Female Athlete Triad


Today there are more school-aged and collegiate females playing competitive sports than ever before. Physical exercise for females is beneficial to overall health and body image and overwhelmingly, the benefits of exercise usually outweigh the risks. A minority of female athletes, however, experience symptoms related to the “female athlete triad”.

Causes & Risk Factors

The female athlete triad refers to the interrelationship between 3 factors:   

  1. not getting enough energy to match their energy requirements of normal activities plus the sport (in the form of balanced calories)
  2. menstrual function – usually irregular or absent menstrual flow
  3. reduced bone formation.  

These factors are intricately related. Female athletes who exercise for long durations and/or with vigorous intensity without consuming enough calories and nutrients consistently to support these activities are most at risk for female athlete triad.

Symptoms & Types

Female athletes should be screened at least annually for symptoms of the female athlete triad, such as weight loss, reduced food intake, menstrual loss or irregularity, and stress fractures or osteoporosis. Parents, coaches, trainers, and other key persons in the life of female athletes should be aware and informed about the female athlete triad syndrome.

Diagnosis & Tests

When symptoms of the triad are present, it is recommended to seek further assessment and treatment from a multidisciplinary health care team, including but not limited to a sports medicine physician who has experience diagnosing and treating this condition and registered dietitian who is certified in sports (CSSD). The physician must rule out other medical causes of the problems discussed above. 

Treatment & Care

A sports dietitian can help female athletes who may be experiencing symptoms of the female athlete triad by assessing their total diet for adequacy and balance of nutrients, obtaining body composition measure, educating the athlete and family on the ideal diet and meal timing for maximal sports performance, and providing meal plans and/or patient tailored recommendations for supplements or other diet-specific therapy.

If the patient is not able to improve their nutrition which often includes some weight gain, then a psychologist may be consulted to assist with this process. Restoring energy balance and in most cases gaining some weight, is the mainstay of trying to improve bone health. In the setting where a young athlete is having absent or infrequent menstrual cycles, estrogen and progesterone may be prescribed to improve bone health. The Young Women's Clinic, which operates within the Adolescent Medicine and Sports Medicine clinics can address the nutritional, hormonal, and potentially, psychological issues discussed above.

There is no medication indicated to treat female athlete triad, rather proper nutrition (sometimes accompanied by a modified training schedule), puts the female athlete in positive calorie balance, restores menstrual function and optimizes bone health.  If the medical and nutritional interventions are not successful, then consideration of a psychological problem must be explored.

Related Topics

Menstrual Irregularities