In the early 1990s, it became apparent that there is a reasonably strong association among
- disordered eating,
- secondary amenorrhea, and
- bone mineral disorders.
This group of disorders has been termed the female athlete triad. From the limited research available at this time, it appears that the triad might start with disordered eating. Over a period of time, the length of which has not been well established and might vary considerably from one athlete to another, an athlete who has disordered eating, creating a prolonged energy deficit, starts to experience disordered menstrual function, which eventually leads to secondary amenorrhea. Following an additional period of time, again the length of which has not been defined, secondary amenorrhea leads to bone mineral disorders. A number of researchers have become interested in these intriguing relationships, and considerable research is now under way. We should know much more about this important sequence of events when the results of these research efforts are known. In 1997, the American College of Sports Medicine issued a position stand on the female athlete triad that presents a strong case for the connection of each of the three components of the triad. This report concluded that female athlete triad disorders can decrease physical performance and cause morbidity (illness or disease) and mortality (death). Anyone working with young athletes, particularly female athletes, should be educated about the triad, know how to recognize it, and have a plan of action involving professionals trained in dealing with the female athlete triad to help prevent it, treat it, and reduce its risks.