1. Lesson 3 September 27 th, 2010

2. What is the Triad? The Female athlete triad is a syndrome of three interrelated conditions that exist on a continuum of severity, Including: Energy Deficit/Disordered Eating Menstrual Disturbances/Amenorrhea Bone Loss/Osteoporosis

3. What is the Triad? The condition is most common in sports that emphasize leanness. Example: Cross-country, gymnastics and figure skating.

4. Each component of Female Athlete Triad is represented as being on a continuum of severity from health to disease.

5. - At the “healthy” end of the continuums are optimal energy availability, the presence of normal ovulatory menstrual cycles, and optimal bone health. -At the “unhealthy” end of the continuums are the clinical outcomes associated with each Triad component, including energy deficiency, with or without disordered eating; abnormal menstrual cycles, referred to as functional hypothalamic amenorrhea; and bone loss, the most severe cases of which are called osteoporosis.

6. Athletes with the Female Athlete Triad may not have the extreme ends of the continuum but may still have the condition. In many cases the athlete will not show all signs as each continuum can progress at a different rate. While the conditions represented by each continuum can occur independent of the other two conditions, it is more likely that, because the three are so closely linked that the athlete will also be suffering from the other two as well.

7. What causes the Triad? 1. Energy Deficiency The major cause of the triad is an energy deficiency. The amount of food (energy) consumed is not enough to meet the energy demands for the daily exercise. Negative Energy Balance Can be caused by not eating enough or excessive exercise In many cases there is a eating disorder involved

8. When the body is deprived of energy it will start to cut back systems and use energy and nutrients stored in the body to make up for the imbalance in energy.

9. 2. Irregular or Missed Periods When energy levels are too low it disrupts the reproductive system. This can result in: (Oligomenorrhea) Irregular or less frequent menstrual cycles (Amenorrhea) Three or more menstrual cycles missed in a row. When periods are less frequent the body makes less estrogen which is needed for strong bones This results in the menstrual disturbances and decrease in bone density. Can lead to infertility or unhealthy pregnancy later on in life.

10. Stress Fractures and other Bone Problems When the body has a negative energy balance it cannot replace old bone cells with new ones. Peak bone building years are between puberty and 20 Can lead to stress fractures Early onset of osteoporosis

11. Common Signs and Symptoms: Irregular or absent menstrual cycles Always feeling tired and fatigued Problems sleeping Stress fractures and frequent or recurrent injuries Often restricting food intake

12. Common Signs and Symptoms: Constantly striving to be thin Eating less than needed in an effort to improve performance or physical appearance Cold hands and feet Preoccupation with body weight and poor body image.

13. Risk Factors Playing sports that require weight checks Social isolation due to sporting activities Exercising more than necessary for a sport Pressure to “win at all costs”

14. Risk Factors Punitive consequences for weight gain Controlling parents and/or coaches

15. Risk Factors Being a gymnast, figure skater, ballet dancer, distance runner, swimmer or diver where undue emphasis is placed on having a low body weight and a lean physique

16. If you suffer from one or more of the following get help: Irregular menstrual cycles Increased stress fractures Restrictive eating patterns

17. Treatment Nutritional guidance Psychologist or mental health counselling

18. Prevention Keep track of when periods occur by writing down the number of days between each cycle. Know how many calories you eat each day in reference to how much you are spending. Eat every three to four hours. Three meals and at least two snacks a day.

19. Prevention Treat snacks as mini meals - make healthy choices for snacks Track how much you exercise in a day (time, type, intensity). It would not be uncommon to burn over 1000 calories during a hard basketball practice for 2 hours.

20. Questions: - Hand In 1. How can the female athlete triad lead to infertility? I (1) 2. How does a negative energy balance affect the body? I (2) 3. What would you do if you thought that one of your friends possibly fit the description of the signs and symptoms? A (2) 4. Why is this condition more prevalent in sports like cross country or sports that require reviling clothing? I (2) 5. Do you think that the popular sports in Moose Factory could possibly push a female athlete into this? Why or why not, explain. A (2)