Female athlete triad and relative energy deficiency in sport – endocrine changes and treatment in women

Abstract

IntroductionFemale athlete triad (FAT) it is a syndrome of three tightly interrelated components: amenorrhea, eating disorder, and osteoporosis. FAT syndrome has been re-evaluated and re-defined and the International Olympic Committee introduced a new relative energy deficiency in sport (RED-S) syndrome.AimThe aim of the study was to review the knowledge on the issues of endocrine changes occurring in FAT and RED-S, and treatment of those conditions on a basis of available literature.Material and methodsThis article was based on a review of the literature search in the electronic databases Medline (PubMed), EBSCO, ClinicalKey, and Willey Online Library, using the terms: ‘female athlete triad,’ ‘relative energy deficiency in sport,’ ‘FAT and RED-S and endocrine changes,’ ‘low energy availability (LEA) and endocrine changes,’ ‘FAT and RED-S and treatment and women’.Results and discussionLEA influences abnormal secretion of gonadotropin-releasing hormone (GnRH) and this leads to the disrupted follicle-stimulating hormone (FSH) and luteinising hormone (LH) secretion. Higher ghrelin levels inhibit secretion of GnRH and of adrenocorticotropic hormone (ACTH), growth hormone (GH), FSH and LH. A high peptide YY (PYY) results in a significant suppression of GnRH secretion. Hypercortisolemia occurring in athletes may directly affect reproductive functions. Lack of estrogen contributes both to disrupted mineralization of bones and to endothelial dysfunction.ConclusionsLow energy levels found in female athletes diagnosed with FAT or RED-S syndrome significantly influence hormonal pathways, disrupting the function of their reproductive system, and this noticeably affects the overall health of sportswomen, influencing endothelial dysfunctions and bone mineral density.