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Female Athlete Triad

Fee-mal Ath-leet Try-add


Female athlete triad is a mix of:

  • Decreased energy with or without an eating disorder
  • Lack of menstrual periods or longer times between them
  • Decreased bone mass and density with or without osteoporosis

It is found in physically active girls and women.


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Causes    TOP

Female athlete triad occurs when the amount of calories taken in is much lower than the amount of calories used. It is the result of:

  • Intentionally restricting food at the same time physical activity is increased
  • Unintentionally not eating enough or not eating the proper foods to support high levels of physical activity

The body responds to this energy deficit by dropping levels of a hormone called estrogen. Estrogen normally stimulates menstrual cycles and maintains the calcium levels in bones, keeping them strong. Low levels of estrogen can lead to irregular menstrual periods and decreased bone mineral density.

Risk Factors    TOP

Factors that may increase the chance of female athlete triad include:

  • Being a competitive athlete
  • Excess exercising beyond the level needed for your sport
  • Participation in sports that emphasize thinness or low body weight, such as gymnastics, ballet, figure skating, and distance running
  • Participation in sports that have weight classes
  • Pressure to lose weight from parents or coaches who think weight loss will improve performance
  • Restrictive dieting
  • Binge eating
  • Induced vomiting
  • Excess concern with weight and eating
  • Low self-esteem or poor family dynamics

Symptoms    TOP

Symptoms may include:

  • Significant weight loss
  • Absent or irregular periods
  • Fatigue and decline in performance
  • Difficulty focusing and mood changes
  • Stress fractures and frequent illness or injury
  • Cold intolerance
  • Muscle cramps or weakness
  • Poor self image

Diagnosis    TOP

The doctor may make the diagnosis based on symptoms and medical history including information about menstrual cycle, eating habits, and exercise routine. Information about regular medications or supplements is also important to know in case they are causing or worsening symptoms.

Additional testing may be done to rule out other conditions before a diagnosis is made.

Treatment    TOP

Treatment plans will depend on the individual but often involves a blend of treatments. Many healthcare professionals may be involved in care, such as a gynecologist, dietitian, endocrinologist, and mental health specialists.

Treatment options include:


There are several different types of therapy. Options include individual or group, cognitive behavioral therapy, or sports psychology. Therapy can help:

  • Manage the pressures experienced as an athlete
  • Identify and manage feelings of depression or low self-esteem
  • Create healthier thought patterns

Work with your care team to find which works best for you.

Diet and Activity Changes

A dietitian can develop a nutrition plan that will provide enough calories to maintain a healthy weight and provide fuel for activities.

The doctor, coach, or trainer may review the exercise routines and advise changes. Changes may include reducing or alternating the length or intensity of workouts. It may also include strength training to help build muscle and bone density.

Medications    TOP

Medication may be needed to prevent further bone loss. These may include the hormones found in birth control pills and/or supplements such as calcium and vitamin D.

Medications to treat depression and anxiety may also be prescribed.

Prevention    TOP

To help reduce your chance of getting female athlete triad:

  • Maintain a healthy weight with a diet that provides enough calories for your exercise level.
  • Exercise at a level that is proper for your activity and calorie intake.
  • Talk to your doctor if you have any changes in your menstrual cycle.
  • If you are involved in high intensity activities:
    • Talk to your doctor or a dietitian about nutrition needs.
    • Be aware of physical limitations and proper training planning.
  • Stay aware of people who may push success in physical activity over wellness.


Family Doctor—American Academy of Family Physicians
Ortho Info—American Academy of Orthopaedic Surgeons


When it Hurts to Move—Canadian Orthopaedic Foundation


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Female athlete triad. Kid's Health—Nemours Foundation website. Available at:
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Female athlete triad: problems caused by extreme exercise and dieting. Ortho Info—American Academy of Orthopaedic Surgeons website. Updated October 2009. Available at:
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Updated June 2016. Accessed December 7, 2017.
Javed A, Tebben PJ, Fischer PR, Lteif AN. Female athlete triad and its components: toward improved screening and management. Mayo Clinic Proc. 2013;88(9):996-1009.
Last reviewed December 2017 by Beverly Siegal, MD, FACOG
Last Updated: 4/7/2015

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