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Female Athlete Triad

(Exercise-Related Menstrual Dysfunction: Athletic Amenorrhea)

How to Say It: Fee-mal Ath-leet Try-add

Definition

Female athlete triad is a mix of:

  • Decreased energy—with or without an eating disorder
  • Changes in menstruation (periods)—may be irregular or fully stopped
  • Loss of bone and body mass—with or without osteoporosis

Osteoporosis

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Causes

The triad happens when the amount of calories eaten is much lower than amount used by the body. This decreases a hormone called estrogen. This causes periods to change. It also makes it hard for the bones to absorb calcium. This causes them to weaken.

Causes are:

  • Decreasing the amount of food eaten while raising activity level
  • Not eating enough of the right foods to support high levels of activity

Risk Factors

This problem is more common in competitive athletes. Other things that may raise the risk of this problem are:

  • Exercising beyond the level needed for a 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
  • Excess worry about weight and eating
  • Low self-esteem or poor family dynamics

Symptoms

Problems may be:

  • Weight loss
  • Missing or irregular periods
  • Tiredness
  • A decline in sports performance
  • Focus and mood problems
  • Feeling very cold
  • Muscle cramps or weakness
  • Poor self image

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. You will also be asked about your medicines, diet, periods, and exercise routine. This is often enough to make the diagnosis.

Treatment

The goals of treatment are to gain weight and resume normal periods. Treatment will be based on specific needs. More than one of the following may be needed:

  • Nutrition counseling to balance calories with activity level
  • Cognitive behavioral or group therapy to change unhealthy thought processes
  • Medicines, such as:
    • Hormones found in birth control pills
    • Supplements like calcium and vitamin D to strengthen bones
    • Anti-depressants

Prevention

The risk of this problem may be lowered by:

  • Maintaining a healthy weight
  • Eating enough calories to fuel activities
RESOURCES:

Family Doctor—American Academy of Family Physicians
http://www.familydoctor.org

Ortho Info—American Academy of Orthopaedic Surgeons
https://orthoinfo.org

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

When it Hurts to Move—Canadian Orthopaedic Foundation
http://whenithurtstomove.org

REFERENCES:

Female athlete triad. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/female-athlete-triad. Accessed February 3, 2021.

Female athlete triad. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/female-athlete-triad.html. Accessed February 3, 2021.

Female athlete triad: problems caused by extreme exercise and dieting. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00342. Accessed February 3, 2021.

Raj MA, Creech JA, et al. (2020). Female Athlete Triad. In StatPearls. StatPearls Publishing.

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

Last reviewed December 2020 by EBSCO Medical Review Board Dianne Scheinberg Rishikof MS, RD, LDN  Last Updated: 2/3/2021