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Female Athlete Triad

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  • Category: Sports

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The female athlete triad is made up of three medical conditions that are becoming increasingly common in active teen girls: Eating disorders, Amenorrhea or lack of menstrual periods and Osteoporosis or low bone mass. Low-calorie diets are usually the first sign of eating disorders. Along with diets, excessive exercise or obsession with exercising can also be another sign of the Female athlete triad. Teenage girls that are lower weight but exercise constantly are the individuals with the higher risk. Teen girls who cut back on eating habits also called “cutting weight” for specific sporting events are more likely to have amenorrhea. Sports that are heavily linked with triads are mostly gymnastics, swimming and ice skating, all sports that weight determines much. After the production of amenorrhea, amenorrhea can ultimately lead to the triad itself. Trakya University in Turkey conducted a study in June of 2004 to have a further understanding in the prevalence of the female athlete triad among athletes.

This university was able to conduct surveys, questionnaires and other data from athletes in the colligate level and high school athletes as well. Consent from the parents in athletes under the age of 18 was indeed followed through. Trakya University gathered 224 female athletes to participate in the study from the city of Edrine in Turkey. To have an average, the ages ranged from 16 to 25 years old. These athletes were taken from all different types of sports in the fact that no bias to one sport was clear. These sports ranged from basketball, tennis and volleyball all the way to handball. On the other hand, females who were taking oral contraceptives had to be excluded from study being that oral contraceptives are known to regulate and control the menstrual cycle.

As well as athletes without oral contraceptives, the athletes also needed to be nulliparous which is another term for a woman who has not yet birthed a child. After several steps and test including a questionnaire, bone densitometry, blood analysis and eating attitude test also known as EAT-40, results varied in many ways. Amenorrhea was present in only 22 (9.8%) of all athletes. Of the 22 athletes, 2 (0.9%) reported primary amenorrhea (not very high). Both women were 16 years old and were in gymnastics. The only triad trait of these women was the amenorrhea. Eighty percent of all participating athletes (n = 181) reported regular menstrual cycles during the past year. On the other hand, the bone densitometry showed that the Body mass index of these remaining woman were lower. Out of 220 athletes (4 being excluded) only 6 women filled the triad trait when it came down to eating disorders. Psychiatric evaluation diagnosed two of the 6 with having eating disorders and one met the diagnosis of anorexia nervosa (again very lower). In the blood analyses, only 6 females were tested in this are, who had whole criteria of the triad.

Only one of these athletes’ FSH/LH ratio changed in favor of LH (FSH, 6.99 mlU•ml-1, LH 12.9 mlU•ml-1). Further testing resulted in the conclusion of ovary syndrome which excluded the thought of the traid being present. The other 5 athletes after undergoing the same testing did not fall under the ovary syndrome and there was no conclusion on why the amenorrhea was present. When it came to bone mineral density of the 6 athletes who had two criteria (disordered eating and amenorrhea) of the triad, they underwent DEXA scans to assess bone mineral density. After Testing it concluded that 3 of the subjects were within osteoporotic or osteopenic limits. There are ways in which I agree with the study overall. The one factor that needs be accounted for the most in this has to be numbers. The numbers of subjects participating are crucial to conclude an overall range and average. With 224 females participating, accurate numbers or close to accurate were able to be collected.

Random obscuring data was not involved (oral contraceptives ect.). Another positive factor I seen in this case study was the use of questionnaires. Questionnaires are very helpful in the fact of learning personal information about the athlete. Questionnaires also are helpful because a lot of individuals will be more honest if their answers are anonymous. In this study Trakya University concluded that the results from the specific test linked together in some way. This was helpful to conclude that the female athlete triad was a possibility.

Also to respond with the specific test, these studies seem to be in depth as well as professionally completed. Also, the highest suitable individuals were only able to participate for the fact that information and data has a decreased chance in being obscured. With all honesty, I disagree with the study with a stronger passion. The subject size was large enough to get an average but in many of the cases they would complete a test and discard individuals who did not meet the criteria for future test. In many of the cases only 6 subject were tested for data collection. This was a big concern for me because accurate averages with only 6 individuals can cause bias if more than one or more athletes share the same characteristics.

The female athlete triad is a condition in which the numbers and individuals vary due to all different factors. For example cross country puts a different stress on the body than another sport like basketball. Stress alone plays an important role on the psychological as well as the physical aspect of an athlete. Higher competition sports result in higher amounts of stress, but in these studies not all different sports were tested. Basketball and running seemed to be the two sports that had the main focus of these scientists. When you only record two sports, you will only receive two compared data pieces. Figure skating, gymnastics as well as cross country are all sports that have seen the triad immensely.

Cutting weight for these sports has seemed to be a highly recognized in the diagnosis of the female athlete triad. In this case study, why would you primarily use basketball? The question still puzzles me because even though Trakya University used around 10 sports including gymnastics, swimming and running, testing could have been done to further the information towards real world applications. With the information that I was able to conclude from the article I would say that I disagree with the overall process and the proceeding steps they preformed to form a conclusion. This is because I am able to see many areas for improvement as well as other and or different steps that could have been made.

Trayka University preformed many test and were able to produce countless amounts of numbers. With the test and the experiments they were able to conduct, Trakya University’s numbers were credited towards their subject. What many fail to realize is that different diseases and conditions can have a different effect under different ethnicities. For example, Sickle cell anemia is a disease that can affect everyone but is most prevalent in African Americans. The same could possibly apply for females when dealing with the female athlete triad. Females are different ethnicities as well as many different woman experience menses at different stages in life; this could have an effect as well in the female athlete triad. With this information, there were some areas in this case study that I believe could use improvement.

Being that this university is based in Turkey, Turkish women were used for this study. If it were possible to increase the subject sizes by involving international women as well, the results of why females go through this could be answered too. As well as increasing this to an international basis I would also set aside of the tests to administer a type of treatment to the conditions these women were experiencing. I feel this would be beneficial to the study because the scientist were all looking for aspects of these test to show positive symptoms of the triad.

If and when they concluded the triad to be possible, steps and other alternatives such as medications could possibly reverse symptoms of the triad. Even though you may have more than one symptom of the triad doesn’t mean that it couldn’t just be another condition masked. I believe that this case study was able to gather information that was vital to the purpose they were trying to fulfill but personally the athlete female triad is just a very broad condition that many still are questioning. In the other ideas and increased test, breaking the code of why the female athlete triad is so prevalent could be that much closer to finding.

Trakya University made a valid effort to find why the prevalence was high in female that were participating in these specific sports. The female athlete triad, which has to do with osteoporosis, eating disorders as well as amenorrhea, has been the main focus. All these diseases and conditions seem to branch from the presence of amenorrhea being the root of all evil. Many women participated in this study being and some of these athletes were experiences symptoms in the first place. In fact a fairly large group of women participated (224).

Many tests were administered along the way as you seen with the eating questionnaire, bone mineral densitometry test as well as the tracking of the menstrual patterns. With all the numbers gathered from the test the outcome was positive towards the goal that Trakya University was trying to accomplish. Trakya University found that the prevalence rate of female athlete triad was 1.36% among young Turkish female athletes. With the results and conclusions drawn, one reason triggers all. Poor eating habits and failed eating routines have seemed to be the overall factor to the female athlete triad alone.


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Drinkwater, B., Johnson, M., Loucks, A. and Wilmore, J. (1997) American Co College of Sports Medicine position stand. The female athlete triad. Medicine and Science in Sports Exercise 29, i-ix. Putukian, M. (1998) The female athlete triad. Clinical Journal of Sports Medicine 17, 675-696. Rodrigez-Cano, T., Beato-Fernandez, L. and BelmonteLlario, A. (2005) New contributions to the prevalence of eating disorders in Spanish adolescents: detection of false negatives. European Psychiatry 20, 173-178. Rosen, L.W., Mc Keag, D.B., Hough, D.O. and Curley, V. (1986) Pathogenic weight-control behavior in female athletes. The Physician and Sportsmedicine14, 79-95. Sabatini, S. (2001) The female athlete triad. The American Journal of the Medical Sciences. 322,193-195. Sundgot-Borgen, J. (1994) Risk and trigger factors for the development of eating disorders in female elite athletes. Medicine and Science in Sports and Exercise 26, 414-419. West, R.V. (1998) The female athlete. The triad of disordered eating, amenorrhoea and osteoporosis. Sports Medicine 26, 63-71. Yeager, K.K., Agostini, R., Nattiv, A. and Drinkwater, B. (1993) The female athlete triad: disordered eating, amenorrhea, osteoporosis. Medicine and Science in Sports and Exercise 25, 775-777.

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