The Unexplored Crossroads of the Female Athlete Triad and Iron Deficiency: A Narrative Review

Abstract

Despite the severity and prevalence of iron deficiency in exercising women, few published reports have explored how iron deficiency interacts with another prevalent and severe condition in exercising women: the 'female athlete triad.' This review aims to describe how iron deficiency may interact with each component of the female athlete triad, that is, energy status, reproductive function, and bone health. The effects of iron deficiency on energy status are discussed in regards to thyroid function, metabolic fuel availability, eating behaviors, and energy expenditure. The interactions between iron deficiency and reproductive function are explored by discussing the potentially impaired fertility and hyperprolactinemia due to iron deficiency and the alterations in iron metabolism due to menstrual blood loss and estrogen exposure. The interaction of iron deficiency with bone health may occur via dysregulation of the growth hormone/insulin-like growth factor-1 axis, hypoxia, and hypothyroidism. Based on these discussions, several future directions for research are presented.

Low energy availability surrogates correlate with health and performance consequences of Relative Energy Deficiency in Sport

“…The relationships between low EA and Triad components are well established,3 4 and this study supports that model. While there is less evidence supporting the other RED-S health consequences,5 our study supports the proposed associations between low EA and endocrine,30 31 metabolic,32 haematological,7 psychological,12 33 cardiovascular34 and gastrointestinal impairments35 of the RED-S model. Specifically, risks of metabolic, psychological and cardiovascular issues were more than two-fold greater in those with low EA than those with adequate EA.…”

IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update

“…This is due to a potential reduction in appetite, decreased metabolic fuel availability and impaired metabolic efficiency, leading to an increase in energy expenditure during exercise and rest 93. Iron deficiency may also interact with bone health via dysregulation of the GH/IGF-1 axis, hypoxia and hypothyroidism, in addition to playing an important role in thyroid function, fertility and even psychological well-being 93. Thus, LEA may be partially induced by, and may contribute to, iron deficiency 93.…”

“…Iron deficiency may also interact with bone health via dysregulation of the GH/IGF-1 axis, hypoxia and hypothyroidism, in addition to playing an important role in thyroid function, fertility and even psychological well-being 93. Thus, LEA may be partially induced by, and may contribute to, iron deficiency 93. Surrogates for LEA have been correlated with haematological dysfunction, including low ferritin and iron deficiency anaemia, in adolescent and young adult female athletes 94…”

Performance Motion Analysis Unable to Predict Running-Related Injury in Collegiate Distance Runners

“…Variables attributed to increased risk of RRI include poor nutrition habits, excessive training volume, history of past injury, poor lower extremity biomechanical characteristics of the athlete such as excessive knee internal rotation during running. 4,5,6,7,8,9,10,11,12 Several of these factors are modifiable and can be addressed and corrected with the proper strategies. For example, Fredericson et al demonstrated a reduction in iliotibial band syndrome symptoms after a hip abductor strengthening program.…”