From the Guidelines
The management of the female athlete triad requires a multidisciplinary approach focusing on restoring energy balance, improving bone health, and normalizing menstrual function, with the first priority being addressing low energy availability by increasing caloric intake and/or reducing exercise intensity, aiming for at least 30 kcal/kg of fat-free mass per day, as recommended by the most recent and highest quality study 1. The management approach should include nutritional counseling to emphasize adequate protein (1.2-1.6 g/kg/day), calcium (1000-1500 mg/day), and vitamin D (600-1000 IU/day) intake.
- Key components of the management approach include:
- Restoring energy balance through increased caloric intake and/or reduced exercise intensity
- Improving bone health through weight-bearing exercise and adequate nutrition
- Normalizing menstrual function through hormonal therapy, if necessary
- Providing psychological support to address disordered eating behaviors
- Regular monitoring of menstrual cycles, body weight, and periodic bone density scans
- The time course of non-pharmacological treatment, including follow-up, is crucial, with recovery of physiological systems occurring at different rates, as noted in the 2014 Female Athlete Triad Coalition Consensus Statement 1.
- The treatment of menstrual dysfunction via supplementation with exogenous hormones, such as the COCP, does not correct the cause of FHA and does not protect against BMD loss, as highlighted in the Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement 1.
- The IOC Consensus Statement introduces a broader, more comprehensive term for the condition previously known as ‘Female Athlete Triad’, referred to as ‘Relative Energy Deficiency in Sport’ (RED-S), which affects many aspects of physiological function, health, and athletic performance, as described in the IOC Consensus Statement 1.
- Regular monitoring and follow-up are essential to ensure the effectiveness of the management approach and to make adjustments as needed, with recovery typically requiring 6-12 months of consistent intervention, as noted in the 2014 Female Athlete Triad Coalition Consensus Statement 1.
From the Research
Management Approach for the Female Athlete Triad
The female athlete triad is a complex condition that requires a multidisciplinary approach for management. The key components of the triad include:
- Energy availability
- Menstrual function
- Bone mineral density
Treatment Strategies
Treatment of the female athlete triad involves:
- Achieving optimal energy balance through adequate caloric consumption 2, 3, 4
- Resumption of menses, which may involve dietary intervention or activity modification 2, 3, 4
- Optimization of vitamin D and calcium intake to enhance bone mineral density 2, 3, 4
- A multidisciplinary team approach, including healthcare professionals, coaches, and family members 2, 3, 4
Screening and Diagnosis
Screening for the female athlete triad can be done during the annual wellness exam, preparticipation physical evaluation, or when the athlete presents with any single component of the triad 5, 6. Early recognition and aggressive treatment are important, especially in adolescent athletes, to optimize bone health 6.
Multidisciplinary Team Approach
A multidisciplinary team approach is essential for the management of the female athlete triad, including: