The female athlete triad in adolescents

A 16-year-old girl, Megan, presents to your practice as a new patient after moving to your community this summer. Her chief complaint is right leg pain. She is a sophomore in high school and a student athlete who decided to transition from swimming to track and cross-country running within the past year. The cross-country season started about 5 weeks ago. Her right lower leg has been hurting for about 3 weeks, starting with mild soreness after long runs (more than 5 miles) and gradually worsening since then. Her leg hurts when walking, and she is frustrated because she cannot get through her daily runs without significant pain and some limping. Her leg pain is preventing her from attaining faster running times.

Further history reveals that Megan was running about 30 miles a week over the summer, rarely taking a day of rest. With cross-country this fall, she has increased her running to about 40 miles weekly. Although she has not run competitively before, she is one of the fastest girls on the team, and she says that her races have been going well. She is determined to be the "best in the state."

Her mother, who has accompanied Megan during part of your visit, says she is concerned about her daughter's weight. She reports that Megan started dieting last spring when her sister lost some weight. Megan says she has not noticed much decrease in her weight, but her mother says that friends began commenting that Megan is looking "sick" and "too thin." She also notes that Megan rarely eats dinner with the family after cross-country practice, saying she is not hungry and will eat later. Megan says she wants to be thin in order to run faster and to be thought of as "small" compared with her friends. She is very insistent that she must not gain any weight because she is already "heavy enough."

Megan is an excellent student. She excels in every academic area with ease. Also, she feels that she is well liked socially and has many friends.

How would you approach Megan's issues?

Certain things should be of immediate concern in Megan's case: She has worsening leg pain, and she has not had normal periods in quite some time. Her mother is concerned about Megan's weight loss, yet Megan seems to downplay these issues except for her leg pain.

Megan's history is typical of a young woman at risk for the female athlete triad. This article will discuss the pathophysiology of the female athlete triad and review the evaluation, management, and prevention of the different components that comprise the triad.