Diana Zuckerman PhD, and Sarah Romano
With all the concern about couch potatoes, let’s start by emphasizing that exercise is good for children and adolescents, and it’s good news that girls are more actively participating in sports than ever before. However, parents, coaches, and others involved in girls’ athletic activities need to be aware of research suggesting possible health problems that can arise.
These health concerns are called the “female athlete triad.” Studies have found three interrelated disorders found in female athletes: 1) low energy availability, which may be the result of disordered eating; 2) abnormal menstrual periods; and 3) low bone density.
Eating disorders are a problem for girls in several different sports, especially swimming, diving, gymnastics, dancing, and figure skating. Sometimes, girls are encouraged by their coaches or teammates to lose weight to improve their appearance or their performance. Binge eating followed by intentional vomiting or use of laxatives are two of the commonly used dangerous weight loss strategies, but compulsive exercise is another form of purging. Despite the use of purging strategies to improve performance, they can impair performance and increase the risk of injury.
When athletic activity results in less body fat, it can also delay puberty in girls, and increase the risk of menstrual problems. If breast development has not begun by age 13, and menstruation has not occurred by age 16, a medical exam should be considered. Also, female athletes who start their periods before the age of 16, but then stop menstruating for more than 6 months should see their doctors. This could be a result of weight changes, low energy intake, or an eating disorder, but a medical exam should be conducted to rule out a serious condition. These problems can affect a girl’s self-esteem, and may also have implications for osteoporosis or other health problems.
Pediatricians, parents, and coaches should all be concerned about these health issues. Exercise and sports should be encouraged in girls, but adults should encourage a reasonable approach to diet and nutrition, and discourage excessive exercise. Menstrual problems should not be considered “normal” for athletes and efforts should be made to encourage weight gain and modify exercise if menstrual problems persist.
 Hoch et al. Prevalence of the female athlete triad in high school athletes and sedentary students. Clinical Journal of Sports Medicine. 2009;19:421-428
 American Academy of Pediatrics Committee on Sports Medicine and Fitness. Medical concerns in the female athlete. Pediatrics 2000:106; 610-613.
 Peacock A, Alvi NS, Mushtaq T. Period problems: Disorders of menstruation in adolescents.Archives of Disease in Childhood. June 2010