Physiological Adaptations to Energy Deficiency and Risk Factors for the Female Athlete Triad in Exercising Women

Open Access
- Author:
- Koltun, Kristen
- Graduate Program:
- Kinesiology
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 17, 2020
- Committee Members:
- Mary Jane De Souza, Dissertation Advisor/Co-Advisor
Mary Jane De Souza, Committee Chair/Co-Chair
William Lawrence Kenney, Jr., Committee Member
Nancy Williams, Committee Member
Alison Diane Gernand, Outside Member
Rebecca Jane Mallinson, Special Member
Jonathan Bates Dingwell, Program Head/Chair - Keywords:
- Female Athlete Triad
menstrual disturbances
energy deficiency
amenorrhea - Abstract:
- The Female Athlete Triad (Triad) is a syndrome of energy deficiency/low energy availability, menstrual dysfunction, and low bone mineral density that affects up to 60% of exercising women. Due to the prevalence and potential long-term consequences of the Triad, it is essential that we continue to advance our understanding of the underlying physiology and resultant clinical conditions, as well as improve our ability to screen for those at greatest risk for Triad-related health consequences. Therefore, the overall purpose of this dissertation was to better understand how energetic status relates to menstrual function and improve our ability to identify those at risk for developing Triad-related clinical conditions, such as bone stress injuries. Specifically, I aimed to: 1) understand the effects of reductions in energy availability on menstrual function, as assessed by luteinizing hormone (LH) pulsatility and the induction of menstrual disturbances, 2) identify the potential role of non-energetic factors, such as elevated androgens, as contributors to the development of menstrual disturbances in exercising women, 3) test whether a 12-month nutritional intervention of increased energy intake in exercising women with menstrual disturbances was associated with increased energy availability and changes in physiological markers of metabolism, 4) qualitatively assess the Female Athlete Triad Coalition cumulative risk assessment tool and compare athlete clearance decisions to those resulting from use of the Relative Energy Deficiency in Sport (RED-S) tool, and 5) recommend alternative scoring strategies for the Female Athlete Triad Coalition cumulative risk assessment tool for when a specific risk factor (i.e., bone mineral density) cannot be assessed. Key findings of the studies in this dissertation include: 1) reductions in energy availability are associated with reductions in LH pulse frequency and, in turn, reductions in LH pulse frequency are predictive of the induction of subclinical menstrual disturbances (luteal phase defects), 2) a subset of exercising women with severe menstrual disturbances (oligo/amenorrhea) exhibit evidence of elevated androgens, which may be contributing to menstrual dysfunction, 3) a 12-month nutritional intervention designed to increase energy intake in exercising women with severe menstrual disturbances (oligo/amenorrhea) also improved energy availability and was associated with changes in physiological markers of metabolism, 4) the Female Athlete Triad Coalition cumulative risk assessment tool results in more conservative clearance decisions compared to the RED-S tool, and 5) alternative scoring strategies based on self-report data are available and result in similar clearance categorizations to the original Female Athlete Triad Coalition cumulative risk assessment tool. Together, these studies highlight the importance of ensuring that exercising women are maintaining appropriate energetic status to sustain their overall health and wellbeing and improve our ability to identify those at greatest risk for developing Triad-related health consequences.