2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013 Mary Jane De Souza, 1 Aurelia Nattiv, 2 Elizabeth Joy, 3 Madhusmita Misra, 4 Nancy I Williams, 1 Rebecca J Mallinson, 1 Jenna C Gibbs, 5 Marion Olmsted, 6 Marci Goolsby, 7 Gordon Matheson, 8 Expert Panel ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ bjsports-2013-093218). For numbered affiliations see end of article. Correspondence to Mary Jane De Souza, Department of Kinesiology, Women’s Health and Exercise Laboratory, 104 Noll Laboratory, Penn State University, University Park, PA 16802, USA; mjd34@psu.edu Received 22 October 2013 Revised 4 December 2013 Accepted 6 December 2013 To cite: De Souza MJ, Nattiv A, Joy E, et al. Br J Sports Med 2014;48:289. ABSTRACT The Female Athlete Triad is a medical condition often observed in physically active girls and women, and involves three components: (1) low energy availability with or without disordered eating, (2) menstrual dysfunction and (3) low bone mineral density. Female athletes often present with one or more of the three Triad components, and an early intervention is essential to prevent its progression to serious endpoints that include clinical eating disorders, amenorrhoea and osteoporosis. This consensus statement represents a set of recommendations developed following the 1st (San Francisco, California, USA) and 2nd (Indianapolis, Indiana, USA) International Symposia on the Female Athlete Triad. It is intended to provide clinical guidelines for physicians, athletic trainers and other healthcare providers for the screening, diagnosis and treatment of the Female Athlete Triad and to provide clear recommendations for return to play. The 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad expert panel has proposed a risk stratification point system that takes into account magnitude of risk to assist the physician in decision-making regarding sport participation, clearance and return to play. Guidelines are offered for clearance categories, management by a multidisciplinary team and implementation of treatment contracts. This consensus paper has been endorsed by the Female Athlete Triad Coalition, an International Consortium of leading Triad researchers, physicians and other healthcare professionals, the American College of Sports Medicine and the American Medical Society for Sports Medicine. INTRODUCTION This consensus statement is the first of its kind and represents a set of recommendations developed fol- lowing the 1st (San Francisco, California, USA) and 2nd (Indianapolis, Indiana, USA) International Consensus Meetings on the Female Athlete Triad (Triad). It is intended to provide clinical guidelines for physicians, athletic trainers and other healthcare providers for the treatment of the Triad and to provide clear recommendations for return to play. The Consensus recommendations herein were developed using a consensus-based approach similar to that utilised by the International Consensus Statement on Concussion. 1 This consensus state- ment will serve as a supplement to the American College of Sports Medicine (ACSM) revised pos- ition stand on the Triad published in 2007. The 2007 position stand provided the scientific evidence documenting the existence and causes of the Triad. 2 Practical information for athletes, coaches, parents and a list of resources and helpful information on the Triad can be readily viewed on the Female Athlete Triad Coalition website at http://www. femaleathletetriad.org. This consensus paper has been endorsed by The Female Athlete Triad Coalition, an International Consortium of leading Triad researchers, physicians and other healthcare professionals, the American College of Sports Medicine and the American Medical Society for Sports Medicine. While agreement exists concerning the primary guidelines and recommendations communicated in this document, the authors acknowledge that the underlying levels of scientific evidence regarding some elements of the Triad, particularly related to treatment strategies, are still evolving. The treat- ment guidelines and return-to-play recommenda- tions proposed herein are based on the published literature available to date, with consensus from the international team of experts convened at the two meetings. As such, management and return-to-play decisions should be based on informed clinical judgement keeping in mind individual risk factors and concerns as described herein. DEFINITION OF THE FEMALE ATHLETE TRIAD MODEL The Triad is a medical condition often observed in physically active girls and women, and involves any one of the three components: (1) low energy avail- ability (EA) with or without disordered eating (DE), (2) menstrual dysfunction and (3) low bone mineral density (BMD) 2 (see figure 1). Female ath- letes often present with one or more of the three Triad components, and an early intervention is essential to prevent its progression to serious end- points that include clinical eating disorders (EDs), amenorrhoea and osteoporosis. 2 In 1997, the Task Force on Women’s Issues of ACSM published the first Triad position stand which described a syndrome of three distinct but Editor’s choice Scan to access more free content De Souza MJ, et al. Br J Sports Med 2014;48:289. doi:10.1136/bjsports-2013-093218 1 of 20 Consensus statement on June 8, 2020 by guest. Protected by copyright. http://bjsm.bmj.com/ Br J Sports Med: first published as 10.1136/bjsports-2013-093218 on 24 January 2014. Downloaded from