Q & A: The Female Athlete Triad: Common or Not?

Q: We hear a lot about the Female Athlete Triad, but exactly how common is it?

A: Although precise data is hard to come by for the female athletic triad as a whole, some information is available about specific elements of the triad, particularly amenorrhea. Those who are at greatest risk of developing the triad are women who participate in so-called “aesthetic” sports such as cheerleading, diving and gymnastics, as well as “endurance” sports and “weight-class” sports such as rowing, judo, karate, boxing, body building, and long-distance running. Women who are at low weight to start with and who then do a lot of training are at greatest risk. Studies suggest that in contrast to the estimated rates of 1% for primary amenorrhea, where menarche hasn’t yet occurred by the age of 15 in the general population, in one study 22% of female aesthetic sports athletes were more than 16 years old before they had their first menstrual period. And, whereas secondary amenorrhea with cessation of menses occurs in about 2% to 5% of the general population, on one track team 65% of the women were amenorrheic. In another study, 78% of women athletes had anovulation and luteal phase deficiencies even while having a menstrual cycle at least once in three months. Women with disordered eating and menstrual disturbances also show low rates of bone formation (The Lancet 2005, 366 Medicine and Sport, s49-50). Careful screening and judicious management, as described elsewhere in this issue, are necessary to optimize the well-being of female athletes.

— J.Y.