The Female Athlete Triad

The female athlete triad refers to three health problems that are linked to one another: energy deficiency (with or without disordered eating), menstrual disturbances, and bone loss or osteoporosis. If an athlete is suffering from one aspect of the triad, then she is at a much higher risk of experiencing the other two conditions, or may already be experiencing them without knowing.

Athletes in sports that emphasize leanness or low body weight—such as cross country running, gymnastics, and figure skating—are particularly at risk for developing the triad, although any athlete may be affected.

The conditions that compose the female athlete triad can cause serious and sometimes lifelong or life-threatening health consequences.

What is Energy Deficiency?

An energy deficiency occurs when the amount of energy (that is, calories) you take in from food is not enough to support the amount of energy that you burn off through exercise or simply being active throughout the day. In an energy deficit, your body does not have sufficient energy to sustain normal functioning—for instance, menstruating.

Sometimes this energy deficit occurs without any sort of disordered eating. An athlete may simply not realize how many calories she needs to consume to compensate for her activity level. Often, however, disordered eating patterns accompany the energy deficit related to the triad. An athlete may restrict her caloric intake in order to lose weight quickly, whether in an obsessive pursuit of thinness or with the intent of performing better in her sport. If an athlete continues to exercise vigorously, yet also under-eats, skips meals, or avoids certain major groups (such as fat), this will result in an energy deficiency.

An energy deficiency makes it hard to perform at your sport. Dehydration and being low on fuel means less stamina. Rather than helping to boost performance (which some athletes believe will happen by losing weight), you’ll get tired more easily, get sick more often, and recover more slowly.

Disordered eating patterns are dangerous not only because they could lead to an energy deficit, but also because these patterns could become full-blown eating disorders such as anorexia or bulimia nervosa. Follow this link to read more about eating disorders.

Energy Deficiency Leading to Menstrual Problems and Bone Loss

Two of the most common results of an energy deficiency are disrupted menstruation and bone problems. When the body senses that it is running low on energy (meaning that a woman is malnourished or underweight) the body halts menstruation because it knows that it would not be able to sustain a pregnancy in that condition. Irregular or less frequent menstrual periods are known as oligomenorrhea, while a total absence of menstrual periods (three or more missed menstrual cycles in a row) is known as amenorrhea. In younger girls, eating too few calories can delay the onset of menstruation altogether.

Although it is not uncommon for athletes training rigorously to lose their periods, the loss of menstruation is never normal-it is the body’s way of communicating that something is wrong. If you are experiencing an irregular period, the best action to take is to consult your doctor.

If menstruation slows down or stops completely, the body also makes less estrogen, which is a hormone necessary for bone strength. Without estrogen, as well as vitamins and minerals such as calcium and vitamin D, the body cannot replace older bone cells with new, healthy cells. As a result, bones become weak and porous, which can lead to stress fractures and osteoporosis or osteopaenia (the precursor of osteoporosis).

If this occurs during a girl’s peak bone-building years (beginning at puberty and ending around age 20), then she will not be able to build the amount of bone mass she is supposed to. The possible result could be permanently weak bones.


If an athlete is experiencing signs of even just one element of the triad, it’s critical to seek medical attention. Ultimately, she may need to be under the care of a multidisciplinary team of professionals, including a physician, a nutritionist, and a mental health professional (especially if there are issues with body image or other concerns). Together, this treatment team can help the athlete learn how to maintain a healthy weight to accommodate her level of exercise and how to use exercise for its health benefits rather than for weight loss.

How to Prevent the Triad

Preventing the triad takes a team approach. Coaches, parents, athletic administrators, and others who have contact with athletes need to refrain from encouraging unrealistic weight goals, which can trigger disordered eating patterns. It is also important to know the warning signs of disordered eating and eating disorders and to reach out to athletes who exhibit these signs. Here is more about ways to talk to someone who you’re concerned may have an eating problem.

Physically active girls and women should monitor their monthly periods and discuss any changes or irregularities with their doctors. A doctor or nutritionist could also help athletes calculate how many calories they expend in their sport and how much food they need to eat in order to maintain their body weight. It might be helpful to make a meal plan to ensure that you are eating an adequate amount. Make sure to adjust your food intake appropriately if you increase your exercise.

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Additional Resources:

Intuitive Movement
Excessive Exercise
Falling into a Fitness Obsession in Eating Disorder Recovery
Female Athlete Triad Coalition
American College of Sports Medicine

About The Author:

Joanna Kay is a New York City writer in recovery from anorexia nervosa. She has written for the National Eating Disorders Association (NEDA), Healthy Minds Canada, and several other well-known websites. She is the author of a blog that deals with issues facing people who are midway through eating disorder recovery. Find Joanna on Twitter.

Written – 2015