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Special concerns for female athletes

Female athletes may experience problems maintaining bone health, a proper diet and healthy menstrual cycles.

For most women, physical activity brings improved fitness and better health. But for some, the pressure to excel can lead to serious medical problems. Three medical conditions—disordered eating, altered menstruation and osteoporosis—are common enough in female athletes that they've been dubbed the female athlete triad.

While these problems can develop in any woman, those who participate in sports that emphasize thinness (such as running, figure skating or gymnastics) are at increased risk, according to the American College of Sports Medicine (ACSM).

Some conditions can threaten performance, health and life. If you notice any of these signs in yourself or someone you care about, a doctor visit is in order.

Eating disorders. In their quest for leaner bodies, some women deprive themselves of nutrients vital to their performance. Many develop eating disorders ranging from an occasional use of diet pills or laxatives to full-blown bulimia or anorexia. Since food is fuel for all physical activity, any female athlete who isn't eating properly can actually worsen her athletic performance.

Women with eating disorders also face a handful of medical complications, including irregular heartbeat, dehydration, a shortage of iron in the blood, irregular periods, thinning bones and depression. Left untreated, eating disorders can be deadly.

Amenorrhea. Some women exercise so much that they stop having periods, says the ACSM.

But this is a signal from your body that something's not right. Female athletes who aren't menstruating can have estrogen levels similar to women who are past menopause. Estrogen helps with the absorption of bone-strengthening calcium, so without it bones can become thin, fragile and highly prone to fracture.

Amenorrhea can also lead to long-term problems with fertility.

Osteoporosis. Amenorrhea and poor nutrition can both lead to thinning, weakening bones. This in turn increases the risk of broken bones, including stress fractures that can result from the repeated stresses of exercise and training.

Losing bone mass when you're young is especially dangerous, as this is the time of life when the bones normally build up a store of dense tissue that's intended to last a lifetime. When women lose out on this one-time opportunity, their bones are affected forever. Even if women go back to having normal periods, a history of amenorrhea increases the risk for broken bones later in life.

This group of conditions can be treated successfully, helping women become stronger, healthier athletes with less risk of future medical problems.

Better yet, parents, coaches and athletes can help prevent these problems by focusing on health rather than weight. Female athletes can also consider these questions from the American Academy of Orthopaedic Surgeons (AAOS):

  • Are you dissatisfied with your body?
  • Do you strive to be thin?
  • Do you continuously focus on your weight?
If you answered yes to all the questions, you may be at risk, says the AAOS. Talk to your doctor.

Reviewed 11/30/2022

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