Female Athlete Triad in dancers

I want to talk about the Female Athlete Triad in dancers because it's horrendously common and is one of those subjects that is rarely acknowledged or discussed openly in dance communities. The Triad is a trio of interrelated pathologies - low energy intake, amenorrhea and osteoporosis. It's a condition that can appear in women participating in any athletic activity, but is most common in those that emphasise a low body fat percentage - dancers, gymnasts and distance runners.

Female distance runners are identified as another high risk population

Low energy intake can cause a whole host of health problems, if you don't eat enough to fuel your body and you push it to it's limits, you're going to be in trouble. Amenorrhea is a serious sign that your body is struggling. Excessively low body fat caused by low energy intake effects your endocrine system, meaning your hormone levels start to function abnormally, hence the onset of amenorrhea.Your body stops ovulating when it realises it doesn't have enough energy to reproduce, it's a survival instinct and a sign that your body is shutting down one of it's most basic and crucial systems.

Changes to hormonal balance have serious implications for bone health. Osteoporosis sets in when your oestrogen levels are too low. Osteoporosis is most commonly associated with postmenopausal and elderly individuals, however instances of either primary or secondary amenorrhea increase the likelihood of the onset of osteoporosis setting in in much younger women. Both primary and secondary amenorrhea have significant implications for bone mineral density. In cases of primary amenorrhea, delaying the onset of menstruation by just 6 months can result in bringing the onset of osteoporosis forward by 2 years. It is during the teenage years that peak bone density should be achieved and if this is compromised through low energy intakes the damage of primary amenorrhea is irreversible.

Osteoporosis is a debilitating condition, and can cause significant pain and mobility issues. Decreased bone density increases the likelihood of fractures, especially stress fractures; acute and chronic pain; vertebral collapse and spinal cord compression. After it's onset there is no cure and in extreme cases it can cause death. It is not something to be taken lightly and dancers, among other female athletes, have been identified as an at risk group for developing it at a startlingly young age.

The tendency of many dancers to attempt to control body composition through excessively low calorie intake is problematic and the loss of menstruation should never be seen as a badge of honour, nor as proof of dedication.

It's worth noting while discussing FT, that prolonged low energy intake can have a severely detrimental effect on men's endocrine system and subsequently their bone mineral density, although it is seen less frequently. Compromised BMD is also a concern in male dancers looking to minimise body fat percentage. BMD is a serious consideration for those involved in any pursuit that tends to involve low body weight and body fat percentages.

Education from the outset of training on the dangers of low energy intake and amenorrhea is crucial. Dancers should know the warning signs and the implications of the onset of each of the pathologies. If more dancers are taught how to control their body composition without the need for excessive dieting, then instances of the FT in dancers are liable to drop. Dance education needs to go further than teaching steps and syllabus and include measures to improve the well-being of those in training.