Steps to Prevention

For Athletes:

Know that amenorrhea and stress fractures are signs of the Female Athlete Triad. Learn the importance of good nutrition.

For Coaches:

Understand the powerful impact words can have and that women are different from men when it comes to training.

For Parents:

Be alert to the warning signs and stay involved and informed as to how your daughter is being trained and coached.

For Medical Personnel:

Pre-participation exams in high school and college need to be revamped to help ferret out those at risk. Complete menstrual and stress fracture histories should be taken.

Steps to Recovery:

* The American College of Sports Medicine recommends medical evaluation within three months of the onset of amenorrhea.

* If disordered eating and exercise contributed to amenorrhea, athletes are encouraged to reduce training, increase calorie intake and gain weight. Doctors may also prescribe hormone-

replacement therapy to compensate for estrogen deficiency.

* Amenorrheic athletes must increase their calcium intake.

* Treatment of a diagnosed eating disorder is multidisciplinary and should include a psychiatrist or therapist, a physician and a nutritionist, experts say.

Steps to Consider:

Experts say a host of other changes should be discussed, at least on a sport-by-sport basis:

* Coaches should be required to have a license, said Women’s Sports Foundation Executive Director Donna Lopiano. Education in triad issues could be part of the licensing procedure, especially for those outside structured school systems--club, private and Little League coaches.

* Clinics, seminars and camps for female athletes and / or coaches should include a talk on the Female Athlete Triad by a sports nutritionist or doctor, said Fordham University nutritionist Elise Sinagra.

* Female athletes might want to delay sport-specific training; research has shown that those who start training for one sport early in life are more likely to develop eating disorders than those who do not, perhaps because they choose a sport not suited to their body type.

* Participation ages could be increased for certain levels in certain sports, as has been done in professional tennis and Olympic figure skating and gymnastics.