Female Athlete Triad

(Exercise-Related Menstrual Dysfunction: Athletic Amenorrhea)


Female athlete triad is a mix of:

  • Decreased energy—an eating disorder may also be present
  • Change in periods—may be irregular or stop fully
  • Loss of bone mass and mass— osteoporosis may or may be there


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The triad occurs when the amount of calories eaten is much lower than the calories used by the body. It is the result of one of these actions:

  • Decreasing amount of food eaten while raising physical activities
  • Unintentionally not eating enough proper foods to support high levels of physical activity

This imbalance causes a change of hormones in the body. Estrogen is one hormone that decreases. Low levels of estrogen change periods. It also makes it hard for the bones to keep calcium, This makes bones weaker.

Risk Factors

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

  • Being a competitive athlete
  • Exercising beyond the level needed for your sport
  • Being in sports that focus on being thin or low body weight, such as gymnastics, ballet, figure skating, and distance running
  • Being an athlete in sports that have weight classes
  • Pressure to lose weight from parents or coaches who think weight loss will help performance
  • Restrictive dieting
  • Binge eating
  • Forced vomiting
  • Too much concern with weight and eating
  • Low self-esteem or poor family dynamics


Symptoms may include any of these:

  • Heavy weight loss
  • Absent or not normal periods
  • Fatigue and decline in performance
  • Problems focusing and mood changes
  • Stress fractures and frequent illness or injury
  • Cold intolerance
  • Muscle cramps or weakness
  • Poor self image


The doctor may have an answer based on your symptoms. Info about your periods, diet, and exercise routine will also help.

Other tests may be done to rule out other health issues.


Treatment will be based on specific needs. A blend of treatment often works best.


There are many types of therapy. Choices include single or group therapy, CBT, or sports therapy. Therapy can help:

  • Handle the pressures athletes face
  • Identify and address 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 help to make meal plans. It should give enough calories to keep you well. The diet will also give fuel for workouts.

Workout plans should be checked. The length and intensity of workouts may need to be changed.


Medicine may be needed to stop further bone loss. They may include:

  • Hormones found in birth control pills
  • Supplements such as calcium and vitamin D

Medicine may also be needed to treat depression and anxiety.


To help reduce your chance of getting female athlete triad:

  • Keep up a healthy weight. Use a food plan with enough calories for your exercise level.
  • Exercise at a level that is proper for your calorie intake.
  • Talk to your doctor if you have any changes in your period.
  • If you are involved in high intensity activities:
    • Talk to your doctor or a dietitian about nutrition needs.
    • Be aware of physical limits and proper training.
  • Be aware of people who may push success in physical activity over health.

Family Doctor—American Academy of Family Physicians

Ortho Info—American Academy of Orthopaedic Surgeons


Health Canada

When it Hurts to Move—Canadian Orthopaedic Foundation


De Souza MJ, Nattiv A, Joy E, et al; American College of Sports Medicine; American Medical Society for Sports Medicine; American Bone Health Alliance. 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad: 1st International Conference held in San Francisco, CA, May 2012, and 2nd International Conference held in Indianapolis, IN, May 2013. Clin J Sport Med. 2014 Mar;24(2):96-119.

Female athlete triad. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116009/Amenorrhea. Updated June 19, 2018. Accessed September 18, 2018.

Female athlete triad. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/female-athlete-triad.html. Updated October 2017. Accessed September 18, 2018.

Female athlete triad: problems caused by extreme exercise and dieting. Ortho Info—American Academy of Orthopaedic Surgeons website. Updated October 2009. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00342. Updated June 2016. Accessed September 18, 2018.

Weiss Kelly AK, Hecht S, COUNCIL ON SPORTS MEDICINE AND FITNESS. The Female Athlete Triad. Pediatrics. 2016 Aug;138(2):e20160922

Last reviewed November 2018 by Monica Zangwill, MD, MPH  Last Updated: 9/18/2018