Female Athlete Triad

Question 1

What was the study performed by Erdelyi 1962?

Answer 1

Large cross sectional study of female athletes, showed that 84% found no change in their menstrual cycle, 11% found unfavourable changes, 5% found favourable changes.

Question 2

What did Malina et al 1973, 1978 find about the age of menarche in athletes?

Answer 2

Age of menarche is much later in athletes than non athletes. Also later at more elite levels.

Question 3

What did Feicht et al 1978 find about the effect of training load and bodyweight on
athletes’ menstrual cycles?

Answer 3

As training mileage increases, amenorrhea incidence increases. No difference found in weight between these groups.

Question 4

What did Drinkwater et al 1984 find about differences between amenorrheic and eumenorrheic athletes?

Answer 4

Bone mineral density in vertebrae was 13% less in amenorrheic athletes

Question 5

What did Marcus et al 1985 find about amenorrhea in distance runners?

Answer 5

Running related fractures were more frequent in amenorrheic runners

Question 6

What did Rosen et al 1986 find about college athletes and eating disorders?

Answer 6

32% of college female athletes displayed pathogenic weight control behaviours such as self induced vomiting, laxitives, diet pills, diuretics, etc.

Question 7

What did Rosen and Hough 1988 find about eating disorders in gymnasts?

Answer 7

All interviewed athletes were dieting, 62% of them were using pathogenic weight control methods

Question 8

What did Pasman and Thompson 1988 find about eating disorders in different sports?

Answer 8

Greater drive for thinness in runners and weightlifters than controls

Question 9

What is the ‘female athlete triad’? Give reference where the term was first used

Answer 9

• Disordered Eating (anorexia, bulimia)
• Amenorrhea (delayed menarche and more than 3 missed cycles)
• Osteoporosis (premature bone loss/inadequate formation)
  Yeager et al 1993

Question 10

What did Bullen et al 1985 find about the effect of exercise on menstrual cylce function?

Answer 10

8 weeks of daily 3.5hr exercise resulted in a higher percentage of menstrual abnormalities after the protocol. After 6 months all back to normal cycle

Question 11

What is energy balance?

Answer 11

Energy Intake - Total energy expenditure

Question 12

what is energy availability

Answer 12

Energy intake - Exercise energy expenditure

Question 13

How do you put energy availability into the right unit of measurement?

Answer 13

Divide energy availability in kcal by fat free mass

Question 14

What is the appropriate unit of measurement for energy availability?

Answer 14

Kcal per kg of fat free mass per day

Question 15

What is the target energy availability for physically active women? Reference

Answer 15

45kcal/kgFFM/day (Loucks 2011)

Question 16

Why does energy availability below 30kcal/kgFFM/day start to cause problems?

Answer 16

Below that and you don’t have enough energy to sustain your BMR (Loucks 2011)

Question 17

In terms of energy balance, why is amenorrhea a response to excessive training load?

Answer 17

Energy Balance = Energy Intake - (Exercise Expenditure + Other Expenditure). If Exercise expenditure is too high, Other expenditure, including menstrual cycle, will decrease to maintain balance to keep the body working.

Question 18

What are the 3 main causes of low energy availability?

Answer 18

• Eating disorders
• Intentional efforts to reduce body size/fatness
• Inadvertent failure to increase energy intake to compensate for exercise energy expenditure

Question 19

What did Loucks et al 1989 find about hormonal balance in athletic amenorrheic women?

Answer 19

Disruption of pulsatile secretion of LH in athletic amenorrheic women relative to matched controls

Question 20

What did Williams et al 1995 find about Exercise vs Low Energy Availability on LH pulse frequency?

Answer 20

LH Pulse frequency reduced in eucaloric exercise and caloric restriction exercise group.

Question 21

What did Loucks et al 1994 find out about the impact of exercise vs low energy availability on LH pulse frequency?

Answer 21

• Low Energy Availability (LEA) lead to 23% reduction in LH pulse frequency during waking hours compared to.High (HEA)
• Adding exercise but increasing intake to match availability to diet restriction trial, DR had 10% lower LEA than HEA
• No difference between HEA with and without exercise

Question 22

What did Loucks and Thuma 2003 find about the energy avilability threshold for LH pusle frequency disruption ?

Answer 22

Below 30kcal/kgFFM/d reduced LH pulse frequency. However the longer the luteal phase, the less effect this has, so older athletes may be less affected than younger.

Question 23

How does bone mineral density get affected by amenorrhea and energy availability?

Answer 23

-Low oestrogen from amenorrhea decreases osteoblast activity
-Low energy availability decreases bone remodelling and increases bone breakdown
(Ihle and Loucks 2004)

Question 24

What did De Souza et al 2008 find out about bone denstiy and amenorrhea and low energy availability?

Answer 24

THose with low oestrogen AND low energy availability had the lowest bone density

Question 25

What is the female athlete triad ACCORDING TO Nattiv et al 2007?

Answer 25

• Low Energy Availability with or without an Eating Disorder
• Functional Hypothalamic Amnorrhea
• Osteoporosis
  It is also a spectrum. The above 3 points are the END of the spectrum

Question 26

What does Gibbs et al 2013 meta analysis say about the prevalence of the female athlete triad?

Answer 26

16-60% of female athletes display any one, 3-27% display any two, 1-16% display all three

Question 27

In simple terms, how do you treat the triad?

Answer 27

Increase energy availability to 45kcal/kgFFM/d or until menstrual function increases

Question 28

What did Vogt et al 2005 determine to be the average energy availability of elite male cyclists?

Answer 28

8kcal/kgFFM/day

Question 29

What did Dolan et al 2012 find about Jockets?

Answer 29

10% lower bone mineral density and greater bone breakdown markers in jockeys compared to matched controls

Question 30

What did Sudgot-Borgen et al 2004 find about eating disorders in males in sport?

Answer 30

25% higher in males in leanness sports than in general population

Question 31

What does Mountjoy et al 2014 prefer to call the female athlete triad?

Answer 31

Relative Energy Deficiency in Sport (RED-S)

Question 32

What is the rationale behind the Mountjoy et al 2014 decision to call female athlete triad the RED-S instead?

Answer 32

• Acronym doesnt spell FAT
• Can occur in non-athletes
• Many more consequences than the two emphasised in the triad and not everyone has all three
• Includes men too
• The key feature is energy deficiency