Medical Issues Women in Sport

• Larry Gaul M.D. • USSA Nordic Team Physician

• FIS Medical Committee

• 3rd FIS Ladies Seminar “Women and Health’

• 28 May 2012

• Kangwonland, Korea

IOC Conference 2012 Los Angeles, USA

Today What WE Should be Aware of For

Our Women Athletes Who Are “We”

ATHLETES Physios Coaches Staff Doctors Everyone in room Trainers

Help Athlete Finish Here Carrie 2nd Place Kikkan 1st Place

NOT Here!

Today’s Focus It’s The Female Athlete and You

Not The Doctor

• Women- Are They Different How? – What is Known (Some)

– What is Not Known (Lots)

– What is Needed (Research)

What is Known ? • Hormones

• Body Size and Muscle Mass

• Heart and Blood Related issues

• Orthopedic Problems- ACL

• Concussion

• Urinary Problems

– Stress Incontinence

– Infections

Hormones

• Growth Hormone

• IGF-1

• Estrogen, Testosterone

• DHEAS

• Thyroid T3

• PTH, Cortisol etc.

Hormonal Issues

• Osteoporosis - Weak Bones

• Amenorrhea - No Period

• Female Athlete Triad- The BIG Problem

Osteoporosis

• Fractures Now and in the future

• 23 year old athlete -17 fractures

– Normal Menstrual cycles

– Ate lots but very constant foods

– Impact sport but trained off season low impact

Bone Mass

• Peak bone mass predicts Fractures

• 90% of bone by age 25

• 60 % Genetic

• Hormones

• Nutrition

• Exercise

Exercise

• Site Specific

• Weight Bearing better

• Fast Intense decreases Bone

• Long endurance Increases Bone

• Overtraining Decreases

So How About Carrie? 2nd Place remember

Periods-Rare Eats- LOTS!

Osteoporosis-?????

Female Athlete Triad

• Term Originated 1992 Revised 2007

• 3 Components (Maybe 4)

– Decreased Energy Availability

• Not enough calories - after exercise

– Low Bone Density

– Menstrual Dysfunction

Triad – Decreased Energy Availability

• After Exercise- How many Kcal are left?

• Concept has Evolved

– Not just “Anorexics or Bulimics”

– Mild = Missing certain beneficial nutrients

– Severe = Classic Anorexia or Bulimia

Good Nutrients

• Lots of Calcium Of Course – > 1000 mg elemental Calcium / day

• Phosphorus

• Vitamin D

• ? Folic Acid for Blood Vessel Function

• Protein

• Already eat lots of Carbohydrates

• LOTS OF CALORIES

Vitamin D

• Check Levels in Young Athletes F and M

• Unknown ideal levels

• < 50 nmol / L = LOW

– Stress Fx, Infections, Poor muscle function

• Levels lower in Winter - less Sun

• Women eat less than Men

So - Does Carrie Have the Triad? NO She is Hypothyroid Not everything is as it looks

Anemia and Low Iron • More common in Female Athletes

• 3 Main Types

– Dilutional “Pseudo-Anemia”

• Blood Volume, Kidney hormones

– Exercise Induced Hemolysis

• Mechanical, Acidosis, High body Temperature

– Iron (Fe) Deficiency

Iron Deficiency Stage 3 - Anemic

• Stage 1 and 2 last months before Anemia

• Iron Stores-Ferritin low before Hgb

• Levels below 20 µg / L Too Low

• Below 40 µg / L MAY cause poor

performance

How Do Women Loose Iron?

• Menstrual up to 1.5 mg/day

• Poor Dietary Intake Need >15 mg/d vs. 10 for

Men

• GI Losses

– Poor Gut Blood Flow

– NSAIDS (Aspirin, Ibuprofen)

– Poor Absorption vs. Non Athletes

• Runners

– Men: 16 % Women 20 % Fe Deficient training

How About the “Other Stuff”

• Concussion: – Women ? 1.5 x higher risk

– Neck Strength, Reporting, Estrogen effects

– Symptoms More Severe • Last Longer Uncertain Why? Metabolic demands

• ACL – more common

– ? Hormonal ? Biomechanical

“Minor” “Other Stuff”

• Pregnancy • Lots of issues, rare in major competitions

• Stress Incontinence • 25 % age 14-21 90 % Don’t report

• Heart Related

– Irregular Heart Beats From Antibiotics

So What Do we Need To Know?

LOTS AND LOTS

THANK YOU!