在1970年代，研究人员开始注意到闭经(absence of normal menstrual cycles) in ballet dancers, and that in those women there was a very high likelihood of suffering from stress fractures in the feet and lower legs.
大约在同一时间（随着标题IX的通过），越来越多的女性开始参加体育运动，并且在最高水平表演的人中开始看到类似的模式。换句话说，越来越多的患有闭经的女运动员倾向于维持压力骨折。
What is the Female Athlete Triad?
确定综合征的时间问题是，将无序饮食与未经月经和压力骨折的发展联系起来。它被命名为女运动员三合会，以及下面的图可以从概念上可视化三合会，该图可以示意性地说明能量可用性（受饮食无序影响），激素过程（破坏月经周期）和骨矿物质密度（导致压力骨折）之间的相互作用如何在光谱。
在最糟糕的情况下，努力训练的女性可能是sacrificing good eating habits, or affected by a distorted身体形象这导致他们发展出真正的饮食失调症。随着持续的劳累状态，常规月经所需的激素过程被中断。这些相同的激素过程是健康的骨形成所必需的，在缺乏骨矿物质的情况下，骨矿物质密度开始恶化导致胁迫骨折。
Detecting the Onset of Symptoms
Fortunately, the effects of the female athlete triad are, for the most part, reversible, but the best way to manage them is to detect the onset of symptoms early to intervene and prevent the development of injuries in the first place. Coaches can have an important role both in precipitating some of the habits that can lead to the triad, but also in the early detection of and intervention in the progression of the triad by knowing what to look for and by being diligent with their female athletes.
对沉淀导致的习惯to the triad, coaches should recognize the outsized impact they may have on their female athletes by over-emphasizing weight loss. Women are subject to untold amounts of societal pressures related to their weight and appearance, and well-meaning coaches can compound this and may have the unintended effect of promoting dieting or dietary restriction—the two most common precursors to disordered eating.
促进healthy nutrition和整体表现减肥is the preferred means to discuss diet with female athletes. While some coaches may have difficulty de-emphasizing weight loss, it’s important they remember that nothing is more important than their athlete’s physical and mental well-being. Healthy nutrition will accomplish both of those ends.
Because disordered eating is the common starting point for the triad, it’s the single best reason for a coach to intervene early in order to prevent the more serious effects of this relative energy deficiency.
Please note, disordered eating is NOT the same as a true eating disorder. While both exist on a spectrum, disordered eating is merely unhealthy eating in that the nutritional needs are not met by the diet of the athlete. A true eating disorder encompasses much more than this, including elements of distorted body image and true manifestations of mental illness.
Challenges for Coaches
为了确定女性运动员的饮食不足的迹象，教练需要克服一些挑战：vwin国际在线平台
- Women who embody many of the habits and characteristics of successful athletes share a lot in common with women who are most at risk for disordered eating. They tend to put in long hours of training and they are very compliant with their coaches’ plans for them.
- 在强调瘦弱或苗条的运动中，往往会发现最有饮食不足的女性运动员。因此，教练可能不会注意到这些女性不适，因为她们适合运动员在运动中的刻板印象。
- 最后，坚定的观念是，很难克服瘦身和瘦弱与提高的表现相关的观念，因此教练可能不会将他们的运动员视为不足。
For coaches to get past these biases they must be hyper-vigilant and pay attention to some subtle signs of poor nutrition:
Physical signs and symptoms包括大量体重减轻，经常出现脱水的抱怨，肌肉痉挛，无力和疲劳。
心理迹象include complaining of feeling fat despite being thin, anxiety and/or depression, difficulty concentrating, and preoccupation with weight and eating.
It should be noted that the mere presence of any one of these signs or symptoms is not enough to make the diagnosis of disordered eating, but should serve to at least raise awareness of the possibility for the coach.
Later signs of disordered eating include amenorrhea and eventually, stress fractures. It’s difficult for a coach to know their athlete’s menstrual health, and this is likely not something many coaches would feel comfortable asking about.
但是，如果教练担心自己的运动员，并认为他们可能有三合会的风险，那么知道他们是否仍在经历时是否非常重要。长期以来，闭经已经被认为是女运动员的“正常”，而且这种态度转变很重要。
Addressing the Issue
For a coach who is worried, a suggested approach might sound like: “I understand there is a fine balance between performance and weight, but there are some really clear signs when that the balance is off. Missing your period is one of those clear signs. If this is happening or begins to happen, we need to address it as soon as possible. I need to know this as a coach because it is indicating to me that you are not fueling adequately and therefore not going to be able to train optimally, and secondly, that you are putting yourself at risk of injury.”
If an athlete is identified with amenorrhea, a frank discussion with her is paramount with an emphasis on the need to get back to a healthy state. A focus on a restoration of energy balance through improved nutrition is almost always adequate to reverse the menstrual irregularities, and over time, any deficits in骨密度。
但是，饮食不足的妇女，尤其是最接近真正饮食失调症的频谱结束时的妇女，可能会拒绝认识到自己有问题，并且不会做出必要的改变以改善其健康状况。更糟糕的是，他们可能会继续进行唇部服务来进行更改。
These latter cases should be strongly encouraged to seek help from a healthcare professional who specializes in the management of these patients. For less seriously affected women, a registered dietician may be helpful to develop an acceptable plan to restore an appropriate energy balance for their athlete.
任何承受压力骨折的女运动员都应鼓励去看医生对月经健康进行全面评估，因为这通常是女运动员三合会的标志。
重要的是要注意，2014年国际奥林匹克委员会发表了共识声明Beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S)。This statement was an effort to update the science on the triad, but also to recognize that a similar syndrome had been purported to exist in male athletes. The redefinition of the female athlete triad toRED-S在运动医学界被嘲笑，仍然是一个引起重大争议的话题。
女运动员三合会与红色S
While it’s true that a significantly smaller number ofmale athletes do suffer from disordered eating, there are several problems with redefining the triad to RED-S:
- 尽管有数十年的研究和关于女运动员三合会的大量研究，但男性中任何此类综合症的研究都缺乏研究。这是因为折磨的男人的人数仍然很少，以至于未知。
- Renaming the female athlete triad shifts the focus of this entity towards men and away from women in the minds of many who study this problem. This, in their minds, is wholly inappropriate given how this so disproportionately affects female athletes.
- 最后，男人和女人之间的另一个重要区别是男人没有月经。因此，男性受到一定程度的饮食效果的影响。尽管它们可能会减肥并遭受许多相同的身体和心理影响，但它们不需要“燃料”排卵和月经。在没有这些激素过程的破坏的情况下，它们不会遭受骨矿物质密度和妇女所做的压力骨折的损失。
出于这个原因,教练应该很多more concerned about their female athletes than theirmale athleteswith regard to the presence of disordered eating and all its associated effects.
In summary, female endurance athletes are at significant risk for disordered eating because of the nature of the sports that they participate in. Coaches need to be careful to de-emphasize weight loss when talking to women and instead highlight overall healthy nutrition as an important contributor to overall health and performance. Coaches should also be vigilant for signs of the female athlete triad and encourage female athletes with signs of it to seek an evaluation by a health professional.
我深切感谢Kelly Phuah和Lucy Brash在提交之前对本文进行审查和编辑的协助。此外，我在准备本文的准备中咨询了以下手稿：
1. The Female Athlete Triad. Med Sci Sport Exerc. 2007;39(10):1867-1882. doi:10.1249/mss.0b013e318149f111
2. Matzkin E, Curry EJ, Whitlock K. Female Athlete Triad. J Am Acad Orthop Surg. 2015;23(7):424-432. doi:10.5435/JAAOS-D-14-00168
3.NCAA Coaches Handbook Managing the Female Athlete Triad。2019年6月17日访问。
4. Souza MJ De, Williams NI, Nattiv A, et al. Misunderstanding the Female Athlete Triad: Refuting the IOC Consensus Statement on Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014;48(20):1461-1465. doi:10.1136/BJSPORTS-2014-093958
5. Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014;48(7):491-497. doi:10.1136/bjsports-2014-093502
