Female Athlete Triad: Energy, Menstruation and Bone Density

effeminate suspensor triplet Energy, Menstruation and B angiotensin-converting enzyme DensityDefine the term the Female Athlete Triad. Explain the interaction between the various elements of the triplet and their effects on health and human performanceIntroductionThe womanish jockstrap triple refers to the interrelationships among sinew approachability, menstrual course, and bone mineral density (BMD), which may beat clinical manifestations including eating unsoundnesss, functional hypothalamic amenorrhea, and osteoporosis (Nattiv et al. 1994). It is unfortunately a disorder which often goes unrecognised in female suspensors.The female athlete terce is ca lend oneselfd by an nothing drain where in that respect is a caloric deficitdue to the athletes energy expenditure exceeding herdietary energy intake (Nattiv et al. 1994). Whether known to the athlete or not, this abject level of energy availability causes disruption of the hypothalamic-pituitary-ovarian axis,whi ch impressions in diminish gonadotropin-releasing ductless gland (GnRH)pulsatility and low-toned luteinizing endocrine gland (LH) and follicle-stimulating hormone (FSH) levels (Loucks 1990). This then petabits to a decreased oestrogen production which causes menstrual disfunction. These decreased estrogen levels in turn impinge on atomic number 20 resorption and bone accretion, which cause decreased bone health (Gottschlich Young, 2006).The 3 atoms of the triad argon all inter-related through physiological and genial means as shown in Fig. 1. The common psychological pressures to repeatedly localize in a performance of optimal measuring rod and often the perceived requirement to maintain a low body mass for sure sports, result in a large add of knowledge. This large tot of facts of life combined with a low energy intake, and likewise in addition to the stress hormones produced by psychological stress, may lead to a physiological alteration in the endocrinological throw of the menstrual steering wheel, which may lead to the athlete becoming amenorrhoeic. The consequence of becoming amenorrhoeic through dysfunction of the hypothalamus and pituitary is that the production of oestrogen will decrease. This hormone has a major role in maintaining adequate BMD. in that locationfore, a hypo-oestrogenic state is associated with a low BMD and an increased essay of osteoporosis (Birch, 2005).Not all sufferers have all 3 components of the female athlete triad however. In recent years, new studies argon continuing to emerge indicating that even having just1 or 2 elements of the triad importantly increases these womens semipermanent morbidity. In addition to this, a study by Burrows et al. (2007) has suggested that the ongoing triad elements do not identify allwomen at risk from the syndrome,rather thatcriteria much(prenominal) as mold-related menstrual alterations, disturbed eating, and osteopenia may be more(prenominal) inhibit (Gottschlich Young, 2006).Eating disordersThere is a reduced energy availability (the amount of dietary energy remaining for other body functions after exercise provision such as cellular maintenance, thermogenesis, immunity, growth, reproduction, and locomotion) associated with disordered eating which is the result of an exercise energy expenditure greater than a dietary energy intake. This compensation by physiological mechanisms to reduce the amount of energy make available to these functions tends to restore energy balance in the body and come along survival, but consequently impairs health.Extreme cases of eating disorders could include anorexia nervosa and bulimia nervosa. many another(prenominal) athletes do not meet the strict criteria for anorexia nervosa or bulimia nervosa that be listed by the American Psychiatric Association (1994) in the Diagnostic and statistical Manual of Mental Disorders (Fig. 2) but will however, manifest similar disordered eating behaviours as part of the triad syndrome (Hobart and Smucker, 2000).The term anorexia athletica or disordered eating has been utilize to distinguish between pathological anorexia and eating disorders associated with training and sports performance. The criteria for this include perfectionism, compulsiveness, competitiveness, high self motivation, menstrual disturbances, and at least one unhealthy method of weight control such as fasting, vomiting, and use of diet pills, laxatives, or diuretics (Birch 2005). The Diagnostic and Statistical Manual of Mental Disorders as mentioned above was reviewed by the American Psychiatric Association (2000) to include a more comprehensive classification of eating disorders not otherwise stipulate (EDNOS) for athletes who do not meet the criteria for anorexia nervosa or bulimia nervosa (Fig. 3).Functional hypothalamic amenorrheaSome clinical menstrual disorders are obvious to modify women such as oligomenorrhea (menstrual cycles 35 days) and amenorrhea (no cycles for 90 days), but sub-clinical menstrual disorders are not, e.g. luteal deficiency and anovulation. Amenorrhea may be cause by a wide range of organic diseases, genetic abnormalities, energy deficiency, and stress. aesculapian tests are required to diagnose the etiology of amenorrhea so that inhibit care can be offered to sufferers of the syndrome (Manore et al. 2007).Amenorrhea that is related to athletic training and weight fluctuation is caused by changes in the hypothalamus which result in decreased levels of estrogen. Amenorrhea in the female athlete triad, according to (Hobart and Smucker, 2000), can be sort out as primary or secondaryPrimary amenorrhea no spontaneous uterine bleeding in the following situations (a) by the age of 14 years without the development of secondary sexual characteristics, or (b) by the age of 16 years with otherwise normal development. junior-grade amenorrhea the absence of menstrual bleeding in a female for (a) 6 months with primary regular menses, or (b) 12 months with previous oligomenorrhea.The lawsuit of amenorrhea caused by low energy availability associated with eating disorders is classified as functional hypothalamic amenorrhea (FHA). In FHA, ovarian function is suppressed by an abnormally slow frequency of luteinising hormone (LH) pulses in the blood. LH pulsatility is regulated in part by neurological pathways originating in specialised neurons which can sense the availability of oxidisable metabolic fuels (Wade Jones, 2004).There are many causes of menstrual disorders, many of which are not completely understood. Pulsatile vent-hole of luteinising hormone is decreased, which leads initially to luteal kind defects. In addition, women with luteal phase defects and amenorrhoea will have higher concentrations of growth hormone and cortisol and lower concentrations of leptin, insulin, and triodothyronine when compared with sedentary women. These hormones are related to metabolism, which means they are also related to nu tritional and metabolic status. When these hormones indicate that energy availability is low over a period of time, the menstrual cycle will be temporarily suppressed in order to conserve energy (Birch 2005).OsteoporosisOsteoporosis, as defined by the American College of Sports Medicine (ACSM), is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhance skeletal fragility and increased risk of fracture (Otis et al. 1997).This is the final component of thefemale athlete triadwhich exists on a continuum from optimal bone health to osteoporosis and focuses on bone strength, which consists of BMD and bone quality. Bone quality refers to bone turnover evaluate (resorption versus formation, time for maturation of the new bone matrix, microarchitecture or trabeculae, bone geometry and size, etc.).The softness to measure bone quality at this time leaves one fractional of the equation for bone health empty and offers an explanation f or why near athletes may suffer more fractures even if they have the same sorry bone density as their peers. Therefore, double energy x-ray absorptiometry (DXA) scans are used as a quantitative measure of bone health. (Gottschlich Young, 2006).The human Health Organization (WHO) has established guidelines on how to classify BMD using dual energy radiographic absortiometry (DXA). Osteoporosis is defined as BMD greater than 2.5 standard deviations on a lower floor the mean of young adults. Osteopenia is defined by a BMD 1 to 2.5 standard deviations below the mean of young adults (Kanis et al. 1994). Recently however, the International Society for clinical Densitometry (ISCD) published a statement (Lewiecki et al. 2004) that the WHOs guidelines for osteoporosis should not actually be used on healthy premenopausal females. They suggest instead that Z-scores should be used rather than T-scores for the diagnosing of osteoporosis in this particular population.According to Brunet (2005 ), there is an increased risk for fracture in the elderly population as well as the young in conjunction with osteoporosis. Some of the associated risk factors include thyroid or corticosteroid medications, smoking, a low calcium diet, amenorrhea, a family history of osteoporosis, a sedentary lifestyle, and a lack of hormone replacement therapy (HRT) post menopause (Bellantoni, 1996). According to the American Academy of orthopaedic Surgeons (1991), gender can play a part with females being 8 times more likely to develop osteoporosis than males. The reason for this is a decreased baseline bone mass and also, an increased level of bone dousing associated with menopause.TreatmentThe clinical suspicion alone that someone is suffering from female athlete triad should be decent indication to start with healing(predicate) and preventive steps, such as a reduction in training loads, an increase in bodyweight, and improvements in diet. These clinical suspicions could be based on person al history such as previous stress fractures, or based on the presence of other factors such as amenorrhea. These steps aim at returning estrogen production to normal levels by normalizing the disturbed menstrual cycle.If this goal is not achieved, the lack of estrogens has to be set with exogenous estrogens administration, particularly in the case of secondary amenorrhea, to ensure execution of peak bone mass (PBM). If osteoporosis is documented, it is an additional indication for hormonal substitution. There are two ways to carry this out, and can be selected in relation to the age or to special wishes of the athletes like contraception and cycle control. Either estrogens as a part of a birth control pill or a HRT with natural estrogens and progestins. Both treatments get hold of to consider the minimal dose of estrogens necessary for prevention of osteoporosis. In addition, sufficient intake of calcium and vitamin D may not be neglected. Regarding the long-term results of the proposed hormonal treatment, it has to be admitted that prospective results from longitudinal studies are completely lacking, and that more research is urgently needed (Roth et al. 2000).ConclusionLow energy availability with or without eating disorders, functional hypothalamic amenorrhea, and osteoporosis, alone or in combination, pose significant health risks to physically active girls and women. Prevention, recognition, and treatment of these clinical conditions should be a priority of those who work with female athletes to ensure that they increase the benefits of regular exercise. (Nattiv et al. 1994).Prevention of the triad, or at least an early diagnosis of it, is certainly better than the cure. More efforts should be undertaken to appropriately inform physicians, athletes, coaches, officials and parents on all the different aspects of the triad. Dealing with this syndrome, according to Roth et al. (2000), may offer a chance to the female athlete the opportunity for a deeper reflection almost her bodily function and the relative importance and perspective of performance and success in sports.ReferencesAmerican Academy of Orthopedic Surgeons. Athletic training and sports treat (1991), 2nd ed., Park Ridge (IL) American Academy of Orthopedic Surgeons.American Psychiatric Association. Diagnostic and statistical manual of mental disorders (1994), 4th ed., Washington, D.C. 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