Children

(414) 266-2000

Urgent Care & ER

Female Athlete Clinic

The Female Athlete Clinic is a branch of Children's Hospital of Wisconsin Sports Medicine Program designed to evaluate and treat the unique conditions found in the female athlete population. Our multidisciplinary team is comprised of medical providers - including a sports medicine physician and a nurse practitioner - a registered dietitian, and licensed athletic trainers. Additionally, a sports psychologist is available if necessary. Our team assesses the whole athlete and evaluates exercise habits, nutritional needs and hormonal balance and how these may impact performance and injury risk. Our team works to keep female athletes healthy and at the top of their game. We use a comprehensive approach to diagnose and manage a condition called the female athlete triad .

Female athlete triad

Female_athlete_triad

The female athlete triad consists of three interrelated conditions:

  • Low energy availability
  • Irregular or absent menstrual periods
  • Decreased bone mineral density 

Athletes who participate in sports that emphasize a lean physique for a competitive advantage, such as distance running, gymnastics, figure skating and dance or those who compete in a weight-class sport are at greater risk for developing the female athlete triad. However, any female athlete with poor energy balance is at risk for developing the female athlete triad.

Causes

All athletes need adequate fuel to perform at their best. This energy is provided by the calories and nutrients in the food we eat. When an athlete trains hard, but does not fuel her body appropriately, she will not have enough energy available to maintain normal body functions, such as her menstrual cycle, and meet the physical requirements of her sport. Consequently, when menstrual cycles are disrupted, estrogen levels fall. Estrogen plays a key role in building and maintaining strong bones. Without sufficient estrogen, bones can weaken and become more susceptible to fractures.

Symptoms

An athlete may exhibit changes in her lifestyle and eating behaviors, such as restricting food intake, eliminating entire food groups from her diet, exercising beyond what is required by her team, or being overly concerned about missing a workout. Sometimes, athletes unintentionally develop an energy deficit when their training regimen increases and they do not change their intake to accommodate for this.

Additional symptoms of low energy availability can include weight loss, irregular or absent menstrual cycles, delay of first menstrual cycle, frequent lightheaded or fatigued. Athletes may experience a decrease in athletic performance or inability to complete workouts, changes in mood, increased recovery time from injury or stress fractures.

Your first visit

At the initial evaluation, your child will meet with several members of our team, including a medical provider, a registered dietitian and a licensed athletic trainer. Your child’s evaluation begins with a comprehensive history and medical exam with a licensed athletic trainer and a sports medicine provider. The team will gather information about your child’s eating habits, menstrual cycles, training/sport schedule, injury history, and attitudes about her weight and body image. Blood tests may be ordered to evaluate for nutritional deficiency or other causes of menstrual dysfunction. If there is a concurrent sports injury, imaging may be ordered. You will also meet with a registered dietitian for a detailed evaluation of your child’s current eating habits, dietary preferences, and nutrition related goals. This comprehensive evaluation will take about 2 hours, so please plan for an extended time in the clinic. We will educate you and your child on female athlete triad and partner with you to identify the best treatment plan.

Treatment

The most effective treatment for the female athlete triad involves a team approach that involves the athlete, her family and the medical team. Athletes are monitored by regularly reassessing symptoms, vital signs and physical exam findings to ensure she has enough energy available to support her sports activities and growth. If there is a history of stress fractures or other significant concerns about bone health, your medical provider may also recommend a bone density test to check the strength of your child’s bones. Additionally, appropriate management of any concurrent sports injuries will be addressed if necessary. Referral to a psychologist may be beneficial for athletes who are struggling with stressful circumstances in their lives or are feeling pressure to succeed, both of which may cause athletes to adopt unhealthy eating patterns. We help our patients’ families develop a supportive environment at home to encourage their child to engage in healthy eating behaviors and safe training practices to achieve her athletic goals. 

Returning to Activities & Sports

Our goal is to return your child to her sport as quickly and safely as possible. In some cases, your child may be able to continue practicing and competing during treatment; however, exercise duration and frequency, along with nutrition, will be closely monitored. In more serious cases, your child may not be returned to sport until she has demonstrated that she can sustain healthy eating behaviors and fuel appropriately to support basic metabolic needs. Additionally, athletes must demonstrate adequate recovery from injury (if present) before she is safely returned to sport.

Sports Psychology

Our providers may recommend cognitive behavioral therapy to help cope with stress associated with the presence of injury and the potential for adjustments to current level of participation.

  • Cognitive behavioral therapy is done with a psychologist or other therapist.
    • This therapy involves recognizing the root cause of increased psychological symptoms, and helping the child rebuild coping strategies to help improve them.
    • Our psychologists, Dr. Myrvik and Dr. Hoff, have extensive experience working with competitive athletes.

Visits with our sports psychologists are scheduled by calling the Concussion Line at (414) 337-8000.

Contact us

If there is concern for female athlete triad, or any related components, please feel free to reach out to our team in the Sports Medicine Program. A staff of licensed athletic trainers and providers can help answer questions and address concerns. This can be done by calling our Sports Line at (414) 604-7512 ext. 3. It is also important to discuss potential concerns with your primary care provider and referrals into the Female Athlete Clinic can be made if appropriate.

Locations

Mequon Clinic

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Call us

To speak with a sports medicine expert or request an appointment, call:

(414) 604-7512

Licensed athletic trainers and nurses are available 8 a.m. to 4:30 p.m., Monday through Friday. You can leave a message anytime, and your call will be answered as soon as possible.

Request a speaker from our orthopedics and sports medicine team.