Amenorrhea, the cessation of menstruation, is categorized into two types. Primary amenorrhea is having no periods by age 16; and secondary amenorrhea is the absence of three to six consecutive cycles or less than three cycles per year after the onset of menstruation.

Poor nutrition is a primary cause of amenorrhea because a healthy level of nutrients are needed to sustain estrogen levels. Women with eating disorders, when attempting to keep low weight and body fat, don't eat enough food with proteins and vitamins necessary to remain healthy. Low calorie intake can lead to decreased metabolic rates and further suppress health.

In addition, extreme exercise intensity contributes to the problem of amenorrhea. Studies have shown that regular cycles of menstruation resume after exercise intensity decreases.

Calorie and calcium deficiency are the main causes of osteoporosis; both are direct effects of disordered eating. Similar to amenorrhea, excessive exercise can contribute to osteoporosis, with serious results including deterioration of bone tissue and low bone mass leading to:

• accelerated bone loss
• increased risk of stress fractures while athletic
• increased spine and hip fractures later in life

Despite being somewhat complex, the female athlete triad is very real and extremely dangerous. If left untreated or undetected, the ramifications of eating disorders, amenorrhea and osteoporosis can ultimately lead to death.

Dr. Nattiv emphasized that the most promising way to deal with the problems associated with the triad is prevention. Coaches and trainers must be able to identify problems and discuss them with the athlete in a sensitive manner. For example, a coach could talk to the athlete about the triad and identify symptoms common both to the triad and the athlete.

Coaches should be aware that if an athlete is affected by one of the disorders of the triad, she may be affected by the other two as well. Redefining an athlete's goals is another means of prevention stress health more than appearance.

Coaches should also play an active role with athletes off the field, monitoring meals and health. Signs of problems for components of the triad include:

• sudden weight loss
• preoccupation with food
• extreme exercise
• mood swings
• depression
• trips to the bathroom following meals
• dieting then binge eating
• criticism of one 's body
• stress
• low calorie and calcium intake