The Female Athlete Triad – Are You at Risk?

The female athlete triad is a devastating health problem facing females in athletics and sports today.

The female athlete triad is a devastating health problem facing females in athletics and sports today. The triad is a syndrome involving nutritional deficits, lack of a menstrual cycle, and issues with bone health.

The triad is defined by the American College of Sports Medicine as, “interrelationships among energy availability, menstrual function, and bone mineral density, which may have clinical manifestations including eating disorders, functional hypothalamic amenorrhea, and osteoporosis.”

Populations most at risk for the triad are usually females participating in sports where lower body weight is optimal, including running, weightlifting, biking, cross country, gymnastics, figure skating, ballet, diving, swimming, and endurance sports. Societal pressure of an “ideal body type” can foster the development of low self esteem and negative body issues associated with the triad. Intense scrutiny, pressure in competition, weigh-ins, and social isolation may perpetuate an environment that can increase the risk for developing the triad. Many athletes do not meet all of the criteria for the triad but may manifest the disorder and behaviors as part of a syndrome.

Three Components of the Female Athlete Triad Defined

  • Energy Deficit/Disordered Eating – This can be defined as a pattern of obsessive dieting and/or poor nutrition, and can be more be severe as in the presence of a clinical eating disorder. Inadequate nutrition and low caloric intake results in lower energy levels and extreme fatigue in these athletes.
  • Menstrual Disturbances/Amenorrhea – Menstrual irregularity or amenorrhea, the complete absence of a menstrual cycle for six months or more. Amenorrhea is often a symptom that is unreported and not commonly discussed between athletes and coaches.
  • Bone Loss/Osteoporosis – Bone loss is the most dangerous component of the triad, as weaker bones may lead to osteopenia and later osteoporosis causing stress fractures and injuries. Stress fractures and broken bones often manifest in the hips and vertebral column of athletes.

Common Symptoms

  • Lower energy levels, fatigue, excessive tiredness, and problems sleeping.
  • Eating issues including low calorie and or low fat diet, obsessive eating patterns and strange diets, and weight loss.
  • Physical changes including; hair loss, dry skin, cold extremities, frequent colds, infections, or illnesses.
  • Irregular or absent menstrual cycle.
  • Recurrent sports related injuries, bone breaks, and stress fractures.

The true prevalence of the triad is somewhat unknown. Studies have reported disordered eating in 15-62% of female college athletes and amenorrhea in 3.4-66% percent of female athletes. Research in Medicine and Science in Sports and Exercise examined 669 elite female athletes and found that over 60% of the female athletes were classified as at risk of the Triad.

female athlete triad, crossfit, bones

Another study in the Journal of American College Health examined bone mineral density of elite endurance runners. Researchers found that 34.2% of the of athletes studied had low bone mineral density at the lumbar spine, and osteoporosis was present in 33% of the sample. Other aspects of the triad including menstrual dysfunction, disordered eating, and low bone mineral density were present in 15.9% of the athletes studied.

The triad is an alarming health concern that can leave females with enduring health problems, and in an extreme form can be fatal. Education and collaborative efforts by strength and conditioning professionals and coaches is extremely important in the prevention of the triad. If you are experiencing these symptoms you should seek qualified medical advice.