Sports are an excellent way to build confidence, friendships, and life skills. Sport should be available, safely, to kids of all ages. Working with young female athletes comes with a special set of considerations that we must be aware of and be able to address if the need arises. This is detailed by what is called the Female Athlete Triad, a spectrum of three interrelated disorders that are specific to the female athlete. Often, just one of these disorders is a risk factors/cause for the other two. An athlete does not need to show signs of all three of these to be affected by any one condition.
The first disorder in the triad is weak or weakened bone due to a lack of mineral content, specifically calcium and its interactions with estrogen. The primary way to test for these conditions is to do a Bone Mineral Density scan to see if the bones have adequate mineralization. Ninety percent of total bone mineral content is accrued by the end of adolescence, creating a window of opportunity to maximize bone mineral density. If the young athlete is showing signs of the following two parts of the triad, and/or has a history of stress/normal fractures, it would be a good idea to follow up with a Bone Mineral Density scan.
2) Low Energy Availability With or Without Disordered Eating
This second sign is well described by the name, chronic fatigue that outweighs the stresses being placed on the athlete. If there is great pressure for the athlete to perform, as well as live up to the female body image standards of our society, this can lead to self-destructive behaviors, such as anorexia and bulimia. Even if they do not meet the strict definitions of these conditions, they can have varying degrees of these issues, and need to be addressed. Besides low energy, some signs and symptoms of disordered eating may be gastrointestinal problems (bloating, constipation, ulcers, etc.), cardiovascular abnormalities, or psychiatric problems (depression, anxiety). This lack of adequate nutrition, and often extreme exercise routines, have drastic effects on overall health, energy availability, bone mineral density, as well as menstrual cycles as detailed below.
3) Amenorrhea (Lack of a Menstrual Cycle)
This last, and most easily determined sign that the triad present in a young female athlete is lack of, or disrupted, menstrual cycle. This can include delayed onset of cycle (after the age of 16), absence of cycle for three months after normal cycle had been established, or a cycle lasting longer than 35 days. A normal menstrual cycle depends on adequate nutrition and balance of hormones throughout the body, so a disruption to it is indicative of deeper seeded problems that need to be addressed. Consequences of menstrual cycle disruption can include low bone mineral density, altered hormone levels, and higher incidences of stress fractures and infertility. This is often the tell-tale sign leading to a diagnosis of the Female Athlete Triad, and needs to be addressed as soon as possible.
The best course of action if you, as a team leader, especially a male team leader, suspect any of these conditions, is a referral to their primary physician or gynecologist to have the athlete evaluated and treated if necessary. The adolescent years are very important for both the maturation of the body and setting the stage for a healthy adulthood. Identifying these signs and symptoms early is paramount to making sure our young female athletes remain safe and continue to thrive.