The Female Athlete Triad - Too Much Exercise and Not Enough Nutrition

Three Related Conditions That Begin With Inadequate Nutritional Intake

female athlete triad
Distance runners may develop female athlete triad. photo (c) Photodisc / Getty Images
The "female athlete triad" is a syndrome of three related conditions generally seen in teen or adult female athletes who aren't meeting their energy requirements, which ultimately leaves them undernourished. The three components of the female athlete triad include:
  1. Energy Deficits or Disordered Eating
  2. Menstrual Irregularities or Amenorrhea
  3. Decreased Bone Density / Osteoporosis)

Who Is at Risk for The Female Athlete Triad?

Those at highest risk for developing the triad include female athletes participating in sports that promote, or emphasize, being thin and lean.
Long-distance runners, cyclists, gymnasts, figure skaters, and dancers are often susceptible to the perceived, and sometimes blatant, pressure to lose weight. The most common risk factors of the triad include:
  • Participating in sports that require weigh-ins
  • Social isolation during sports
  • Perfectionism in the athlete
  • Excessive training and exercise -- particularly endurance exercise
  • Hearing negative comments about the athlete’s weight, weight gain or body shape
  • Controlling parents or coaches who emphasize winning

Common Signs and Symptoms of the Female Athlete Triad

The warning signs and symptoms of the triad should be recognized as warning signs that something is wrong and should not be ignored. The most common of these include:
  • Irregular or absent menstrual cycles
  • Chronic fatigue
  • Insomnia and sleep disturbance
  • Recurrent stress fractures
  • Frequent or recurrent injuries or illness
  • Routinely restricting calories
  • Obsession with thinness and body image
  • Cold hands and feet

Complications of the Female Athlete Triad

Athletes who strive to reduce body fat by using excessive exercise or calorie restriction often think being thin will help their sports performance. In fact, too little body fat in an athlete significantly reduces sports performance.
But more significantly, too little body fat increases the risk of developing serious and severe health complications.

Nutritional deficiencies, along with fluid and electrolyte imbalances, set up a cascade of effects that involve nearly every system of the body: cardiovascular, endocrine, reproductive, skeletal, gastrointestinal, renal, and central nervous systems.

Inadequate calorie intake leads to a loss of body fat, an irregular or lack of menses (amenorrhea), and a reduction in estrogen levels that eventually leads to bone loss. Decreased bone density then results in increased risk of stress fractures and even osteoporosis).

The most serious complications of the triad include irreversible bone loss, starvation, decreased estrogen production, and sudden death. Research points to energy deficiency as the cause of the cascade of problems. A woman with this triad doesn’t eat enough to meet her energy demands, which puts a tremendous strain on every system of the body.

Although an eating disorder is often an underlying component of the triad, some athletes experience energy deficits even without consciously restricting calories. For this reason, it’s important to monitor calorie needs and watch for warning signs of a calorie deficit.

Eating Disorders in Athletes

Eating disorders are a common underlying cause for the female athlete triad. However, identifying athletes with an eating disorder is not easy. Such athletes may try to hide their eating habits, or blame their training regime for extreme eating and exercise patterns. Perceptive coaches, teammates and family can often notice the early warning signs of an eating disorder:
  • Significant weight loss
  • Preoccupation with food and weight
  • Increasing criticism of one's body
  • Frequent eating alone
  • Use of laxatives
  • Compulsive and or excessive exercise
  • Complaining of always being cold

    Treating the Female Athlete Triad

    An athlete who suspects she has this condition should seek medical attention. A visit to a physician for a complete history and physical, blood work and perhaps bone density testing may prevent long-term health problems. Some of the signs of the triad, such as amenorrhea, may have other causes that can be ruled out with medical evaluation.

    Recovering from the condition often requires a multidisciplinary approach that includes a physician, a nutritionist, a counselor, as well as the athlete's coach and family. Today, there are many successful treatment methods that combine nutrition, counseling, and medication attention.

    Preventing the Female Athlete Triad

    Some women are more susceptible to the female athlete triad, however prevention should be aimed at all athletes. It’s important for parents, coaches and teammates to communicate appropriate messages about exercise, body image and self esteem. It’s also important for adults and peers to talk openly about the condition, and the pressures to be thin, or to look a certain way -- whether they play sports or not. Talking about the warning signs will not cause anyone to develop an eating disorder, but can help uncover or prevent one.

    Nutrition and Athletes

    Sports nutrition should be encouraged as a means to improve both training and performance, and eating healthy should be the bottom line. This means eating enough of the right calories to fuel exercise, and aid in recovery. Encouraging an athlete to eat healthy as a part of training can keep them focused on how they feel and their energy levels, rather than the scale or mirror.

    Eating Disorder Treatments

    Eating disorders in an athlete are serious and can become life-threatening if left untreated. Identifying the type of eating disorder is essential to get the right help.


    American Academy of Orthopaedic Surgeons. AAOS Information Statements: Female Athlete Issues for the Team Physician – A Consensus Statement. [] Accessed Aug 2011

    American College of Sports Medicine Position Stand on the Female Athlete Triad []. Accessed Aug 2011

    []Eating Disorders - Related Reports - A.D.A.M.

    The Female Athlete Triad Coalition []. Accessed Aug 2011