The Female Athlete Triad: What Every Women Athlete Needs To Know

Hard training, constant dieting and a desire to achieve a better looking physique are all common elements that can come into play in a disorder known as the Female Athlete Triad. Learn what it is...

Hard training, constant dieting and a desire to achieve a better looking physique are all common elements that can come into play in a disorder known as the Female Athlete Triad. The components that comprise this disorder are osteoporosis, menstrual dysfunction and eating disorders and most commonly seen in appearance related sports such as gymnastics, figure skating, ballet and fitness/bodybuilding.

The effects of this disorder can be devastating on the athlete and if not treated can lead to a forced early retirement from the chosen sport. Even athletes who do not show all three components of this disorder can be at an increased health risk for many other complications.

1st /// Eating Disorders

The first component of this disorder is eating disorders. Eating disorders such as anorexia and bulimia are becoming more and more frequent among those participating in appearance related sports where the pressures to transform themselves into the "ideal" body shape are being felt.

Athletes may result to numerous methods to achieve their goal, whether it be drastically restricting calories, turning to methods of purging to rid their body of what they just consumed, or excessive exercise.

Not only will eating disorders affect the physical aspects of the body, they will also affect the psychological well being of the athlete.

Effects of eating disorders are lowered basal metabolic rate, below normal body temperature, endocrine irregularities, electrolyte imbalances, difficulty concentrating, and often depression.

The two other components of the female athlete triad also occur as a result of eating disorders, those being osteoporosis and menstrual irregularities, however may also occur without the presence of an eating disorder.

2nd /// Osteoporosis

The second component I will discuss is osteoporosis. This factor is compounded if menstrual dysfunction is occurring as well. Many female athletes who are restricting their food intake or "dieting down" for a show will reduce or completely eliminate diary products.

This makes it much harder for many of these women to consume adequate amounts of dietary calcium that is needed to promote strong bones. It is possible to achieve adequate amounts through supplementation, however, it is much more preferable to have some sources from actual food products.

Athletes who are participating in high impact activities (such as those involved in training gymnastics for a routine, or who regularly do HIIT running) also are at risk for stress fractures since they're bones may not be as dense due to inadequate calcium and constant dieting.

While it is true that these activities will help to strengthen the bone to an extent (activities that place stress on the bones such as weight training), if you take someone who is already at risk for osteoporosis and place extremely hard impacting activities on them, you may run into some problems.

It is extremely important for a woman to be concerned about her bone health because if she goes too long without taking care of her bones and they begin to become more and more depleted, she could set herself up for a lifetime of joint pain and inactivity.

Final /// Menstrual Dysfunction

The final, and perhaps most predominant factor in the female athlete triad is menstrual dysfunction. Many females who show no signs of eating disorders or established osteoporosis can suffer from this problem as well. There are two main types of menstrual dysfunction, amenhorrhoea (one or no menstrual periods in one year) and oligomenorrhoea (six or fewer periods per year).

The mechanisms behind these disorders are considerably variable among individuals therefore what may cause a problem in one woman may not pose any threat to another. The prime reasons why this disorder takes place however are believed to be periods of energy deficiency, high intensity exercise, and high psychological stress.

Energy deficiency could perhaps pose the biggest influence upon menstrual problems. When an athlete is expending more energy than she is taking in, she will go into a state of negative energy balance and the body will do it's best to conserve energy for vital functions.

This means that oftentimes menstruation will cease as the process of pregnancy requires a tremendous amount of energy that her body is just not capable of supplying at that moment. As energy stores drop, levels of blood estrogen are decreased and menstruation will no longer occur.

Factors that affect when an athlete will begin to show signs of estrogen deficiency are related to body composition, body size, glycogen stores, and genetics. Other reproductive hormones that may be affected include GnRH (gonadotropin-rleasing hormone), LH (leteinising hormone), FSH (follicle stimulating hormone), prolactin, and progesterone.

Together, all these hormones help to regulate a cycle and prepare for the occurrence of childbirth. Along with reproductive hormones, other metabolic hormones of the body are also affected, including the thyroid hormones, cortisol, hGH (human growth hormone), and Leptin (an important factor in hunger regulation) that work together to regulate the bodies' functions.

As all these hormones begin to become unbalanced, side effects such as decreased bone density (due to lowered estrogen levels), decreased exercise performance, impaired cognitive ability, lowered immune function, and increased risk of cardiovascular health begin to develop. The lowered bone density that results increases the risk that the individual will go on to develop osteoporosis that was discussed earlier.

Being under constant psychological stress, which is not uncommon for many fitness athletes or bodybuilders who put pressure on themselves to succeed can also work against the body and impair menstrual function.

Often these athletes will feel great anxiety focused around whether they will be able to maintain their diet or exercise schedule on top of the daily demands of their everyday life. This will lead to an increased release of cortisol (the "stress" hormone), which will decrease the regularity of their menstrual cycle.

Finally, increasing loads of exercise placed on the body not only impair a great deal of physiological stress upon the athlete but also put them into an even more negative energy balance unless they supplement this increased exercise with additional nutritional intake (which often does not occur as many times the exercise is imposed as a means to reduce body weight or fat).

The body will perceive this increased negative energy balance (if a large enough one was created - which isn't unreasonable considering many fitness athletes are only eating around 1300-1500 calories a day and doing between 1 to 2 hours of cardio training a day when dieting down for a show) as a famine and will preserve all fat stores and eliminate any body processes that are not essential, once again, a prime one being menstruation.


The Female Athlete Triad is a disorder that many women do not which to talk about as they do not feel comfortable admitting to eating disorders and discussing their menstrual health with others. It is important to increase the awareness of this disorder however, as it can have detrimental long term effects, even if not all components are apparent.

It is important to especially consider the menstrual dysfunction as this often leads to osteoporosis and can occur in any women, regardless of whether she has an eating disorder or not. Many times, if the disorder persists long enough, damaging effects will develop that may not be able to be reversed.

However, if steps are taken early enough to either prevent (among those athletes at risk) or treat (those who already show signs of some parts of the disorder), many of the devastating consequences of the Female Athlete Triad can be defeated.

Don't miss Part 2: What you can do if you show signs of all or part of the Female Triad.

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