The Female Athlete Triad and Cardiovascular Dysfunction

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In the past 35 years, a significant increase has occurred in sports participation by women. An estimated 3 million girls and young women compete in American high school sports. Women who participate in sports and fitness programs are generally healthier and have higher self-esteem. However, an increase has also been seen in gender-specific injuries and medical problems. The female athlete triad is a syndrome of separate but interrelated conditions of disordered eating, amenorrhea, and osteoporosis. Athletic amenorrhea is known to have a hormonal profile similar to menopause characterized by decreased circulating estrogens. Menopause is known to be associated with osteoporosis and accelerated cardiovascular disease. Although enhanced risk for cardiovascular disease is theoretically possible, it has not been explored in the young athletic population. Premature cardiovascular disease first manifests as endothelial dysfunction, which can be examined noninvasively with ultrasound. This article discusses disordered eating, amenorrhea, osteoporosis, and the potential for heightened cardiovascular risk in young athletic women.

Section snippets

Disordered eating

Women, including female athletes, are under intense pressure to be thin and have a low percentage of body fat, not only for aesthetic purposes but also because of the misperception that a thin physique will increase athletic performance. Hence, eating disorders are much more common in female athletes compared with nonathletes. Disordered eating refers to a spectrum of abnormal eating patterns ranging from a mild preoccupation with calories and body image to frank anorexia nervosa and bulimia

Menstrual dysfunction in athletes

Menarche refers to the age menses begins, which on average occurs at 12.5 years of age for nonathletic Caucasian American girls. Athletic females experience menarche at a later age, with retrospective studies varying between 14 and 15.4 years [27]. Warren and Perlroth [27] followed up pubertal progression for 4 years in 15 ballet dancers. The average age of menarche in 13 of the ballet dancers was 15.4 years; however, 2 still had primary amenorrhea at age 18. Primary amenorrhea has recently

Osteoporosis

The U.S. Department of Agriculture recently reported that only 13.5% of girls and 36.3% of boys aged 12 to 19 years in the United States get the recommended daily amount of calcium, placing them at serious risk for osteoporosis and other bone diseases. Furthermore, peak bone mineral acquisition seems to occur earlier in girls (aged 11–14) than boys (aged 13–17). The National Institute of Child Health and Human Development has stated that the nation's youth are in the midst of a calcium crisis

The female athlete triad and cardiovascular disease

Cardiovascular disease is the number one cause of death in women in the United States. Cardiovascular disease risk increases significantly after menopause, with one in four women ultimately dying of a cardiac event [43]. The key pathophysiologic event of menopause is suppression of hypothalamic pituitary reproductive axis and ultimately ovarian failure and decreased circulating estrogens. Epidemiologic observations suggest that estrogen may have a significant cardioprotective influence. This

Summary

The female athlete triad position stand was published by the ACSM in 1997 [7]. It described in detail three distinct, yet interrelated, medical conditions. In the past 10 years, a tremendous effort has focused on prevention, education, and treatment of this condition. Understanding the pathophysiology of athletic amenorrhea raises the additional question of whether these athletes also at risk for premature vascular dysfunction. If current ongoing studies prove that they are, a better name for

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