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JOIN IN! Doctors Christopher Mehallo and Jennifer Malcolm, along with DyeStat, invite your participation in a confidential survey related to the health of female runners. The Female Athlete Triad is an important issue for women long distance runners and may have a long-term impact on the health of these athletes. The survey focuses on a particular aspect of the Triad-- menstrual irregularity-- to determine if high school XC runners are at increased risk of menstrual irregularities, as well as assess the adequacy of screening and education on menstrual dysfunctions.

Menstrual Irregularities in High School Cross Country Runners

My name is Jennifer Malcolm and I used to run Pennsylvania District 1 cross-country and track with Villa Maria Academy and went on to compete at Bucknell University. I am now a first year resident at the Medical College of Georgia and am pursuing a career in sports medicine. Dr. Christopher Mehallo of the Rothman Institute and I would like your help this fall with our study on menstrual irregularities in high school cross-country runners.

This is a VOLUNTEER study involving an ONLINE questionnaire. The study is strictly CONFIDENTIAL. The runners will NOT indicate their name or school on the questionnaire. The initial survey takes approximately 15 minutes to complete, and athletes will be asked to keep a log of their menstrual cycles during the 2007 cross-country season. The log is also online and requires less than 5 minutes of your time each month.

Please email Jennifer Malcolm at Jennifermal@pcom.edu if interested, so the link can be emailed to you monthly.
The study opens on August 1, 2008.

Medical Awareness for Female Cross Country Runners

What is the Female Athlete Triad?
Female athlete triad is a combination of three conditions: disordered eating, amenorrhea, and osteoporosis. A female athlete can have one, two, or all three parts of the triad.

Disordered Eating - Most girls affected by the female athlete triad try to lose weight primarily to improve their athletic performance. Disordered eating can range from avoiding certain types of food to serious eating disorders like anorexia nervosa - diminished appetite or the act of refusing to maintain normal body weight for age and height - or bulimia nervosa - diet binge and purge disorder.

Amenorrhea - When an athlete’s weight falls too low, she may experience decreases in estrogen, the hormone that helps to regulate the menstrual cycle. As a result, a girl's periods may become irregular or stop altogether. A missed period does not automatically mean a girl has female athlete triad. Some girls who participate intensively in sports may never even get their first period because they've been training so hard. Other girls may have had periods, but once they increase their training and change their eating habits, their periods may stop. A missed period could indicate normal teen menstrual variation, pregnancy or a medical condition. If you have missed a period and you are sexually active, talk to your doctor.

Osteoporosis - Low estrogen levels and poor nutrition, especially low calcium intake, can lead to osteoporosis. Osteoporosis is a weakening of the bones due to the loss of bone density and improper bone formation. This condition can ruin a female athlete's career because it may lead to stress fractures and other injuries. Improper bone formation during the teen years can cause lasting lifetime effects on bone density.

Risk Factors: The Female Athlete Triad
• Girls that are highly competitive athletes and participate in a sport that requires you to train extra hard.
• Girls with the female athlete triad often care so much about their sports that they would do anything to improve their performance.
• Girls that participate in sports where a thin appearance is valued.
• Girls pressured by teammates, parents, partners, and coaches who mistakenly believe that "losing just a few pounds" could improve their performance.
• Girls with low self-esteem
• Girls with a tendency toward perfectionism
• Girls who are pressured by others around them to uphold their body habitus and sports performance.

What are the signs and symptons of the Female Athlete Triad?
• Weight loss
• Irregular or absent periods
• Fatigue or decreased ability to concentrate
• Stress fractures that develop[ after minor trauma
• Muscle injuries

Girls with female athlete triad often have signs and symptoms of eating disorders as well:

• Continued dieting despite weight loss
• Preoccupation with food and weight
• Frequent trips to the bathroom during and after meals
• Using laxatives
• Brittle hair or nails
• Dental cavities caused by frequent vomiting
• Abnormal sensitivity to cold

Fast Facts: The Female Athlete Triad
• Athletes can look “normal” for their sport and posses 1, 2 or even all 3 aspects of the female triad
• 50% of female runners & dancers have amenorrhea
• 15-62% of female athletes have disordered eating
• 49% of amenorrheic runners have stress fractures
• 57.1% of high school runners reported infrequent periods
• Bone Mass Density (BMD) of 25 yr. old amenorrheic runners was similar to those of 50 yr. old women

Tips for the Female Athlete

Visit your Doctor for an annual physical. An extensive physical examination is a crucial part of diagnosing the female athlete triad as well as other medical problems. Your doctor will assess your health & can answer questions about your periods, nutrition and exercise habits.

Keep track of your periods. Keep a calendar in your gym bag and mark down when your period starts and stops and if the bleeding is heavy or light. That way, if you start missing periods, you'll know right away and you'll have accurate information to give to your doctor.

Don't skip meals or snacks. Eating properly will help provide energy to improve your performance, so stock your locker or bag with quick and easy favorites such as bagels, string cheese, unsalted nuts and seeds, raw vegetables, granola bars, and fruit.

Visit a dietitian or nutritionist who works with teen athletes. He or she can help you get your dietary game plan into gear and determine if you're getting enough key nutrients such as iron, calcium, and protein.


Menstrual Study Update
Thus far, we have seen a correlation between mileage and intensity of training with menstrual irregularities.

43 percent of athletes were asked specifically about menstrual irregularities during their pre-participation physical, a number we hope will improve.

80 percent of athletes are aware that participation in athletics can put them at increased risk for menstrual irregularities, with physicians, parents and coaches being the most common sources of this information. We were surprised and happy with how many individuals were aware of such issues.

More than 25 percent of athletes skipped their period in the month prior to cross country start. More data is needed to determine the percentage of missed periods/menstrual irregularities during the entire cross country season.

About the Researcher
Jennifer Malcolm, D.O., a regular medalist for Villa Maria Academy in the 4x800 and DMR at states and the Penn Relays with former team members Liz O'Connor, Lauren Graham and her sister, Kim, is currently a first year family medicine resident at Medical College of Georgia.

She graduated Bucknell with a Bachelor of Science degree in cell biology/biochemistry and as one of legendary coach Art Gulden's last recruits and ended her career with a 1,500 PR at the Patriot League Championships and as a four-year member of the Patriot League Honor Roll.

Malcolm has moved to Grovetown, GA, with her fiancé, Tim Carey. She's still running because she said "it is the one thing that keeps me sane during the crazy hours of a resident" and hopes to soon run a marathon.

What does the study involve?
This is a VOLUNTEER study involving an ONLINE questionnaire. The study is strictly CONFIDENTIAL. The runners will NOT indicate their name or school on the questionnaire.

The initial survey takes approximately 15 minutes to complete, and athletes will be asked to keep a log of their menstrual cycles during the 2008 cross-country season. The log is also online and requires less than 5 minutes of your time each month.