Jan20th 2017

FEMALE ATHLETE TRIAD!!! What is this? What do you need to know and why is it important for you as a female athlete?

Exercise is very important to a healthy life and scientific studies encouraged the same to everyone. Normal physical activities are good for the bones and it has been suggested that exercise improves conditions for heart disease, hypertension, mortality, morbidity, diabetes, mood and stress. Exercises also improve psychological health and provide confidence, self satisfaction and improve self esteem. In last decades or so, female participation in competitive sports has dramatically increased. So, what’s the problem? Too MUCH of anything without a proper plan is not good. It can create a health problem among female athletes known as “FEMALE ATHLETE TRIAD”.

According to the 2014 Female Athlete Triad Coalition Consensus, The Female Athlete Triad is a medical condition often observed in physically ACTIVE girls and women, and involves three components:

  1. Low energy availability with or without disordered eating
  2. Menstrual dysfunction
  3. Low bone mineral density.

Since 1990, there has been alarming increase in stress fractures rates, decreased bone mineral density (BMD) and menstrual dysfunction among otherwise healthy female athletes. So, what’s probably happenening?

LOW ENERGY availability: Not enough caloric support for growth and repair of injured tissues. Athletes are spending more energy and calories performing exercises but not eating enough or not eating proper nutrition to recover from it. Which causes decreased energy availability and results in limitation of post-exercise repair of bone micro-damage, reduce muscle mass, reduce glycogen storage and increased muscle fatigue. Energy availability will directly affect menstrual status, and in turn, energy availability and menstrual status will directly influence bone health.

Menstruation: Very Important for hormonal regulation in female. Roughly once a month menstruation cycle is considered normal. 4-9 cycles are irregular cycles and are called Oligomenorrhea. If less than 5 menstruation cycles per year – that’s a big problem – called Amenorrhea. Studies suggests 20% of exercising females gets affected by the irregular menstruation cycle. Decreased menstruation cycles will affect the hormonal imbalances which results in decreased energy availability and makes female at a greater risk for stress fracture. Bone mineral density declines as the number of missed menstrual cycles months – Amenorrheic women will lose 2-3% of bone mass per year if left untreated. If untreated, this can lead to a bigger problem called osteoporosis in young females (softening of bones which can lead to bone fracture easily).

RECOVERY TAKES TIME: If you are diagnosed with Female Athlete Triad, the recovery process will take months to years. There are three components of Triad recovery: recovery of energy status will take few days of weeks, recovery of menstrual status will take months and finally recovery of bone mineral density can take years.

So, how do we prevent this? EDUCATION, EDUCATION, EDUCATION. As an athlete, you need effective nutritional strategies along with “hardcore” exercises to preserve bone structural integrity and strength. Need to improve energy availability to resume menstrual function and optimize healing potential. If continue to have stress fractures and missed menstruation cycle – seek professional HELP.

Take Home Message: Prevention is better than cure. Educate yourself regarding proper exercise and nutrition. Eat to perform. As a female athlete, it is very important to watch missed menstruation cycles: less than 5 cycles per year is not considered very healthy and may cause bone loss which may result in stress fractures. Go to for more information.

Reference: De Souza et al 2014. “2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad.”