Unique Challenges for Young Female Athletes


Trinity Malott, Photo by Texas Scottish Rite Hospital for Children

Photo by: Texas Scottish Rite Hospital for Children

A girl’s developing body has nutritional needs that are very different from a boy’s. When training for a sport or activity, the differences are even greater. Many have heard of the medical condition female athlete triad. Though it is not a frequent diagnosis, it can negatively impact the lives of young and growing female athletes. It not only negatively affects an athlete’s performance, recovery time and training responses, but also can negatively impact the athletes heart health, bones and hormones. Fortunately, it can be avoided.

What is female athlete triad?

This is a condition that involves an aspect of one or more of the following components, which are all inter-related:

Energy availability – The body needs energy for basic functions, like heart functions growth, but also needs energy for exercise. This must be balanced with the food or energy coming “in.”

Menstrual function – Hormones are important for good bone health and they also allow young women to eventually reproduce. When the hormone cycle is irregular, young women notice changes or the absence of menstruation.

Bone health – Since bone development is 90% complete by the age of 30 years, the cellular health of bones during adolescence is crucial. Bone health can decline with poor nutritional status, low energy availability or abnormal hormonal functions.

Who is at risk?

Though this can happen to anyone who does not eat enough calories to maintain these body functions, it is more common in athletes who train at high intensities. This is seen most commonly in endurance athletes, such as long distance runners, and athletes required to perform many hours of training. Sports that demand a certain figure or weight like gymnastics, dancing or wrestling have also been shown to increase the risk of this condition.

How is it diagnosed?

Since unhealthy bones are at greater risk of injuries like stress fractures, some athletes come to the clinic with complaints of pain from their activity with no specific injury. This may be a problem that occurs more than once. Discussing the athlete’s eating habits, menstrual cycle and history of injuries may lead to a decision to pursue further investigation with imaging, blood work and other tests.

How is it treated?

Because the female athlete triad is a spectrum, every athlete’s care plan is unique. In cases where there is a history of stress fractures or abnormal labs, medications or specific vitamins may be recommended. There may be counseling to help with improving eating habits to match energy expenditure. Because the hormonal cycle is dependent on a well-balanced diet, changes to eating habits may naturally improve this.

How can it be prevented?

Though one component is not more important than another, improving energy availability can help reduce the risk of complications in the other areas. Young athletes should be aware of the nutritional needs of their bodies to meet the physical demands of training. For various reasons, some adolescents are motivated to limit calories in order to not gain weight and this can actually cause a decline in performance or lead to symptoms of female athlete triad.

How do I teach my daughter about energy availability?

Energy for exercise comes from food. When the simple equation of “what goes in” minus “what goes out” doesn’t leave energy for normal body functions, something suffers. Therefore, we need to teach young females to be aware of this in a very positive way without clouding the conversations with topics like “weight management” or “body image.” Here are some healthy statements to use when you start discussing energy needs with female athletes:

  • Athletes use a lot of energy especially during seasons of intense training or competition. During these times, an athlete needs more fuel than in an off-season.

  • Foods provide our body with a variety of resources: learn what your body needs and when. For example, carbohydrates are a very important part of all meals but growing athletes may avoid them because they have heard that “carbs are bad.”

  • Choosing foods that are dense in nutrients can help you feel full and ready for activity. Eating more is not necessarily the solution. Making good choices can help with things you see like speed or strength and things you can’t see like bone health.

This condition was once thought to exist when all three areas were affected. Now we know that clinical signs and symptoms may not all occur at the same time, so further evaluation is needed with the presence of any of these problems. Education and early intervention are keys for young ladies at risk for female athlete triad.

Dr. Jane S. Chung, Texas Scottish Rite Hospital for Children

Dr. Jane S. Chung is a Sports Medicine physician at Texas Scottish Rite Hospital for Children. She specializes in concussion management, return-to-play decisions and non-operative management of musculoskeletal injuries in young and growing athletes. As a board certified pediatrician with fellowship training in Sports Medicine, Dr. Chung provides comprehensive care for athletes with a particular interest in problems affecting female athletes. She completed her medical degree at St. George’s University School of Medicine. Dr. Chung completed her internship and pediatric residency training at Louisiana State University Health Sciences Center, Children’s Hospital. She completed a fellowship in Pediatric Sports Medicine at the Case Medical Center, University Hospitals Rainbow Babies and Children’s Hospital in Cleveland, Ohio. Dr. Chung is board-certified in Pediatric Medicine and Sports Medicine.

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