Hannah joined the track team her freshman year and trained hard to become a lean,
strong sprinter. When her coach told her losing a few pounds would improve her performance,
she immediately started counting calories and increased the duration of her workouts.
She was too busy with practices and meets to notice that her period had stopped —
she was more worried about the stress fracture in her ankle slowing her down.
Although Hannah thinks her intense training and disciplined diet are helping her
performance, they may actually be hurting her — and her health.
What Is Female Athlete Triad?
Sports and exercise are part of a balanced, healthy lifestyle. People who play
sports are healthier; get better grades; are less likely to experience depression;
and use alcohol, cigarettes, and drugs less frequently than people who aren't athletes.
But for some girls, not balancing the needs of their bodies and their sports can have
Some girls who play sports or exercise intensely are at risk for a problem called
female athlete triad. Female athlete triad is a combination of three conditions: disordered
eating, amenorrhea, and osteoporosis. A female athlete can have one, two, or all three
parts of the triad.
Triad Factor #1: Disordered Eating
Most girls with female athlete triad try to lose weight as a way to improve their
athletic performance. The disordered eating that accompanies female athlete triad
can range from not eating enough calories to keep up with energy demands to avoiding
certain types of food the athlete thinks are "bad" (such as foods containing
fat) to serious eating disorders like anorexia nervosa or bulimia nervosa.
Triad Factor #2: Amenorrhea
Exercising intensely and not eating enough calories can lead to decreases in the
hormones that help regulate the menstrual cycle. As a result, a girl's periods may
become irregular or stop altogether. Of course, it's normal for teens to occasionally
miss periods, especially in the first year. A missed period does not automatically
mean female athlete triad. It could mean something else is going on, like pregnancy
or a medical condition. If you are having sex and miss your period, talk to your doctor.
Some girls who participate intensively in sports may never even get their first
period because they've been training so hard. Others may have had periods, but once
they increase their training and change their eating habits, their periods may stop.
Triad Factor #3: Osteoporosis
Estrogen is lower in girls with female athlete triad. Low estrogen levels and poor
nutrition, especially low calcium intake, can lead to osteoporosis, the third aspect
of the triad. Osteoporosis is a weakening of the bones due to the loss of bone density
and improper bone formation. This condition can ruin a female athlete's career because
it may lead to stress fractures and other injuries.
Usually, the teen years are a time when girls should be building up their bone
mass to their highest levels — called peak bone mass. Not getting enough calcium now
can also have a lasting effect on how strong a woman's bones are later in life.
Who Gets Female Athlete Triad?
Many girls have concerns about the size and shape of their bodies. But being a
highly competitive athlete and participating in a sport that requires you to train
extra hard can increase that worry.
Girls with female athlete triad often care so much about their sports that they
would do almost anything to improve their performance. Martial arts and rowing are
examples of sports that classify athletes by weight class, so focusing on weight becomes
an important part of the training program and can put a girl at risk for disordered
Participation in sports where a thin appearance is valued can also put a girl at
risk for female athlete triad. Sports such as gymnastics, figure skating, diving,
and ballet are examples of sports that value a thin, lean body shape. Some athletes
may even be told by coaches or judges that losing weight would improve their scores.
Even in sports where body size and shape aren't as important, such as distance
running and cross-country skiing, girls may be pressured by teammates, parents, partners,
and coaches who mistakenly believe that "losing just a few pounds" could
improve their performance.
The truth is, losing those few pounds generally doesn't improve performance at
all. People who are fit and active enough to compete in sports generally have more
muscle than fat, so it's the muscle that gets starved when a girl cuts back on food.
Plus, if a girl loses weight when she doesn't need to, it interferes with healthy
body processes such as menstruation and bone development.
In addition, for some competitive female athletes, problems such as low self-esteem,
a tendency toward perfectionism, and family stress place them at risk for disordered
What Are the Signs and Symptoms?
If a girl has risk factors for female athlete triad, she may already be experiencing
some symptoms and signs of the disorder, such as:
no periods or irregular periods
fatigue and decreased ability to concentrate
stress fractures (fractures that occur even if a person hasn't had a significant
Girls with female athlete triad often have signs and symptoms of eating disorders,
continued dieting in spite of weight loss
preoccupation with food and weight
frequent trips to the bathroom during and after meals
brittle hair or nails
dental cavities because in girls with bulimia tooth enamel is worn away by frequent
sensitivity to cold
low heart rate and blood pressure
heart irregularities and chest pain
How Doctors Help
An extensive physical examination is a crucial part of diagnosing female athlete
triad. A doctor who thinks a girl has female athlete triad will probably ask questions
about her periods, her nutrition and exercise habits, any medications she takes, and
her feelings about her body. This is called the medical history.
Poor nutrition can also affect the body in many ways, so a doctor might order blood
tests to check for
and other problems associated with the triad. The doctor also will check
for medical reasons why a girl may be losing weight and missing her periods. Because
osteoporosis can put someone at higher risk for bone fractures, the doctor may also
request tests to measure bone density.
Doctors don't work alone to help a girl with female athlete triad. Coaches and
trainers, parents, physical therapists, pediatricians and adolescent medicine specialists,
sports medicine doctors, nutritionists and dietitians, and mental health specialists
can all work together to treat the physical and emotional problems that a girl with
female athlete triad faces.
It might be tempting to shrug off several months of missed periods, but getting
help right away is important. In the short term, female athlete triad may lead to
reduced physical performance, stress fractures, and other injuries. Over the long
term, it can cause bone weakness, long-term effects on the reproductive system, and
A girl who is recovering from female athlete triad might work with a dietitian
to help reach and maintain a healthy weight while eating enough calories and nutrients
for health and good athletic performance. Depending on how much the girl is exercising,
she may have to reduce the length of her workouts. Talking to a psychologist or therapist
can help her deal with depression, pressure from coaches or family members, or low
self-esteem and can help her find ways to deal with her problems other than restricting
food intake or exercising excessively.
Some girls may need to take hormones to supply their bodies with estrogen to help
prevent further bone loss. Calcium and vitamin D supplementation can also help when
someone has bone loss as the result of female athlete triad.
What If I Think Someone I Know Has It?
It's tempting to ignore female athlete triad and hope it goes away. But it requires
help from a doctor and other health professionals. If a friend, sister, or teammate
has signs and symptoms of female athlete triad, discuss your concerns with her and
encourage her to seek treatment. If she refuses, you may need to mention your concern
to a parent, coach, teacher, or school nurse.
You might worry about seeming nosy when you ask questions about a friend's health,
but you're not: Your concern is a sign that you're a caring friend. Lending an ear
may be just what your friend needs.
Tips for Female Athletes
Here are a few tips to help teen athletes stay on top of their physical condition:
Keep track of your periods. It's easy to forget when you had
your last visit from Aunt Flo, so keep track of your periods on a calendar and mark
down when your period starts and stops and if the bleeding is particularly heavy or
light. That way, if you start missing periods, you'll know right away and you'll have
accurate information to give to your doctor.
Don't skip meals or snacks. If you're constantly on the go between
school, practice, and competitions you may be tempted to skip meals and snacks to
save time. But eating now will improve performance later, so stock your locker or
bag with quick and easy favorites such as bagels, string cheese, unsalted nuts and
seeds, raw vegetables, granola bars, and fruit.
Visit a dietitian or nutritionist who works with teen athletes.
He or she can help you get your dietary game plan into gear and find out if you're
getting enough calories and key nutrients such as iron, calcium, and protein. And
if you need supplements, a nutritionist can recommend the best choices.
Do it for you. Pressure from teammates, parents, or coaches can
turn a fun activity into a nightmare. If you're not enjoying your sport, make a change.
Remember: It's your body and your life. You — not your coach or teammates — will have
to live with any damage you do to your body now.