Female Athlete Triad

BMD

Bone mineral density. Z-Score below -2.0 is termed "low bone density"

? = (EI - EEE) / ?

EA = (EI - EEE) / FFM Energy Availability equals Dietary intake minus exercise expenditure divided by normalized fat free mass.

What are the progessive steps from Eumenorrhea to Amenorrhea?

Eumenorrhea --> Luteal Phase Deficiency --> Anovulation --> Oligomenorrhea --> Amenorrhea --> Hypothalmic Amenorrhea

Energy availability in a female has dropped to 30 kcal/kg FFM/day for the past 5 days, which hormones can be affected?

GNRH and LH/FSH pulsatility will be disrupted. Leads to decreased E2 production, in turn, accelerating bone resorption and decreasing BMD.

What is the major factor contributing to "unhappy" triad?

Lack of energy availability, aka lack of nutrition.

Why are the three corners of the Triad inter-related?

Low-energy availability leads to a disturbance in hormonal control of Menstrual cycle, this will also reduce estrogen's effect on bone formation.

LPD

Luteal Phase defect - Menstural cycle with a luteal phase less than 10 days or with low progesterone. Follicular phase is prolonged, but cycle length does not change. Athlete will ovulate and menstruate.

Anovulation

Menstrual cycle without ovulation, low levels of estrogen and progesterone, Impaired follicular development. Athlete will often menstruate (cycles either shortened or prolonged)

The female athlete triad consists of three inter-related disorders:

Osteoporosis, Disordered eating, Amenorrhea

Amenorrhea (secondary)

Secondary amenorrhea occurring after menarche. Absence of menstrual cycle lasting more than 90 days. Primary amenorrhea, delayed menarche, may slo develop Oligomenorrhea.

What is amenorrhea?

absence of menstruation

Oligomenorrhea

A period of 35 days or more between cycles, irregular menses