-------------Screening urged for menstrual, eating, bone problems

By Jeff Kelliher
　　HealthSCOUT Reporter

WEDNESDAY, Sept. 6 (HealthSCOUT) -- Your adolescent daughter needn't be a budding Olympic star to face medical risks that are unique to young female athletes.
　　That's why the American Academy of Pediatrics (AAP) has released an updated policy statement asking pediatricians to screen sports-minded girls not only for menstrual irregularities, but for signs of eating problems and osteoporosis (bone loss).

Together, these three issues have come to be known as the Female Athlete Triad.

"The last time this policy was written we knew amenorrhea (having irregular or no menstrual periods) was associated with exercise," says Dr. Mimi Johnson, a member of the AAP's Committee on Sports Medicine and Fitness. "We know an awful lot more about the energy drain when [female] athletes are active that can result in a variety of hormonal changes."

While the AAP wholeheartedly endorses exercise and sports participation for girls, the new recommendations ask pediatricians to query female athletes (and their parents) about eating habits, exercise intensity and duration, and menstrual history. Girls with amenorrhea should be checked for "disordered eating" and given treatment and counseling when appropriate.

The updated recommendations appear in the September issue of the journal Pediatrics.

Food for thought

Johnson says the problem often boils down to the fact that some girls are simply unaware of the need to eat more food when they expend more energy.

"A small group of these athletes don't realize they need to change their food intake when they're active," says Johnson, who adds that education is a simple and effective remedy in most of these cases.

"But there's also a significant number of [female] athletes who are trying to cut back on diet because of body image issues," warns Johnson. "It's this group that probably needs more input in terms of meeting their psychological needs."

Attention should be paid to the sports where leanness is an asset -- swimming, gymnastics, ballet, diving, long-distance running, and the like. One study showed that 60 percent of elite swimmers of average weight were trying to take pounds off, and another 18 percent of underweight swimmers were trying the same.

Dr. Jacob Rozbruch, an orthopedic surgeon and pediatrician from New York City, says the AAP's concern is warranted.

"You have to worry about kids who overdo it," says Rozbruch. "These are the ones who shut down their periods and actually change their hormone cycles."

A resulting decrease in the female hormone estrogen can create problems with osteoporosis, explains Rozbruch.

"Estrogen is what protects the bone in females," says Rozbruch. "If you have decreased estrogen, then young women can lose the same type of protection that older women lose at menopause."

What To Do

Johnson advises parents, coaches and teammates to play close attention to girls who voice concerns about weight and body fat. Other warning signs include abnormal weight loss, overemphasis on fat-free foods, changes in eating patterns and over-exercising.

"There's an old myth that if you're not having your menstrual periods you're training well," says Johnson. "Now we know that's just not true."

While education corrects problems in some cases, other girls may benefit from more intense nutritional and psychological counseling, says Johnson.

Should your daughter have Olympic aspirations, remind her that eating properly is important.

"Athletes who eat properly actually perform better," says Johnson. "Girls who aren't eating well may excel in the short run, but their bodies eventually burn out. It's awfully hard to get to the Olympics without treating your body right."

You can visit the American Academy of Pediatrics for more information on this topic. The American College of Sports Medicine offers free brochures you may find helpful.

(From HealthSCOUT)