Reading Passage: Management of an Athlete with Low Energy Availability

Module 10: Management of an Athlete with Low Energy Availability

Managing an athlete with low energy availability, is a complex process that requires a multidisciplinary approach.

The first step in managing an athlete with low energy availability is to refer the patient to a trained health care professional, such as a family medicine physician or pediatrician, to identify and diagnose the condition. It is of upmost importance to intervene early in patients with any component of the female athlete triad to prevent negative long-term health effects. Successful treatment is highly dependent on the athlete having a trusting and positive relationship with the multidisciplinary treatment team.

The main objective of treatment is to restore body weight and energy status by increasing food consumption and/or reducing energy expenditure (i.e. volume or intensity of exercise) to increase energy availability. If LEA is severe enough, athletes may have to take a break from training and competition completely.

Pediatricians or family physicians should lead the decision-making process and treatment of low energy availability. Including a dietitian in the care team can help ensure the patient receives adequate macronutrients and micronutrients. Mental health professionals can help patients with disordered eating avoid harmful eating behaviors, reduce dieting attempts, and alter negative emotions associated with food and body image.

Nonpharmacologic methods, including increasing caloric intake and body weight, should be tried initially to restore menses. Health professionals may recommend supplementation with calcium or vitamin D in order to improve bone restoration and maintenance. Although medications such as combined oral contraceptive pills may treat symptoms of menstrual dysfunction, they do not restore normal menstruation and may lead to a false sense of security. Similarly, hormone replacement with combined oral contraceptives did not improve bone density in women with low estrogen states, and they may worsen bone health by reducing bone producing hormones. In contrast, using a transdermal 17β-estradiol (estrogen) patch has been shown to improve bone density in athletes with irregular periods.

With proper treatment, normalization of metabolic hormones may occur in days to weeks. However, it may take several months for menstrual function to improve and years for improvement in bone mineral density to occur.

It is crucial to understand that the management of an athlete with low energy availability is not a one-time process, but rather a long-term process that requires ongoing monitoring and support.

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