The myth of the female athlete triad

In conclusion, current research evidence suggests that exercise associated reproductive dysfunction in women is nutritional in origin and may be attributed to a deficit of readily available energy, primarily in the form of circulating glucose, liver glycogen, and adipose tissue triacylglycerol. A low plasma insulin concentration, consequent to a low blood glucose concentration, a low body fat content, or both of these factors, is accompanied by a disturbance of leptin secretion and a reduced plasma leptin concentration. It would seem that a reduction in plasma leptin concentration below a critical threshold value, for a significant period of time, disturbs the activity of the hypothalamic GnRH pulse generator, which instigates the endocrine events that lead to ovarian stimulation. The susceptibility to ovarian suppression and FHA is therefore greatest in lean women with chronically low energy availability, as indicated by a reduced plasma triiodothyronine concentration. To avoid reproductive dysfunction, female athletes should consume adequate energy and carbohydrate to balance energy expenditure and replace glycogen. They should avoid abrupt and rapid weight loss and maintain an ''adequate'' body fat content, which may be individually specific, but coincides with regular menses.