The female athlete - Sports Medicine Doctor Malta - Dr Danica Bonello Spiteri

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The female athlete

The female athlete (First published on vida magazine on June 2013)

The more time goes by, more and more women are realizing the importance of physical activity (PA) for health. Although PA is good for you, too much of anything can be harmful in its own way. The female athlete triad is related to inadequate nutrition, irregular or absent menstruation and bone thinning (osteoporosis).

Certain sports have a greater preponderance to image (ballet, gymnastics) and/or decreased weight, especially in endurance sports, such as long distance running. The female athlete attempts to lose weight in order to fit in with the image of the sport she practices, or to be lighter in order to run faster. This leads to inadequate nutrition, including essential vitamins and minerals. The body requires these in order to repair and rebuild itself after each and every training session. If not enough energy is supplied to the body, it starts to ‘shut down’ non essential activities in the body, such as the reproductive system. The body does this in order to conserve energy for its own survival. The female will start to have missed periods, and these may also cease altogether (amenorrhea), which is the body’s way of shutting down the reproductive system in order to conserve essential energy.

The inadequate nutrition also leaves its mark on bone strength. Bone turnover in the body occurs on a daily basis and requires energy and calcium to do this. Repetitive exercise, such as the impact on the ground from running, repeated jumps, pulls and other sporting movements all leave a strain on bones. In a normal healthy person with adequate nutrition, the body takes care of these movements and builds up stronger and healthier bones. However, if decreased energy intake, lack of calcium and vitamin D is ingested, this will lead to poor repair of bone. Over time bone will get weaker and will eventually lead to injuries, such as ‘stress fractures’. These are tiny hairline type of fractures that occur in the bones at the site where there is the impact on the bone during sporting activity. Such injuries will invariably cause pain, causing the athlete to stop their exercise regime. With time and correct treatment, the bony stress fracture will heal. However, in the long term, prolonged duration of the above process will thin out the bones throughout the athlete’s body, and osteoporosis (bone thinning) may result as they grow older. Osteoporosis is a high risk factor for fractures of other bones in later life, and hence must be prevented.

It is important to recognise the athlete suffering from this female athlete triad. Eating patterns must be analysed at an early stage, especially in adolescence, as this is crucial to identifying the condition. Eating disorders are found in about 20% of female athletes, and about 10% of male athletes, and they are most often overlooked for years. It is also a cause of underperformance in athletes, even at elite level.


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