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Bright Futures

Articles and Updates from Phoenix Children's

August 05, 2020, Jennifer Gaitley, MD
Identifying Low Energy Availability in Female Athletes

During this time of year, young athletes are usually preparing for volleyball, getting ready for dance competitions or training for cross county. Sport and exercise are a large part of daily life for many middle and high school students, and while exercise has many health benefits, it’s also important to be aware of certain exercise-related issues that may arise. One such issue is the Female Athlete Triad or Relative Energy Deficiency in Sport (RED-S).

The female athlete triad is made up of three components. Energy availability, menstrual function and bone health. This condition is often seen in high school and collegiate athletes because they are involved in competitive sports and train frequently. However, it can occur at any age and any level of sport. 

Girls and teenagers require a lot of energy for growth, development and everyday activities. Once an athlete starts playing a sport and begins to practice more often, she requires even more energy. If she doesn’t take in enough energy to support her level of activity, it leads to low energy availability. This energy deficiency is the primary driver of the female athlete triad and RED-S.

A low energy state can lead to irregular or absent periods and possibly poor bone health, which contributes to injuries like stress fractures. Other signs of energy deficiency include:

  • Feeling more tired than usual during practice and other daily activities
  • Weight loss
  • Recurrent illnesses
  • Recurrent injuries
  • Declining athletic performance

Low energy availability can be intentional or unintentional. Some athletes will restrict their nutritional intake in an effort to change their physique or improve their performance. Girls who participate in sports with an emphasis on leanness, like distance running, gymnastics and dance often fall into this category. Other athletes may start training harder and not realize that because they are exercising more, they need to eat more to meet their new energy needs. In either case, the end result is a mismatch between energy intake and energy used.

It’s important to identify athletes who are at risk of developing the female athlete triad: Early detection and treatment can help stop progression to clinical eating disorders like anorexia or bulimia, prevent worsening menstrual dysfunction, and can help prevent progression to osteoporosis.

There are some habits and notions that put athletes at increased risk of developing the female athlete triad:

  • Athletes who specialize in one sport early on and practice often
  • Athletes involved in sports that emphasize a lean physique, such as distance running, gymnastics, and dance
  • Lack of knowledge regarding nutrition among athletes
  • Athletes who have received critical comments about eating or weight by coaches, parents or teammates

Symptoms of the female athlete triad or RED-S may also be caused by medical issues, so it is important to see your doctor to rule out other possible causes. If it is determined that low energy availability is the likely cause of an athlete’s symptoms, it is important to start treatment as soon as possible. The treatment team may include a doctor, a dietitian, your child’s athletic trainer, and possibly a mental health provider.

We want girls to be able to pursue their athletic interests into adulthood, and by restoring the energy balance, we help them do so with their health and safety at top of mind.

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