When it comes to understanding women’s health, it has always seemed so hard to find answers and still is to this day for many. Some physicians still do not receive comprehensive training on women’s health, physicians are less likely to take women’s health concerns seriously or are deemed “women’s issues”. But there is one female-specific phenomenon that happens that we know a lot about and we thought it would be important to educate those who read this blog about it.
The Female Athlete Triad, also called RED-S, is a phenomenon that occurs when three things happen to individuals who exercise extremely.
1. Menstrual Dysfunction: this is when the menstrual cycle becomes extremely irregular or stops completely. Irregular menstruation can be the time of the full cycle or a specific phase in the cycle being irregular. The reason this can occur outside of birth control is when an energy deficiency occurs with extreme exercise and the stress of performing well/looking a certain way.
2. Decrease in Bone Density: natural bone loss can occur in women later in life because of the stopping of their menstrual cycle. Therefore, when there is a dysfunction in the menstrual cycle, bone density decreases causing a higher risk of fractures, decreased bone remodeling, and more! The reason this occurs is that estrogen prevents the breakdown of bone so when menstrual dysfunction occurs, estrogen decreases and allows for this breakdown to occur more often and affects the calcium content of the bone.
3. Low Energy: This can happen in a few ways but it either be through excessive exercise, disordered eating, or a combination of both. This can also be done on purpose to maintain a lower body composition or be done unknowingly because the individual may not understand why the way they are eating, or exercising is considered unhealthy.
To some, this may seem like something that doesn’t happen often, but it may be more common than you are expecting. In 2006, a study found that 5.9% of high school 170 high school students in eight different sports already had two out of the three criteria. More shocking, 18.5% were demonstrating disordered eating patterns, 21.8% had a low bone density, and 23.5% had unexplained menstrual irregularities. Another study showed that moving up into collegiate sport, the prevalence was higher.
Now, there is the issue of recovery from the triad. Whether it is an athlete, a close friend, or someone you don’t know, it can be difficult if you notice any of these signs and suggest something. Recovery from the triad should be a multidisciplinary approach, which a physician, psychologist, and dietician should be a part of on top of the person’s natural support team (i.e., friends, family (biological/found), coaches, teammates). However, unless the individual is a part of a high-level sports team, they are not likely to have easy access to such a large support team. For someone who is in the general population and may develop this triad, it is up to a physician to notice all the signs and symptoms. But is that the case?
Females have always struggled a lot more with physicians than males. Older research has shown that female patients, whether seen by and male or female physician, are less likely to receive a diagnosis and told that it was a ‘women’s issue’, as mentioned earlier. However, newer research shows that female doctors tend to have a higher degree of satisfaction with female and male-identifying patients because female-identifying doctors focus on more preventative and psychosocial techniques, whereas male-identifying doctors are very technical with their medical history taking and physical exams. This difference in technique may help with better noticing earlier signs of RED-S in the non-competitive athlete. Due to the high likelihood of psychological links to RED-S, the approach seen in female physicians would be more beneficial.
Sports may also need to start changing, especially those that highlight low body compositions outside of the minimums that are suggested for healthy adults. With the understanding of health at every size (we talked about that last week!), the sports world knows that there is no need to require incredibly petite sizes for sports. Competitive sports fall into the "win at all costs" mentality that can be incredibly damaging to an athlete's career. What happens if someone doesn’t win when they have given up everything? Do they have the supports to process the loss, get their health back and move forward in either another competition or a different path?
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