The Silent Majority: Triad Risk Classification, Birth Control Use, And Anxiety

Elevated anxiety levels have been demonstrated in female athletes and those using birth control. The Female Athlete Triad (Triad) Cumulative Risk Assessment (CRA) tool was developed to screen for Triad symptoms including menstrual health. PURPOSE: Our aim was to compare female athlete’s risk classification to anxiety and birth control utilizing the Triad CRA tool. METHODS: Female athletes aged 18-40 were invited to complete an anonymous survey distributed via snowball sampling through social media. Survey contained the Triad CRA, Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and questions about menstrual cycle health. Descriptive statistics were computed in addition to chi-square analyses to identify associations between CRA to menstrual health and CRA to GAD-7 scores. RESULTS: 111 participants (age = 22.2 ± 3.9 years) started the survey with 81 completing it (completion rate 73%). Athlete competition level included club/recreational (n = 18, 22.2%) and collegiate (n = 63, 77.8%). Birth control use was reported by 61.7% (n = 50), of those 88% (n = 44) were taking a hormonal form. Looking at Triad CRA Scores, 33 (40.7%) had full clearance, 45 (55.6%) were limited, and 3 (3.7%) were determined as restricted from training and competition. The majority of participants yielded ‘minimal’ GAD-7 scores (full, n = 13, 39.4%; limited, n = 18, 40%; restricted, n = 3, 100%). Comparing age of menarche to Triad CRA was significant (p = .047), yet we did not find significance when comparing Triad CRA to GAD-7, menarche to GAD-7, contraceptive use to GAD-7, oligomenorrhea/dysmenorrhea to GAD-7, or oligomenorrhea/dysmenorrhea to contraceptive use (p > .05). CONCLUSIONS: Age of menarche was associated to an athlete’s Triad CRA score. The majority of participants (~60%) scored as limited/restricted on the Triad CRA also presented with mild anxiety levels. While our findings did not demonstrate participants trending to be at high ‘risk’ or be in a severe mental state, they also were not in an optimal state of performance. Screening for Triad and mental health concerns can allow the clinician to pragmatically monitor an athlete’s health status for sustained sport performance and wellbeing.