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Women Running Marathons: Weighing the Risks and Benefits

Running has been a popular hobby for some time now. It’s no surprise that so many are trying marathons. They offer long term motivation and a give you a challenge to meet. Regular workouts are a healthy goal. But marathons are more than your average activity. The intense physical needs of training and the marathon itself may cause more harm than good.

Marathons challenge men and women, young and old. But, in women, this type of training can cause changes such as energy loss, poor bone health, and changes to monthly periods. A long list of strong female marathoners show us it can be done and be done well. All you need is awareness and a safe training program.

Benefits of Running a Marathon

First the good. Running, like other exercise, can release happy chemicals and decrease stress. It is often called “runner’s high”. Running clubs and programs offer social benefits as well.

Long-distance runners also have a lower risk of:

The more your run, the better it is. But, there can be too much of a good thing.

Knowing the Triad

Intense training without support can lead to health problems in women. This is known as the Female Athlete Triad. The triad is a combo of:

These factors will affect your overall health. It will also make it harder for you to become a top-notch runner. Knowing the pitfalls that can lead to this triad is the best way to stay healthy.

Disordered Eating

Marathon training burns a high number of calories. Food is the fuel your body needs to run on. Too little food or poor food choices mean your body is not fueled well. Your body will then turn to your own body tissue for fuel. Muscle is a common choice. This will make it even harder to improve your running. It will also slow your recovery from runs. You’ll have less energy, feel more sore, and make less progress.

This imbalance may happen if you are trying to lose weight while training or by accident if you do not have a plan. You will need to replace the extra calories that your body burns during training. Tips that may help include:

  • Get nutrition advice from a dietitian or physician.
  • Talk to your doctor about a goal weight. Find balance to learn how to control it.
  • Therapy may be needed. It can help to manage stress triggers and provide emotional support.

Once good eating habits are made, the next 2 pieces of the triad will be easier to manage.


Amenorrhea is the loss of monthly periods. In this case, both intense exercise program and poor nutrition cause the changes. The triad is not the only thing that affects your period. Discuss any changes in your period with your doctor.

A lack of monthly periods itself may not cause problems. However, it is a sign of hormone imbalance. These changes can also put you at risk for other issues such as osteoporosis. Your doctor can help you find the cause.


Poor nutrition and amenorrhea can cause changes in your bones. The bones will have a harder time staying strong. The bone changes can lead to osteoporosis. This increases your risk of fractures.

It is important to build and keep strong bones while you are young. Weaker bones in youth increase the risk of problems as you age. This makes it even more important to have a balanced training program.

Eat Enough and Eat Well

A great benefit to training for a marathon is that you can eat more. In fact, you likely will have to eat more to replace all the calories you burn during training. Make sure your diet can meet your body's increased demands. Other tips include:

If you are concerned about low estrogen levels and bone health, talk to your doctor. Birth control pills or other hormones may help with bone health. These medicines have other side effects. It is important to weigh out the risks and benefits with your doctor.

The most important thing is awareness. Listen to your body and give it what it needs. If you train right and eat well, you can stay healthy and conquer a few marathons along the way.


American College of Sports Medicine

Female Athlete Triad Coalition

Canadian Resources:

Dietitians of Canada

Public Health Agency of Canada


Amenorrhea. EBSCO DynaMed Plus website. Available at: Updated March 14, 2016. Accessed December 7, 2017.

Female athlete triad. Kid's Health—Nemours Foundation website. Available at: Updated January 2014. 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.

Female athlete triad. Brown University website. Available at: Accessed December 7, 2017.

Female athlete triad. Family Doctor—American Academy of Family Physicians website. Available at: Updated October 2017. Accessed December 7, 2017.

Female athlete triad: problems caused by extreme exercise and dieting. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: Updated June 2016. Accessed December 7, 2017.

Long-Distance runners less likely to have metabolic syndrome. American College of Sports Medicine website. Available at: Accessed July 20, 2016.

Troy K, Hoch AZ, et al. Awareness and comfort in treating the female athlete triad: Are we failing our athletes? WMJ. 2006;105(7):21-24.

Last reviewed September 2018 by Michael Woods, MD  Last Updated: 10/2/2018