With dreams of Olympic trials and college scholarships in her mind, Hannah joined the track team her freshman year and trained hard to become a lean, strong sprinter. When her coach told her losing a few pounds would improve her performance, she didn't hesitate to start counting calories and increasing the duration of her workouts. She was too busy with practices and meets to notice that her period had stopped - she was more worried about the stress fracture in her ankle slowing her down.

Although Hannah thinks her intense training and disciplined diet are helping her performance, they may actually be hurting her - and her health.

What Is Female Athlete Triad?

There's no doubt about it - playing sports and exercise are part of a balanced, healthy lifestyle. Girls who play sports are healthier; get better grades; are less likely to experience depression; and use alcohol, cigarettes, and drugs less frequently. But for some girls, not balancing the needs of their bodies and their sports can have major consequences.

Some girls who play sports or exercise are at risk for a problem called female athlete triad. Female athlete triad - also known as female athletic triad - is a combination of three conditions: disordered eating, amenorrhea (pronounced: ay-meh-nuh-ree-uh, which means loss of a girl's period), and osteoporosis (a weakening of the bones). A female athlete can have one, two, or all three parts of the triad.

Triad Factor #1: Disordered Eating

Girls who have the disordered eating that accompanies female athlete triad often have many of the signs and symptoms of anorexia nervosa or bulimia nervosa, such as low body weight for their height and age and episodes of binge eating and purging. But girls with female athlete triad try to lose weight primarily to improve their athletic performance. Sometimes the disordered eating that accompanies this condition isn't technically an eating disorder. Many girls with female athlete triad are simply trying to become better at their chosen sports. But like teens with eating disorders, girls with female athlete triad may use behaviors such as calorie restriction, purging, and exercise to lose weight.

Triad Factor #2: Amenorrhea

Because a girl with female athlete triad is simultaneously exercising intensely and reducing her weight, she may experience decreases in estrogen, the hormone that helps to regulate the menstrual cycle. As a result, a girl's periods may become irregular or stop altogether. (In many cases, of course, a missed period indicates another medical condition - pregnancy. If you have missed a period and you are sexually active, you should talk to your doctor.) Some girls who participate intensively in sports may never even get their first period because they've been training so hard - this is called primary amenorrhea. Other girls may have had periods, but once they increase their training and change their eating habits, their periods may stop - this is called secondary amenorrhea.

Triad Factor #3: Osteoporosis

Low estrogen levels and poor nutrition can also lead to osteoporosis, the third aspect of the triad. Osteoporosis is a weakening of the bones due to the loss of bone density and improper bone formation. This condition can ruin a female athlete's career because it may lead to stress fractures and other injuries due to weakened bones. Because of poor nutrition, a girl's body may not be able to repair the injuries efficiently.

Usually, the teen years are a time when girls should be building up their bone mass to their highest levels - called peak bone mass. Female athlete triad can lead to a lower level of peak bone mass and a lot of time on the sidelines. After she becomes an adult, a girl may also develop health problems related to osteoporosis at an earlier age than she would have otherwise.

Who Gets Female Athlete Triad?

Most girls have concerns about the size and shape of their bodies, but girls who develop female athlete triad have certain risk factors that set them apart. Being a highly competitive athlete and participating in a sport that requires you to train extra hard is a risk factor. Girls with female athlete triad often care so much about their sports that they would do almost anything to improve their performances. Martial arts and rowing are examples of sports that classify athletes by weight class, so focusing on weight becomes an important part of the training program and can put a girl at risk for disordered eating.

Participation in sports where a thin appearance is valued can also put a girl at risk for female athlete triad. Sports such as gymnastics, figure skating, diving, and ballet are examples of sports that value a thin, lean body shape. Some girls may even be told by coaches or judges that losing weight would improve their scores.

Even in sports where body size and shape aren't as important for judging purposes, such as distance running and cross-country skiing, girls may be pressured by teammates, parents, partners, and coaches who mistakenly believe that "losing just a few pounds" would improve their performance. Losing those few pounds generally doesn't improve performance at all - people who are fit and active enough to compete in sports generally have more muscle than fat, so it's the muscle that gets starved when a girl cuts back on food. Plus, if a girl loses weight when she doesn't need to, it interferes with healthy body processes such as menstruation and bone development.

In addition, for some competitive female athletes, problems such as low self-esteem, a tendency toward perfectionism, and family stress place them at risk for disordered eating.

What Are the Signs and Symptoms?

If a girl has risk factors for female athlete triad, she may already be experiencing some symptoms and signs of the disorder, such as:

• weight loss
• no periods or irregular periods
• fatigue and decreased ability to concentrate
• stress fractures (fractures that occur even if a person hasn't had a significant injury)
• muscle injuries

Girls with female athlete triad often have signs and symptoms of eating disorders, such as:

• eating alone
• preoccupation with food and weight
• continuous drinking of water and diet soda
• frequent trips to the bathroom during and after meals
• using laxatives
• presence of lanugo hair (fine, soft hair that grows on the body)
• tooth enamel that's worn away from frequent vomiting
• anemia (fewer red blood cells in the blood than normal)
• sensitivity to cold
• heart irregularities and chest pain