2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad

Abstract

The Female Athlete Triad is a medical condition often observed in physically active girls and women, and involves 3 components: (1) low energy availability with or without disordered eating, (2) menstrual dysfunction, and (3) low bone mineral density. Female athletes often present with 1 or more of the 3 Triad components, and an early intervention is essential to prevent its progression to serious endpoints that include clinical eating disorders, amenorrhea, and osteoporosis. This consensus statement represents a set of recommendations developed following the first (San Francisco, California) and second (Indianapolis, Indianna) International Symposia on the Female Athlete Triad. It is intended to provide clinical guidelines for physicians, athletic trainers, and other health care providers for the screening, diagnosis, and treatment of the Female Athlete Triad and to provide clear recommendations for return to play. The 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad Expert Panel has proposed a risk stratification point system that takes into account magnitude of risk to assist the physician in decision-making regarding sport participation, clearance, and return to play. Guidelines are offered for clearance categories, management by a multidisciplinary team, and implementation of treatment contracts. This consensus paper has been endorsed by The Female Athlete Triad Coalition, an International Consortium of leading Triad researchers, physicians, and other health care professionals, the American College of Sports Medicine, and the American Medical Society for Sports Medicine.

Sports Specialization and Intensive Training in Young Athletes

“…There is support for closely monitoring nutritional intake in all youth athletes, especially those who participate in highintensity and endurance sports, focusing particularly on caloric intake required to meet the demands of training as well as to maintain adequate growth and development. 35 Some female athletes experience menarche 1 to 2 years later than nonathletes but still within the normal range. 36,37 Theories proposed for this difference include lower body fat, training, stress, undernutrition, or a sport-specific preselection bias.…”

Promotion of Healthy Weight-Control Practices in Young Athletes

“…BMI less than the fifth percentile, BMI less than 17.5 in a skeletally mature adolescent, or weight less than 85% of expected body weight would warrant further evaluation for unhealthy weight loss behavior. 16,63 Education of athletes, parents, and coaches about unhealthy weight loss behaviors and their negative impact on health and athletic performance is important to prevent adverse health effects. For non-weight-class sports, coaches should promote healthy eating habits and be alert to unhealthy eating habits in their athletes.…”

“…64 The definition was subsequently altered to reflect the spectrum of low energy availability and its consequences in female athletes. 63,65 Low energy availability refers to an imbalance between caloric intake and energy expenditure. A small body of research supports the concept that male athletes also appear to be susceptible to inadequate energy availability and may experience adverse health consequences as a result.…”

“…16 Recommendations have also been published on returnto-play criteria in female athletes with disordered eating, menstrual dysfunction, and decreased bone mineral density. 61,63 healthy Weight Loss in the Athlete Classified as having overweight or obesity…”

MECHANISMS IN ENDOCRINOLOGY: Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions

“…Swimmers have fewer irregularities than other athletes, probably due to their higher oestrogen-generating fat mass than other sportswomen (for review (53,58)). The lack of oestrogens may become so severe that the syndrome of the 'female athlete triad' (disturbed energy balance due to disturbed eating behaviour, menstrual irregularities and low bone mineral density) has been identified as a severe consequence of intensive sport activity (59,60). The high frequency of reproductive anomalies among female athletes highlights the difficulty in disentangling the effects of exhausting sport activities and of AASs abuse in the absence of controlled studies and based on only few case reports.…”