Female Athlete Triad: Part 2

Check out Understanding the Female Athlete Triad and Amenorrhea: A Patient-Friendly Guide to get a comprehensive understanding of this important topic. In this blog post we’ll explore how to best seek help, as well as to prevent and treat the Female Athlete Triad.

Seeking Help

If you are experiencing amenorrhea or any symptoms related to the Female Athlete Triad, it's essential to seek help. Your health is worth taking care of, and there are medical doctors, naturopathic doctors, and dieticians who specialize in helping female athletes maintain a healthy balance between their performance goals and overall well-being. Ensuring an adequate caloric intake is critical to supporting your body’s metabolic needs, especially if you are increasing your energy expenditure with intense athletic training.

Treatment of the Female Athlete Triad

The main goal in treatment of young female athletes with the triad is a natural return of menses as well as enhancement of bone mineral density. There is no specific drug intervention that has shown to be successful to improve bone density and metabolic abnormalities, though studies do show positive outcomes with increasing caloric intake, as well as optimizing vitamin D and calcium intake. The first step in treatment of this triad is to increase energy availability, through dietary strategies and nutritional counselling, while also using psychotherapy to address disordered eating if indicated. Increasing education to athletes, parents and coaches is also a critical aspect to prevention and treatment of the female athlete triad.

Treatment of this condition and return to normal physiological processes is possible, but there are instances when damage is irreversible. This can be common if the disorder goes unrecognized for a long time. The consequences on bone health include premature osteoporotic fractures and lost bone mineral density that may never be regained. Long term effects on fertility and reproductive health are also possible. 

Calculating Your Caloric Needs

Calculating caloric intake needs and increasing caloric intake in competitive athletes requires careful consideration of various factors, including individual goals, activity level, and specific sport requirements. Here are some steps to calculate and increase caloric intake for competitive athletes:

Calculate Basal Metabolic Rate (BMR): The BMR is the number of calories your body needs at rest to maintain basic functions like breathing and circulation. You can use the Harris-Benedict equation to estimate BMR based on your age, sex, weight, and height. For athletes, the Mifflin-St Jeor equation is considered more accurate. 

Account for Physical Activity: Competitive athletes engage in vigorous physical activity, which significantly increases their daily energy expenditure. Determine your Total Daily Energy Expenditure (TDEE) by multiplying your BMR by an activity factor that reflects your training intensity. Common activity factors include:

Sedentary (little or no exercise): BMR x 1.2

Lightly active (light exercise or sports 1-3 days a week): BMR x 1.375

Moderately active (moderate exercise or sports 3-5 days a week): BMR x 1.55

Very active (hard exercise or sports 6-7 days a week): BMR x 1.725

Super active (very hard exercise or physical job & exercise 2x/day): BMR x 1.9

Determine Specific Sport and Training Needs: Different sports and training regimens have different energy requirements. Some athletes may need more calories to support muscle building, endurance, or recovery. Consult with a sports dietitian or doctor who specializes in your sport to get a personalized assessment.

Consider Goals: Athletes have various goals, such as weight maintenance, weight gain (muscle building), or weight loss (rare for competitive athletes). Adjust caloric intake based on your specific goal.

Monitor and Adjust: After determining your estimated daily caloric needs, monitor your progress. If your performance is suffering or you're not making progress toward your goals, you may need to adjust your caloric intake. 

Increasing Caloric Intake for Competitive Athletes

Increasing caloric intake to ensure an optimal energy balance is key for the prevention and treatment of the female athlete triad. The body needs enough energy to complete vital processes such as menstrual and ovarian cycles. If you need to increase your caloric intake, do so gradually and focus on nutrient-dense whole foods. Here's how to do it effectively:

Add Nutrient-Dense Foods: Opt for whole, nutrient-dense foods like lean proteins, whole grains, fruits, vegetables, and healthy fats. These foods provide essential vitamins and minerals needed for optimal performance and recovery. 

Increase Protein Intake: Protein is crucial for muscle repair and growth. Include high-quality protein sources like lean meats, poultry, fish, dairy, eggs, legumes, and nuts in your diet.

Healthy Fats: Incorporate healthy fats like avocados, nuts, coconut oil, seeds, and olive oil to increase caloric intake. Fats are a concentrated source of energy and can be beneficial for athletes engaged in endurance sports.

Carbohydrates: Carbohydrates are essential for providing energy during exercise. Opt for complex carbohydrates like whole grains, sweet potatoes, quinoa, and fruits to fuel your workouts.

Frequent Meals and Snacks: Eating more frequently can help you increase your caloric intake. Include snacks between meals and consume a post-workout meal or protein shake to aid recovery.

Hydration: Proper hydration is crucial for athletic performance. Drink enough water to support your increased caloric intake and training demands.

Consult a Professional: For personalized guidance, work with a sports dietitian or nutritionist. They can help create a customized meal plan to ensure you meet your increased caloric needs while optimizing your nutrient intake.

Remember that individual needs can vary significantly, so what works for one athlete may not work for another. It's essential to listen to your body, monitor your progress, and adjust as needed to meet your performance goals.

Wrapping Up

Understanding amenorrhea and the Female Athlete Triad is crucial for female athletes. Remember, it's essential to nourish your body with the right amount of calories to maintain your overall health. If you're ever concerned about your menstrual cycle or other health issues, don't hesitate to reach out to a healthcare professional who can guide you in achieving a balance between your passion for athletics and your well-being. Your body deserves to perform at its best, and that includes staying healthy and strong.

References

Hobart, J. A., & Smucker, D. R. (2000). The Female Athlete Triad. American Family Physician, 2000(61), 3357–3364.

Holtzman, B., & Ackerman, K. (2019). Measurement, determinants, and implications of energy intake in athletes. Nutrients, 11(3), 665. https://doi.org/10.3390/nu11030665

Nattiv, Aurelia & Loucks, Anne & Manore, Melinda & Sanborn, Charlotte & Sundgot-Borgen, Jorunn & Warren, Michelle. (2007). The Female Athlete Triad. Medicine and science in sports and exercise. 39. 1867-82. 10.1249/mss.0b013e318149f111

Nazem TG, Ackerman KE. The female athlete triad. Sports Health. 2012 Jul;4(4):302-11. doi: 10.1177/1941738112439685. PMID: 23016101; PMCID: PMC3435916.

Schweiger, U., Laessle, R., Schweiger, M., Herrmann, F., Riedel, W., & Pirke, K.-M. (1988). Caloric intake, stress, and menstrual function in athletes. Fertility and Sterility, 49(3), 447–450. https://doi.org/10.1016/s0015-0282(16)59771-4