Management

Management

• prevention is better than treatment
  • education
    • all individuals and agencies involved with female athletes to be made fully aware of the potential causes, mechanisms, and long term risks of the female athlete triad
      • also women athletes, their parents, and medical staff should be informed about the triad and its pitfalls
  • the management of the athlete is most imperative
    • eating disorders
      • treatment of true eating disorders (anorexia nervosa, bulilmia nervosa) should be undertaken only by qualified staff on an inpatient or outpatient basis
      • goal is to increase the nutritional status of the woman
        • will reverse many of the symptoms associated with disordered eating (for example, constipation, fatigue, lanugo, and dry skin-although not loss of enamel from teeth), reverse menstrual disorders, and help reduce the risk of osteopenia or osteoporosis
        • many of these changes will ultimately
          • increase muscle strength
          • reduce risk of injury
    • menstrual disturbances
      • establish that the menstrual disturbances are non-pathological and related to exercise load
        • treatment is based on training load and nutritional intake
      • athletes will benefit from decreasing the intensity or duration of training by 10% (1); they then should increase energy intake by initially small amounts.
    • menstrual disturbances and decreased bone mineral density
      • treatment is reliant on oestrogen replacement
        • oestrogen replacement can be provided with the contraceptive pill
          • progestogen-only pills should be avoided
          • if the athlete agrees to take the pill, she should understand that it does not correct the underlying problem
          • if menses is not desired, provide monophasic pills in which the placebo week is missing may be occasionally be used - should only be a short term approach
      • hormone replacement therapy, as provided for postmenopausal women, has been successful in only a few studies
      • other treatments recommended for bone loss are specific oestrogen receptor modulators, intranasal calcitonin, and bisphosphonates
        • these products are used primarily in older women, and little is known about their effects on bone mineral density in amenorrhoeic women
      • calcium intake should be increased to 1500-2000 mg a day
        • calcium should be taken alongside vitamin D. Calcium does not increase bone mineral density but may aid in preventing further decreases

Notes:

• athletes with menstrual disturbances can increase bone mineral density with weight bearing exercise or treatment on reversal of the menstrual disturbance. Bone mineral density, however, will never return to what it may have been if the athlete had remained eumenorrhoeic
  • if trabecular bone is lost during long term amenorrhoea, reversal of bone mineral density may be impossible

Reference:

• 1) Birch K. Female athlete triad. BMJ 2005;330(7485):244-6
• 2) Schtscherbyna A et al. Female athlete triad in elite swimmers of the city of Rio de Janeiro. Brazil Nutrition 2009;25(6): 634-639.