Estrogen replacement therapy and female athletes: current issues.
ABSTRACT Physicians commonly recommend estrogen replacement as treatment for exercise-associated amenorrhoea. While the evidence shows that the basis of the amenorrhoea is estrogen deficiency, it is not clear that it is the only factor in the development of lowered bone density found in oligo-amenorrhoeic female athletes. Nutritional factors, significant in the development of the reproductive dysfunction, could also contribute to bone loss. No randomised, controlled studies of estrogen replacement in athletes have been published. However, one nonrandomised study of a small group of athletes does suggest that there are significant gains in bone density to be made by the initiation of estrogen therapy. More research is clearly needed.
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ABSTRACT: This paper, which was part of the International Association of Athletics Federations (IAAF) 2007 Nutritional Consensus Conference, briefly reviews the components of the female athlete triad (Triad): energy availability, menstrual status, and bone health. Each component of the Triad spans a continuum from health to disease, and female athletes can have symptoms related to each component of the Triad to different degrees. Low energy availability is the primary factor that impairs menstrual dysfunction and bone health in the Triad. We discuss nutritional issues associated with the Triad, focusing on intakes of macronutrients needed for good health, and stress fractures, the most common injury associated with the Triad. Finally, we briefly discuss screening and treatment for the Triad and the occurrence of the Triad in men.Journal of Sports Sciences 12/2007; 25 Suppl 1:S61-71. · 2.10 Impact Factor
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ABSTRACT: Objectives: The female athlete triad (Triad), links low energy availability (EA) with oligomenorrhea/functional hypothalamic amenorrhea (FHA) and impaired bone health. The aims of this study were to examine associations between EA, oligomenorrhea/FHA and energy metabolism and to investigate the prevalence of Triad-associated conditions in Swedish and Danish endurance athletes. Furthermore, the aim was to describe dietary characteristics of athletes with low/reduced EA and/or oligomenorrhea/FHA but without disordered eating (DE). Finally, the aim was to develop and vali-date a screening tool designed to identify female athletes at risk for the Triad. Methods: Athletes (n = 84) 18–39 yrs. of age, training ≥5 times/week were recruited from national teams, competitive clubs and a professional dancing company. They filled out the Low EA in Fe-males Questionnaire (LEAF-Q), comprising questions regarding injuries, illness, dizziness, gastrointestinal and reproductive functions. Reliability and internal consistency were evaluated in a sub-sample of female dancers and endurance athletes (n = 37). Discriminant as well as concurrent validity were evaluated in endurance athletes from weight bearing endurance sports (n = 45), by testing self-reported data against clinical examinations including gynaecological examination; assessment of bone health; indirect respiratory calorimetry for assessment of RMR and work efficiency; diet and exercise measured 7-days to assess EA; eating disorder (ED)-examination; biochemical markers. Subjects with MD other than oligomenorrhoea/FHA (n = 5) were excluded when assessing energy metabolism and Triad conditions as was athletes with ED/DE (n = 11) and low dietary-record validity (n = 4) when assessing dietary characteristics. Results: Subjects with low/reduced current EA (n = 25; < 188 kJ/kg FFM/day), had lower resting metabolic rate (RMR) compared to those with optimal EA (n = 15; ≥188 kJ/kg FFM/day) (P=0.003), as did subjects with oligomenorrhea/ FHA (n = 24) compared to eumenorrheic subjects (n = 16) (P=0.040). Subjects with secondary FHA (n = 14) also had increased work efficiency com-pared to eumenorrheic subjects (P=0.017). 63% had low/reduced current EA, 25% ED, 60% oligomenorrhea/FHA, 45% impaired bone health, and 23% had all three Triad conditions. 53% had low RMR, 25% hypercholesterolemia and 38% hypoglycaemia. There were no differences in energy intake (P=0.475) or current EA (P=0.977) between oligomenorrheic/FHA and eumenorrheic subjects. However, subjects with oligomenorrhea/FHA shared the same dietary characteristics as sub-jects with low/reduced current EA with a lower energy density (P=0.012 and P=0.020) and fat in-take (P=0.047 and P=0.027). Oligomenorrheic/FHA subjects had, furthermore, a higher fibre intake (P<0.001). The 25-item LEAF-Q produced an acceptable sensitivity (78%) and specificity (90%) for correctly classifying current EA and/or reproductive function and/or bone health. Conclusions: Athletes with low/reduced current EA and/or oligomenorrhea/FHA had lower RMR and those with secondary FHA also had increased work efficiency, indicating a more profound adaptation in female athletes with severe clinical MD. Triad-associated conditions were common in this group of athletes, despite a normal BMI-range. Diets lower in energy density and fat content together with higher fibre content, were associated with low/reduced EA and oligomenorrhea/FHA and may constitute targets for dietary intervention in order to prevent/treat these conditions. The LEAF-Q is brief and easy to administer, and may be used as a complement to existing validated DE questionnaires, when screening female athletes at risk for the Triad, in order to enable early detection and intervention.01/2015, Degree: PhD, Supervisor: Associate professor Anders Sjödin, PhD Åsa Tornberg, Professor Sven Skouby, Professor Jorunn Sundgot -Borgen
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ABSTRACT: Low energy availability (EA) in female athletes with or without an eating disorder (ED) increases the risk of oligomenorrhoea/functional hypothalamic amenorrhoea and impaired bone health, a syndrome called the female athlete triad (Triad). There are validated psychometric instruments developed to detect disordered eating behaviour (DE), but no validated screening tool to detect persistent low EA and Triad conditions, with or without DE/ED, is available. The aim of this observational study was to develop and test a screening tool designed to identify female athletes at risk for the Triad. Female athletes (n=84) with 18-39 years of age and training ≥5 times/week filled out the Low Energy Availability in Females Questionnaire (LEAF-Q), which comprised questions regarding injuries and gastrointestinal and reproductive function. Reliability and internal consistency were evaluated in a subsample of female dancers and endurance athletes (n=37). Discriminant as well as concurrent validity was evaluated by testing self-reported data against measured current EA, menstrual function and bone health in endurance athletes from sports such as long distance running and triathlon (n=45). The 25-item LEAF-Q produced an acceptable sensitivity (78%) and specificity (90%) in order to correctly classify current EA and/or reproductive function and/or bone health. The LEAF-Q is brief and easy to administer, and relevant as a complement to existing validated DE screening instruments, when screening female athletes at risk for the Triad, in order to enable early detection and intervention.British journal of sports medicine 02/2014; · 3.67 Impact Factor