What Is the Female Athlete Triad?

The female athlete triad (“the triad,” for short) is a medical condition with 3 parts.

Girls with the triad may:

1. not eat enough for their activity level. Some girls may diet, avoid some foods, or have an eating disorder.
2. miss periods or stop having periods
3. have weak bones that can lead to osteoporosis

A female athlete can have one, two, or all three parts of the triad. Because girls with one part of the triad are at risk for the other parts, it’s important to catch the signs early.

What Are the Signs & Symptoms of Female Athlete Triad?

Signs of the female athlete triad include:

• no periods or irregular periods
• weight loss or low BMI
• stress fractures (tiny cracks in bones)
• other broken bones or sports injuries

What Happens in Female Athlete Triad?

Exercising a lot and not eating enough calories can cause problems like a decrease in the hormones (such as estrogen) that help control a girl’s monthly cycle. Low estrogen levels, poor nutrition, and not enough calcium or vitamin D in the diet cause bone loss.

Who Gets Female Athlete Triad?

Female athletes, especially those who play sports that look for thinness — such as dancing, gymnastics, cheerleading, figure skating, distance running, and rowing — are more likely to have the triad. Other things that make someone more likely to have the triad include:

• focusing on one sport at a young age
• training too much
• dieting, losing weight, or feeling pressure to lose weight
• family problems

How Is Female Athlete Triad Diagnosed?

A doctor might think it’s female athlete triad if a girl has period problems, stress fractures, overuse injuries, weight loss, or a low BMI. At yearly checkups or sports physicals, female athletes might be asked to fill out a questionnaire. The answers can help doctors find girls who may get the triad. The doctor also will ask about periods, diet, and exercise habits.

There’s no test to diagnose the triad. But a doctor may order:

• blood tests to check for other reasons a girl may be missing periods or losing weight. The doctor also may check for anemia, low vitamin D, or other nutrition problems.
• electrocardiogram (EKG) to look for irregular heartbeats in girls with eating disorders
• bone density testing (dual-energy radiographic absorptiometry, also called DEXA or DXA scan) to measure bone health. This might be done when girls have stress fractures, poor nutrition, or no periods for 6 months or more.

How Is Female Athlete Triad Treated?

A team of specialists usually treats girls with female athlete triad. This may include doctors, nutritionists or dietitians, mental health specialists, and athletic trainers. The goal of treatment is to help girls get their energy into balance, start having periods, and improve bone health. Girls will learn to eat enough to support their level of physical activity.

The treatment plan includes:

• increasing calories eaten
• decreasing calories burned through exercise
• improving calcium and vitamin D intake through diet and supplements

Some girls have a hard time changing their eating habits and training schedules. Mental health specialists are an important part of the team, especially when dealing with eating disorders. Family members, friends, and coaches also can support and encourage athletes.

What Else Should I Know?

Exercise is part of healthy lifestyle. Girls and young women who exercise regularly feel better about themselves, do better in school, have better bone health, and are more like to keep a healthy weight.

Here are some tips for female athletes:

• Keep track of your periods. It's common for girls to miss periods once in a while. But talk to your doctor if:
  • You miss periods often.
  • You had regular periods and now are missing periods.
  • You are 15 or older and have never had a period.
• Don't skip meals or snacks. Athletes need more fuel, not less. Schedule 3 meals and 1–2 healthy snacks a day. 
• Meet with a sports nutritionist who works with teen athletes. A sports nutritionist can help you find out if you're getting enough calories to match your activity level. They also can see if you’re getting the right amount of key nutrients like calcium, vitamin D, and protein. Good nutrition can help improve your sports performance.
• Take a break. To help prevent injury and burnout, take time off from your main sport. Experts recommend taking off at least 1 day a week, plus at least 1 month 3 times a year. You can still do other sports and physical activities during the time off, but keep it fun.