"Female Triad" Linked to Long-Term Health Problems in Soccer Athletes

SAN FRANCISCO—New research presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) found that despite reporting appropriate body perception and attitudes toward eating, elite youth soccer athletes (club level or higher) face an increased risk for delayed or irregular menstruation.

The “female athlete triad”—menstrual dysfunction, eating attitudes and stress fractures—puts female athletes at risk for diminished performance and long-term health problems.

To determine the prevalence of the female triad among soccer players, investigators recruited 220 athletes (median age 16.4) from an elite youth soccer club, an NCAA Division I university team, and a women’s professional team. The participating athletes completed questionnaires regarding age of menarche, menstrual history, and history of musculoskeletal injuries including stress fractures. The Eating Attitudes Test was used to assess each athlete’s body image and attitudes toward eating.

The average age of menarche was 13 years of age among the participants. Irregular menstruation cycles or absence of menstruation, were reported by 19% of the participants in the 15-17 age group, 18% of the college-age players, and 20% of the professional athletes. A history of stress fractures was reported in 14% of the players, with a majority of the injuries in the ankle and foot.

Only one player scored in the “high risk” range and 16 in the “potentially high risk range,” in terms of body perception and eating attitudes.

“Elite female soccer athletes are at risk for delayed onset of menarche, menstrual dysfunction and stress fractures, which may be due to an imbalance of energy intake and output,” said Robert H. Brophy, MD, co-investigator and assistant professor of orthopaedic surgery at Washington University School of Medicine in St. Louis, MO. “The risk for soccer athletes appears to be lower than for female athletes in aesthetic (gymnastics, dancing, etc.) and endurance sports. More research is needed to identify the underlying causes, and potential remedies, for these findings in elite female soccer athletes, and whether these findings translate to female athletes participating in other team sports."

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