The Female Athlete Triad—Tips for Recognition and Prevention
George C. Phillips, MD
In the 35 years since the passage of Title IX, sports medicine providers have learned a great deal about the relationship between women's health and participation in sports. One major health concern for female athletes is the "female athlete triad" – a combination of irregular menstrual periods, abnormal bone mineral density, and disordered eating practices. Research indicates that the cause of the triad is low energy availability, or more simply put, not eating enough calories to meet the demands of exercise.
Understandably, many young women consider menstrual periods a nuisance for a variety of reasons, some of which can be magnified by sports participation. However, an absence of menstrual periods should not be considered a normal response to exercise. In fact, missing periods during a competitive season can be a sign of a hormonal imbalance that negatively affects the athlete's overall metabolism, which in turn can place the athlete at increased risk for stress fractures. Abnormal bone mineral density can also increase the risk of long-term, debilitating conditions such as osteoporosis. The use of disordered eating practices, such as restricting
calories or purging with laxatives, can create the caloric deficit that results in the female athlete triad.
Research has also recognized that some female athletes are at increased risk for suffering from the female athlete triad. Athletes participating in sports that emphasize body shape or weight (dance, gymnastics, figure skating, or cheerleading) are more prone to develop the female athlete triad. Other risk factors might include recent injury, coaching changes, or a new training regimen.
Preventive measures can include a nutritional assessment to make sure adequate calories and nutrients are in the diet and calcium supplementation to maximize bone mineral density. Restoring a normal pattern of menstrual cycles has been linked with significant increases in bone mineral density in younger female athletes. Again, missing menstrual periods should not be considered a normal effect of exercise. Athletes, families, and coaches should be aware of the signs of the female athlete triad, and they should discuss these issues with the athlete's healthcare provider if concerns arise.