The first time I met my 16-year-old patient, she hadn't had a period for 14 months. For the past year, she had felt moody, had difficulty concentrating, and had experienced "hot flashes" and "night sweats." This teenager was a competitive volleyball player with Olympic aspirations. She exercised every day and lost 20 pounds over the prior six months. She didn't eat very much, but at night she often dreamed about food. Luckily, she hadn't had any bone fractures … yet.

  1. Low energy availability from disordered eating

  2. Menstrual problems

  3. Low bone mineral density for the patient's age

Here's a run-down on the triad:

Menstrual problems occur when weight loss interrupts normal pathways and leads to decreased production of estrogen. A teenage girl with the Female Athlete Triad may have primary amenorrhea, meaning she has never had a menstrual period. Or she may not get them anymore, a condition known as secondary amenorrhea. Although it may be normal for a teen to miss a menstrual period in the first year or two, a missed period after having had monthly periods is often a red flag.

Be on the look-out for signs that an athlete is overdoing it:

  • Weight loss

  • Frequent injuries

  • Obsession with exercising every day

  • Problems with menstrual periods

If there's a problem, it's time for a team huddle. This team includes a physician, a nutritionist, and possibly a mental health professional.  Other important team members include the coach and athletic trainer. The goal is to restore weight and regular menstrual periods and help the young athlete enjoy her sport in a healthy way!

Teen athletes need to take a "time-out" to do these important things:

Help your teen stay in the game!

Rima Himelstein, M.D., is a Crozer-Keystone Health System pediatrician and adolescent medicine specialist.