What is female athlete’s triad? How can it lead to infertility?
Many women athletes work hard in training to build up as much body muscle as possible and reduce body fat. In training they will work extensively to improve their athletic performance, often by running large distances and decreasing their body weight, to make themselves as light, fit and strong as possible and win athletic competitive events.
The female athlete’s triad is a menstrual dysfunction that occurs in some women athletes where they either convert too much body fat to muscle protein or do not consume enough fat in their diet. Fertility hormones such as Oestrogen are made (synthesized) from Cholesterol fat, and therefore low body weight and insufficient fat intake and body fat percentage can cause cessation of menstruation called Amenorrhea. As Oestrogen also supports the formation of bones, this can also lead to Osteoporosis (brittle bone disease) and associated Osteoarthritis (chronic inflammation of the joints) which can cause disability and chronic pain.
If untreated the associated amenorrhea can lead to metabolic disturbances (changes in metabolic rate and thyroid function), sexual dysfunction (low libido and dry vagina which can make sexual intercourse painful) and infertility. Athletes’ triad can also be associated with insomnia (and associated fatigue), bone fractures (such as frequent low-impact compression fractures such as shin-splints), bradycardia (slowed heart rate) and an increase in Cortisol (stress hormone) as the body sees the absence of menses (periods) and excessive intensive exercise as a body stressor. Low body weight is also associated with thinning of the hair, anxiety (from the excessive Cortisol and insomnia) and increased sensitivity to cold (as less body fat insulation). Increased sensitivity to cold can increase brown adipose tissue production (the type of body fat associated with energy expenditure for the production of heat) and thermogenesis (the body shivering or moving to stay warm) further increasing weight loss.
What are the key points in the Athletes Triad?
Athletes’ triad is a three-pointed symptom triangle with menstrual dysfunction, low energy availability (whether caused by an eating disorder or not) and decreased bone density. Diagnosis is made upon the cessation of menses (periods) for more than four months without other underlying conditions (such as polycystic ovarian syndrome). Treatment requires a complex interdisciplinary team, especially if combined with a comorbid eating disorder and psychological refusal to eat more dietary fat or gain more body fat which is needed for the return of menses (periods). Disordered eating is common in female athletes, with a perfect athlete’s body (with a six-pack and toned arms and legs) requiring a high body muscle percentage and low body fat percentage. Often the ratio of body fat: to body muscle content is associated with cessation and return of menses.
Patients with athlete’s triad are prescribed vitamin D and calcium supplements to support their bone health and advised to increase their dietary fat and body fat content. They are advised to reduce their athletic training and do less-intensive and less-frequent exercise and rest more. There are stages of amenorrhea (cessation of periods), varying from patient to patient. Ideally, a person wishes to have eumenorrhea (normal periods every 28 days between the ages of 14 and approximately 50 years of age, in the reproductive window which varies from person to person). Oligomenorrhea is when you have irregular periods at intervals longer than once a month (so for example a period every 2–4 months). Amenorrhea is the cessation of periods. It can be caused by many things, other than energy deficiency. Stress is the main cause of this condition, as the production of the Cortisol stress hormone, “steals” Cholesterol from the production of Oestrogen, Progesterone and Testosterone hormones, reducing fertility.
Why can exercise be addictive?
Excessive exercise is also seen as a stressor on the body, as it puts the joints, muscles and bones at considerable stress and energy deficits cause the release of Adrenaline (the brain chemical that makes a person hyper and go out and “hunt and gather” food). Therefore, energy deficits are often masked by increased physical and mental energy, as a person will be hyper and unable to sleep properly and wired and this will increase their desire to exercise further, leading to exercise addiction. This is increased by the production of endorphins from exercise which are pain-killing brain chemicals, which can mask the stress that a person is doing to their body and result in a “runners high” which can make the person feel happier through the release of Dopamine pleasure brain chemical, and Serotonin the happiness chemical.
Exercise outside also increases oxygen availability if you run in fresh air, which can increase energy (as oxygen is needed for respiration) and increase red blood cell production and, as red blood cells carry oxygen, can further increase the energy of a person. Running in nature has also been found to have mental health benefits, stimulating the release of Noradrenaline which reduces anxiety.
Additionally, reaching your aims and achieving success, releases the brain chemical Dopamine, again increasing mental pleasure. This is why competitive sports can give athletes such a mental buzz, and why cessation of athletics and regular exercise, can be difficult for many athletes. Finding Dopamine replacements is essential for this as the more Dopamine you have in the brain, the more your brain downregulates the Dopamine (D2) brain receptors, and therefore the more Dopamine you need to feel pleasure (which is why people get addicted to their phones, to work, to sex, to alcohol etc.). Dopamine can also be released from achieving mental tasks such as work success, learning a language, creativity, time in the sun or anything else that you enjoy. Meditation and yoga have also been reported to help Dopamine increase for those used to high levels of Dopamine.
It is essential for those with athlete’s triad that they regain sufficient body fat in order to return to normal menses, consume more dietary fat (ideally the so-called “unhealthy” LDL cholesterol that is essential for hormone production) and reduce physical activity. Only once women are at a stable healthy (for their body type) weight can menstruation continue, and infertility and osteoporosis be prevented.
Copyright Laura Campbell 11/10/2022
Health, science (neuroscience, gut microbiota, food & nutrition) & mental health academic and journalist, food waste warrior & health/business/brand content writer and editor. I write expert content.
