The Female Athlete Triad: Amenorrhea and Infertility
The “Female Athlete Triad” is a model for visualizing symptoms comorbid with functional hypothalamic amenorrhea. Featured in this video is Dr. Vitaly Kushnir, a physician at Center for Human Reproduction in New York, NY.Want to Consult Dr. Kushnir?
So the Female Athlete Triad, the three components of it are low energy availability, with or without any eating disorder, Functional Hypothalamic Amenorrhea, and osteoporosis – that is when the bones become too thin and are prone to fracture. So that is the most severe aspect of Functional Hypothalamic Amenorrhea, when someone has osteoporosis, has a net energy deficit and no menzies at all.
But it’s important to understand that this works on a sliding scale, so for example if someone has somebody who is very severe like this and they start eating more, they start exercising less and they gain weight, they may improve. Now it doesn’t completely go back to normal, there’s an intermediate state, where they might start having menstrual cycles but somewhere irregular menstrual cycles, the osteoporosis can improve, but it may just be osteopenia – not completely normal bone mineral density.
So as the energy balance improves, so may the other conditions improve. And this is where it’s often missed, because often times it’s not the women who have absolutely no periods that are missed, it is the ones who are still getting periods but where there is a little bit of an energy deficit, there are sub-clinical problems with their bone mineral density, and these are the very important ones to identify correctly, particularly in the setting of infertility treatment which we will get to a bit later.