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.
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
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
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.
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. 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
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