decrease in regional bone mass relative to that of 14 of their eumenorrheic peers. The two groups of athletes were matched for age, height, weight, sport, and training regimens. Bone mass was measured by dual-photon and single-photon absorptiometry at the lumbar vertebrae (L1 to L4) and at two sites on the radius. Vertebral mineral density was significantly lower in the amenorrheic group (mean, 1.12 g per square centimeter) than in the eumenorrheic group (mean, 1.30 g per square centimeter). There was no significant difference at either radial site. Radioimmunoassay confirmed a lower mean estradiol concentration (amenorrheic group, 38.58 pg per milliliter; eumenorrheic group, 106.99 pg per milliliter) and progesterone peak (amenorrheic group, 1.25 ng per milliliter; eumenorrheic group, 12.75 ng per milliliter) in the amenorrheic women, in four venous samples drawn at seven-day intervals. A three-day dietary history showed no significant differences in nutritional intake, including calcium with and without supplements. The two groups were similar in percentage of body fat, age at menarche, years of athletic participation, and frequency and duration of training but differed in number of miles run per week (amenorrheic group, 41.8 miles [67.3 km]; eumenorrheic group, 24.9 miles [40.1 km]). We conclude that the amenorrhea that is observed in female athletes may be accompanied by a decrease in mineral density of the lumbar vertebrae.

The relationship of prior menstrual irregularities and current menstrual status to the bone density of 97 young athletes was determined at seven sites using single- and dual-photon absorptiometry. Menstrual patterns were ranked on a scale of 1 to 9 in terms of their potential adverse affect on bone. Only vertebral density was significantly related to menstrual patterns (r = -.43). Women who had always had regular cycles had higher lumbar densities (1.27 g/cm2) than those with a history of oligomenorrhea/amenorrhea interspersed with regular periods (1.18 g/cm2). The lumbar density of both groups exceeded that of women who had never had regular cycles (1.05 g/cm2). Body weight became more important as a predictor variable as the severity of menstrual irregularities increased. The combination of menstrual pattern and body weight predicted 43% of the total variation in lumbar density. These data suggest that extended periods of oligomenorrhea/amenorrhea may have a residual effect on lumbar bone density.

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