Premenopausal women can face a triad of syndromes when they are training intensively while emphasizing weight loss. Studies involving female athletes in recent years have found a tendency to engage in disordered eating. These are often connected to menstrual irregularities (such as amenorrhea or cessation of menstrual flow). They are also linked with energy drain and osteoporosis.
According to the American College of Sports Medicine Position Stand, the female athlete triad of disordered eating, osteoporosis, and amenorrhea is connected a number of issues and characteristics. Women are often most at risk if they are likely to be self-critical, perfectionistic, depressed, and highly competitive. Compulsive behavior, lean and low body mass are also risk factors. Its more common among adolescent or young adult women (especially those without peak bone mass) and can lead to multiple or recurrent stress fractures.
One crucial factor for the female athlete triad is bone density. Research has found that it is closely related to menstrual regularity and the total number of cycles. When menstruation is stopped prematurely, the protective impact of estrogen on bone is removed. Estrogen plays a crucial role in bone health. It increases intestinal calcium absorption, reduces urinary calcium excretion, inhibits bone respiration, and decreases bone turnover.
So without sufficient estrogen, bones become more vulnerable to calcium loss and thus a decrease in bone mass. The worse the menstrual disorder, the worse the effect upon bone mass. The negative effects are most felt in bones that need a higher level of density the most, such as the various leg bones for any sport involving the legs.
Studies have shown that even a 5% loss in bone mass can increase the risk of stress fractures by up to 40%. If amenorrhea is consistent from an early age, it can lead to a permanent level of suboptimal bone mass and a higher risk of musculoskeletal injuries. This also can leave some female athletes at risk for osteoporosis later on.
At the same time, energy deficit and poor diet can hurt the body's ability to safely exercise as well. With a poor diet, there can be insufficient protein, fat and even calcium intake. Insufficient calcium also hurts the ability of bones to come properly dense.
According to the 1996 study everyone appears to reference when discussing how to treat athletic amenorrhea, there is a well supported treatment method. While it needs diet and training interventions as well, these are the four keys to be done in order:
- Reduce training level by 10% to 20%
- Gradually increase total energy intake
- Increase body weight by 2% to 3%
- Maintain calcium intake at 1500mg daily
Finally, its worth noting here that women are also more at risk for anemia, or iron deficiency. In the United States, between 10% and 13% of premenopausal women have low iron intake and 3% to 5% are diagnosable as anemic. Pregnancy and menstrual cycles both result in lower iron. And if dietary iron is low, then the risk factors for anemia rise as well. During menstrual cycles, an additional 5 mg of dietary iron for females is recommended.