General Recommendations for Female Athletes

1. Female athletes should be made fully aware of the negative consequences associated with menstrual dysfunction and the role energy inadequacy plays in its development.¹⁶ Put simply, female athletes should consume sufficient energy to, at the very least, eliminate the risk that menstrual dysfunction results from inadequate energy consumption.
2. A pre-participation physical examination should be a standard feature for all athletes involved in all sports. For the female athlete, the screening should include an assessment for the presence of the female athlete triad and any of its sequelae.¹⁷
3. Calcium and iron intakes and status should be assessed and, if inadequate, corrected through a program of altered food intake (preferred) or through a doctor-supervised supplementation program. A reasonable means of assessing calcium status is to periodically assess bone density (once every 3 years if no osteopenia or osteoporosis; more often if bone disease is present). In addition, a dietary intake analysis will determine if consumed foods are providing sufficient calcium. Iron status should be assessed yearly, with special attention paid to stored iron. In the event of iron deficiency, a supervised program of iron supplementation with follow-up blood tests should be immediately implemented.

Female athletes are at higher risk than male athletes for eating disorders, in adequate bone density attainment, and inadequate iron consumption. They also have the unique risk of dysmenorrhea. Most of these difficulties can be controlled with the intake of a nutritionally balanced diet that delivers an adequate caloric load. To achieve this, female athletes should understand that an underconsumption of calories, while lowering weight, is likely to have a greater catabolic impact on lean mass than on fat mass. This altered body composition, by forcing the athlete to consume a still lower food intake to achieve a desired body profile, will place the athlete at greater future risk of malnutrition and associated diseases.